ADHD

Question 1

Metadote CD, Ritalin LA, Quillivant XR/Quillichew ER, Concerta are all?

Answer 1

Long acting methylphenidates

10-12 hours

Question 2

Ritalin SR, Metadote ER, Methylin ER are all?

Answer 2

3-8 hours intermidiate

Methylphenidates

Question 3

Dexedrine Spansule what is it and what is its DOA?

Answer 3

Dextroamphetamine

6-8 hours

Question 4

Adverse effects of stimulants?

Answer 4

• Anorexia - GI distress - Insomnia - Rebound symptoms - Irritability - Dysphoria - Zombie state

Question 5

What is the delay with Daytrana?

Answer 5

2 hour delay

Question 6

DSM-5 6 or more of the following

Answer 6

• Careless
• Difficultly sustaining attention in activity
• Unable to listen
• Fails to finish school work, doesnt follow through with instructions
• Difficulty organizing tasks
• Loses important things
• Easily distracted
• Forgetful in daily activities

Question 7

Adderall XR (50/50)

is a? what is its DOA?

Answer 7

Levoamphetamine and dextroamphetamine

8-12 hours

Question 8

Ritalin, Methylin, Methylin Oral Liquid are all?

Answer 8

Short acting methylphenidates

3-5 hours

Question 9

What are the advantages of long acting stimulants?

Answer 9

• Once daily dosing
• Extra coverage for extracurricular activities
• Privacy issues
• Store them at home so you know theyre taking it.

Question 10

What are the disadvantages of methylphenidate?

Answer 10

• Intermediate acting are too short acting for most patients
• – Erratic peaks and troughs w/ intermediate acting
• – Concerta- risk of obstruction in patients with GI narrowing
• – Transdermal – slow onset (2 hours)
• – Redness from the patch

Question 11

Nonpharm treatment for ADHD

Answer 11

• Behavioral interventions
• Individualized education program
• Shorter homework Adults
• Organizers and regular schedules

Question 12

Daytrana transdermal is?

Answer 12

Long acting 10-12 hours Methylphenidate

Question 13

Non-stimulant medications?

Answer 13

• Atomoxetine
• Bupropion
• TCA
• Clonidine ER (Kapvay)
• Guanfacine XR (Intuniv)
• Atomoxetine, Clonidine, Guanfacine are FDA approved

Question 14

Dosing principles for psychostimulants?

Answer 14

• Start low
• Increase every 3-4 days or weekly until there is a response
• Initial response is typically rapid
• Drug holidays
• If one fails you can switch to another
• If there isnt a response reconsider diagnosis

Question 15

Adderall is a? what is its DOA?

Answer 15

5-7 its a levoamphetamine or Dextroamphetamine

Question 16

Subtypes of ADHD?

Answer 16

Inattention Hyperactivity or impulsivity.

Question 17

Counseling tips for patients

Answer 17

• How to take the meds/ what its for
• What ADHD is, risk of untreated ADHD
• When to expect results
• SEs
• Risk of abuse
• growth delay

Question 18

Lisdexamphetamines?

Answer 18

Vyvanse 10 hour duration,

Question 19

Dexmethylphenidate

Brand names?

Durations?

Answer 19

Focalin- 6 hours

Focalin XR- 10-12

Question 20

TCAs

Answer 20

• Response in the first 2 weeks
• Effective in adult ADHD
• Imipramine, Desipramine
• Disadvantages: Increase SEs, Risk of death in OD, Monitor EKG

Question 21

ADHD and abuse

Basically patients with ADHD are more likely to have substance abuse

Question 22

AEs of stimulants?

Answer 22

• Anorexia
• GI distress
• Insomnia
• Rebound symptoms
• Irritability
• Dysphoria
• Zombie state

Tics, HTN, Hallucinations, and cardiovascular events, rare

Question 23

Medications for aggression and explosive behavior?

Refractory ADHD cases with severe aggression?

Answer 23

• Lithium
• Valproate
• Carbamazepine

Antipsychotics

Question 24

What are the advantages of methylphenidate?

Answer 24

• Most Studied
• – Least effects on worsening tics, appetite and mood
• – Potential for less abuse?
• – Less regulatory requirements? –
• Transdermal - alter the duration of its effects (wear time)
• – Potentially less BP changes

Question 25

Clonidine XR and Guanfacine Adjuncts for? Monitor? SEs? Do what when stopping?

Answer 25

* For sleep and aggression * Monitor EKG * Sedation, Hypotension, Constipation * Taper

Question 26

Pharm treatment for ADHD?

Answer 26

* Stimulants * Atomoxetine * Clonidine/ Guanfacine * Antidepressants * Cognitive treatment

Question 27

Atomoxetine Onset of action, what line of treatment? metabolized by? SEs? Black box

Answer 27

* 2nd line ofr treatment * Onset is 2-4 weeks * full in 6-8 week s * 2D6 * Increase LFT, BP and P, Nausea, decreased appetite * Suicide in children

Question 28

Stimulants should be avoided in patients with?

Answer 28

* Serious structural cardiac abnormalities * Cardiomyopathy * Serious heart rhythm abnormalitites

Question 29

Symptoms need to be present in multiple? Stimulant medications are? Non-stimulant medication benefits include?

Answer 29

* Settings * First line * No abuse potential, less growth effects and less sleep disturbances

Question 30

Bupropion what line? Advantages for who? Contraindications?

Answer 30

* 2nd line * Less toxicity than TCA, less appetite suppression than stimulants * For adults * No seizures

Question 31

Phychostimulants

Answer 31

* - Methylphenidate * - Dexmethylphenidate * - Dextroamphetamine * - Mixed amphetamine * - Lisdexamfetamine

Question 32

How is ADHD diagnosed?

Answer 32

* Symptom onset prior to age 12 * Symptoms must be present in multiple settings for at least 6 months * Need to rule out other causes like a learning disability

Question 33

Dexedrine and Dextrostat are both? And what is their DOA?

Answer 33

Dextroamphetamines 3-5 hours