Metadote CD, Ritalin LA, Quillivant XR/Quillichew ER, Concerta are all?
Long acting methylphenidates
Ritalin SR, Metadote ER, Methylin ER are all?
3-8 hours intermidiate
Dexedrine Spansule what is it and what is its DOA?
Adverse effects of stimulants?
- Anorexia - GI distress - Insomnia - Rebound symptoms - Irritability - Dysphoria - Zombie state
What is the delay with Daytrana?
2 hour delay
DSM-5 6 or more of the following
- 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
Adderall XR (50/50)
is a? what is its DOA?
Levoamphetamine and dextroamphetamine
Ritalin, Methylin, Methylin Oral Liquid are all?
Short acting methylphenidates
What are the advantages of long acting stimulants?
- Once daily dosing
- Extra coverage for extracurricular activities
- Privacy issues
- Store them at home so you know theyre taking it.
What are the disadvantages of methylphenidate?
- 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
Nonpharm treatment for ADHD
- Behavioral interventions
- Individualized education program
- Shorter homework Adults
- Organizers and regular schedules
Daytrana transdermal is?
Long acting 10-12 hours Methylphenidate
- Clonidine ER (Kapvay)
- Guanfacine XR (Intuniv)
- Atomoxetine, Clonidine, Guanfacine are FDA approved
Dosing principles for psychostimulants?
- 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
Adderall is a? what is its DOA?
5-7 its a levoamphetamine or Dextroamphetamine
Subtypes of ADHD?
Inattention Hyperactivity or impulsivity.
Counseling tips for patients
- How to take the meds/ what its for
- What ADHD is, risk of untreated ADHD
- When to expect results
- Risk of abuse
- growth delay
Vyvanse 10 hour duration,
Focalin- 6 hours
Focalin XR- 10-12
- Response in the first 2 weeks
- Effective in adult ADHD
- Imipramine, Desipramine
- Disadvantages: Increase SEs, Risk of death in OD, Monitor EKG
ADHD and abuse
Basically patients with ADHD are more likely to have substance abuse
AEs of stimulants?
- GI distress
- Rebound symptoms
- Zombie state
Tics, HTN, Hallucinations, and cardiovascular events, rare
Medications for aggression and explosive behavior?
Refractory ADHD cases with severe aggression?
What are the advantages of methylphenidate?
- 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
Clonidine XR and Guanfacine
Do what when stopping?
- For sleep and aggression
- Monitor EKG
- Sedation, Hypotension, Constipation
Pharm treatment for ADHD?
- Clonidine/ Guanfacine
- Cognitive treatment
Onset of action, what line of treatment?
- 2nd line ofr treatment
- Onset is 2-4 weeks
- full in 6-8 week s
- Increase LFT, BP and P, Nausea, decreased appetite
- Suicide in children
Stimulants should be avoided in patients with?
- Serious structural cardiac abnormalities
- Serious heart rhythm abnormalitites
Symptoms need to be present in multiple?
Stimulant medications are?
Non-stimulant medication benefits include?
- First line
- No abuse potential, less growth effects and less sleep disturbances
Bupropion what line? Advantages for who?
- 2nd line
- Less toxicity than TCA, less appetite suppression than stimulants
- For adults
- No seizures
- - Methylphenidate
- - Dexmethylphenidate
- - Dextroamphetamine
- - Mixed amphetamine
- - Lisdexamfetamine
How is ADHD diagnosed?
- 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
Dexedrine and Dextrostat are both? And what is their DOA?