ADHD pharmacology and therapeutics Flashcards
(71 cards)
1
Q
two general types of ADHD symptoms
A
- inattention
- hyperactivity and impulsivity
2
Q
factors that contribute to ADHD
A
- genetics
- maternal smoking
- preterm birth or low birth weight
- deficits in monoamine NT system
3
Q
childhood diagnosis criteria
A
- at least 6 symptoms
- before age 12
- at least 6 months in duration
- symptoms present in two or more settings
- symptoms interfere with life
4
Q
adult diagnosis criteria
A
- at least 5 symptoms
- present before age 12
- last at least 6 months
- in two or more settings
- symptoms interfere with lifeS
5
Q
inattention symptoms
A
- fails to give attention to detail
- careless mistakes
- trouble holding attention
- does not seem to listen
- does not follow through on instructions
- fails to finish work
- avoids or is reluctant to do tasks that take a long period of time
- loses things needed for tasks
- easily distracted
- forgetful
6
Q
hyperactivity and impulsivity symptoms
A
- difficulty organizing tasks
- excessive talking, fidgeting
- runs about or climbs when not appropriate
- unable to play or have leisure quietly
- often on the go
- talks excessively
- blurts out answers
- has trouble waiting for their turn
7
Q
3 types of presentation
A
- combined
- mostly inattentive
- mostly hyperactive-impulsive
8
Q
most common presentation in adults
A
inattentive
9
Q
common comorbid conditions
A
- anxiety
- mood disorders
- learning disabilities
- medical conditions
- substance abuse
10
Q
non-stimulant ADHD medications
A
clonidine guanfacine atomoxetine modafinil armodafinil
11
Q
target of stimulant drugs
A
monamine transporters
12
Q
primary NE pathway
A
dorsal noradrenergic bundle
13
Q
role of the NE pathway
A
mediates orienting response, selective attention, and vigilance (helps response to sensory stimulation and filtering)
14
Q
cocaine CNS MoA
A
prevents reuptake of dopamine, serotonin and norepinephrine
15
Q
cocaine anesthesia MoA
A
inactivates sodium channels and stops depolarization
16
Q
cocaine uses
A
local anesthesia, usually EENT
17
Q
amphetamines general MoA
A
- taken up via NET and inhibits VMAT
- increases release of dopamine, NE, and serotonin
- not dependent on firing rate of neuron
18
Q
general structure of amphetamines
A
phenyl ethyl amine
19
Q
pharmacological effect of amphetamines
A
- increase mood
- improved attention span and alertness
- euphoria at high doses
- reduced appetite
20
Q
amphetamines adverse effects
A
- euphoria
- restlessness
- tremor
- anxiety
- dizziness
- insomnia
21
Q
dextroamphetamine
A
enantiomer of amphetamine that is more potent and centrally active
22
Q
adderall
A
combination of dextroamphetamine and amphetamine
23
Q
methylphenidate MoA
A
- blocks reuptake transporter in the synapse
- dependent on firing rate of neuron
24
Q
stimulants adverse effects
A
- reduced appetite
- stomachache
- insomnia
- headache
- rebound symptoms
- irritability/jitteriness
25
atomoxetine MoA
selective presynaptic NE reuptake inhibitor
26
atomoxetine side effects
- nausea
- anorexia
- increased BP
- insomnia
- fatigue
- sedation
27
clonidine MoA
alpha 2 adrenergic agonist, inhibits NE release presynaptically
28
clonidine adverse effects
- sedation
- hypotension
- constipation
- bradycardia
- syncope
29
guanfacine MoA
alpha 2 adrenergic agonist that is more selective than clonidine
30
guanfacine adverse effects
- sedation
- hypotension
- constipation
- bradycardia
- syncope
31
guanfacine PK
- longer half life and duration than clonidine
| - more selective alpha 2 means less sedation and dizziness
32
treatment goals for ADHD
specific for the patient involving reduced symptoms
33
ADHD in ages 6-11
- usually combined inattentive and hyperactive/impulsive
- crucial time for development of self
- accurate diagnosis/treatment is crucial
- most studied group
34
nonpharm therapy for ADHD
- parent training
- education on ADHD
- coordinate care between parents, teachers, clinicians
- behavior interventions
35
behavior interventions
- positive rewards for good behavior
- break up homework into shorter segments
- individualized educate programs
- cognitive behavioral therapy
- external organizer
36
selection of drugs for ADHD
- methylphenidate OR amphetamines
- if inadequate response try the other drug
- if still inadequate response try non-stimulants
- if still inadequate try a combination or TCA
37
patients to avoid stimulants in
- bipolar
- psychosis
- substance abuse
- anxiety
38
general dosing for stimulants
- start at lower dose and titrate to find max efficacy with min side effects
- food can delay absorption
39
symptoms that should improve with stimulants
- hyperactivity
- attention span
- impulsivity
- compliance
- aggression
- social interactions
- academic productivity
40
IR dosing
BID or TID
41
dextroamphetamine onset
30-60 mins
42
dextroamphetamine duration
IR 4-6 hours
43
adderall onset
20-60 mins
44
adderall IR duration
6 hours
45
adderall XR duration
10-12 hours
46
lisdexamfetamine (vyvanse) onset
1 hour
47
lisdexamfetamine duration
over 12 hours
48
methylphenidate onset
30-60 mins
49
drug with ghost tablet
methylphenidate ER (Concerta)
50
daytrana patch onset
2 hours
51
daytrana patch duration
up to 3 hours after taking patch off for total of 12 hours
52
daytrana patch application
in hip area for 9 hours at a time
53
quillivant XR
oral suspension
54
quillivant onset
4-5 hours
55
quillivant duration
12 hours
56
dexmethylphenidate onset
20-60 mins
57
dexmethylphenidate duration
IR-5 hours
| XR-12 hours
58
risks when using stimulants
- BBW for CV risk so avoid if known cardiac abnormalities
- growth may be decreased
- potential for psychosis or mania
59
contraindications of stimulants
- hypersensitivity
- MAO-I use in last 14 days
- anxiety, active psychosis
- untreated hyperthyroidism or HTN
- structural or symptomatic CV disease
60
what are some things that are not contraindications
- Hx drug abouse
- seizure disorders
- Tourettes
61
stimulants drug interactions
- MAO-I
| - antihypertensives (still ok to use though)
62
atomoxetine place in therapy
used alone or in combination with stimulants
63
atomoxetine dosing
QAM or BId
| takes up to 2-4 weeks for benefit
64
clonidine place in therapy
- alone or in combination with stimulants
| - useful for disruptive behavior, aggression, or improving sleep
65
guanfacine place in therapy
- alone or in combo with stimulants
- useful for disruptive behavior, aggression, and sleep
- longer half life than clonidine
- less sedation and dizziness
66
bupropion MoA
weak dopamine and NE reuptake inhibitor
67
bupropion place in therapy
- more benefit seen in children
- less effective than stimulants
- less appetite suppression
- onset in 2-4 weeks
68
bupropion adverse effects
nausea
rash
seizures
tics
69
TCA MoA
serotonin-NE reuptake inhibitor
70
most studied TCAs
imipramine and desipramine
71
TCA place in therapy
- last line
| - onset 2-4 weeks
