ADHD: Stimulants and Nonstimulants Flashcards Preview

Behavioral Science > ADHD: Stimulants and Nonstimulants > Flashcards

Flashcards in ADHD: Stimulants and Nonstimulants Deck (24)
Loading flashcards...
1

Five stimulant ADHD medications. All are derivatives of what?

All derivatives of amphetamine.

-Amphetamine, Dextroamphetamine
-Lisdexamfetamine (pro-drug)
-Methylphenidate and Dexmethylphenidate.

2

Three non-stimulant ADHD meds.

Atomoxetine, guanfacine, clonidine

3

Main effect of stimulant meds in treatment of ADHD.

How is methylphenidate different?

Uptake into cell via membranes, then interferes with vesicular monoamine transporter (VMAT), thereby
**increasing neurotransmitter release (NE/DA/5‐HT).

Methylphenidate's - **inhibition of dopamine reuptake and doesn’t appear to stimulate release of neurotransmitters, as amphetamines

4

??(slide 7) Name the Immediate Release and XR stimulants.

Amphetamine salts (adderall)
Dextroamphetamine
Methamphetamine

5

___hrs for onset of stimulants.

What is special about prescription?

24

Controlled substances - 1mo supply, no refills, no samples

6

What is amphetamine/dextroamphetamine.

% of immediate release v. Delayed/ER.

What is the XR DoA?

Adderall - IR/XR

XR=50%IR and 50% XR beads. Sprinkle capsule onto food.

QD XR (8-12hrs duration) = BID IR

7

What amphetamine has a biphasic release?

DoA
Age

d/l - methylphenidate (concerta)

Phase1: 22%IR; Phase 2: 78% Delayed release

DoA 10-12 hrs
Age: >6 yo

8

>3 years old v. >6 years old

>3 years = amphetamine/dextroamphetamine (adderall), dextroamphetamine
>6 years = lisdexamfetamine, d/l-methylphenidate (ritalin, metadate, aptensio, daytrana), dexmethylphenidate

9

d,l-methylphenidate (IR/LA)

DoA
% of immediate release v. Delayed/ER.

Ritalin:
8-10 hours DoA

LA=50% IR beads and 50% LA beads

Sprinkle in food (QD for LA or BID for IR)

10

Dosing, formulation, age for lisdexamfetamine (ro drug of dextroamphetamine)

contents into water, QD, for >6

11

d,l-methylphenidate (IR/CD)

DoA
% of immediate release v. Delayed/ER.

Metadate:
8-10 hrs DoA
CD=30% IR beads and 70% CD beads into food

12

d,l-methylphenidate (XR)

DoA
% of immediate release v. Delayed/ER.

Aptensio:
DoA:12hrs
XR=40% IR and 60% XR sprinkled onto food

13

d,l-methylphenidate (patch on HIP)

DoA
% of immediate release v. Delayed/ER.

Daytrana
DoA: onset w/i 2 hours for 12 hours of action

14

d-methylphenidate (what release?)

% of immediate release v. Delayed/ER.

Quillivant:
XR oral suspension, shkae well OR chew tablet

20% IR, 80% ER

15

dexmethylphenidate (what release?)

Focalin (IR/XR)
XR=50% IR beads and 50% XR beads sprinkled on food

16

Side effects of stimlants

-Decreased appetite - Weight loss
-Insomnia
-HA/Abdominal pain
-Irritability/Aggression - Tics and Psychoses
-Cardiac - Elevated BP/HR (Stroke/MI in adults) or Sudden cardiac death (rare ,check for structural abnormalities)

17

MOA of nonstimulants - atomoxetine

Inhibition of neurotransmitter pre‐synaptic reuptake (only
NE) (atomoxetine)
• Also has down‐stream impact on DA system due to overlap

18

MOA of nonstimulants guanfacine/clonidine

 Activation of centrally‐located (CNS) alpha‐2 adrenergic receptors (guanfacine/clonidine)
• Post‐synaptic alpha‐2 inhibition in prefrontal areas

19

Onset of non-stimulant activity. When is it useful? Scheduled?

-Onset of activity 2‐4+ weeks
-Used when intolerant of stimulant effects or parents resistant to stimulant class
-Non‐scheduled, refills & samples possible

20

Atomoxetine, Guanfacine, Clonidine:
DoA
Admin
Age

18-24 hrs

Not sprinkled or in water. Not broken up.

>6 years old

21

Dosing of clonidine

QD.

22

Side effects of non-stimulants

-Decreased appetite - Weight loss
-Insomnia (atomoxetine)
Sedation/Somnolence (guanfacine/clonidine)
Headache/Abdominal pain
Dizziness
Suicidal ideation (rare; atomoxetine)
Liver injury (rare; atomoxetine)
Hypotension (guanfacine/clonidine)

23

What non-stimulant has insomnia, suicidal ideation or liver injury (rare) as a side effect?

atomoxetine

24

What non-stimulants have sedation/somnolence, hypotension as a side effect?

guanfacine/clonidine