ADHD- Stimulants General Info Flashcards

1
Q

First-line treatment in ADHD

A

Stimulants (for the most part unless there’s SUD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Stimulants in ADHD

A

Methylphenidate (MPH) and amphetamine (AMP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Which stimulant is more potent?

A

Amphetamines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What happens if you try one stimulant and it doesn’t work?

A

Just try a different one! Lack of response to one doesn’t mean lack of response to another

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Features of IR formulations of stimulants: frequency

A

BID-TID due to their short half-lives

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Features of IR formulations of stimulants: drug onset

A

15-30 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Features of IR formulations of stimulants: duration

A

2-6 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Features of IR formulations of stimulants: advantages

A

Lower cost, less insomnia, fewer growth-related ADEs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Features of LA/ER formulations of stimulants: frequency

A

QD

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Features of ER formulations of stimulants: duration of action

A

8-12 hours, may need another afternoon dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Features of ER formulations of stimulants: advantage

A

Increases adherence!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Stimulant ADEs: psychiatric

A

psychosis/mania, aggression/violent behavior, severe anxiety/anxiety attacks –> decrease dose or cessation of stimulant, supportive treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Stimulant ADEs: cardiac

A

Increased HR by ~5 BPM, increased BP by 2-7mmHg, but not a cause of concern if there’s no underlying cardiac issues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Stimulant ADEs: growth

A

~1cm/year decreases over 3 years
~3kg weight deficit in 1st year, 1.2kg in 2nd year

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Will the weight loss go away when taking a stimulant?

A

Yes! (But also attempt a drug-free trial every year)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Which stimulant is more likely to have DDIs?

17
Q

Stimulant DDIs: combo with psychostimulants

A

Additive effects

18
Q

Stimulant DDIs: MAOIs

A

Don’t use an MAOI within 14 days

19
Q

Stimulant DDIs: MPH and TCA

A

MPH can increase TCA concentrations

20
Q

Stimulant DDIs: MPH IR, MPH DR with antacids, PPIs, H2RAs

A

Antacids, PPIs, and H2RAs can increase absorption of the IR formulation and decrease it for DR

21
Q

Stimulant DDIs: antacids and PPIs vs. AMP

A

Antacids decrease excretion of AMP
PPIs can increase rate of absorption of AMP

22
Q

Stimulant DDIs: Acidic agents and AMP

A

Acidic agents can lower AMP absorption

23
Q

Stimulant DDIs: 2D6 inhibitors and mixed AMP salts

A

2D6 inhibitors can increase mixed AMP salt exposure

24
Q

Stimulant DDIs: concomitant use with alcohol

A

Can result in stimulant dumping

25
Monitoring/patient evaluation: what should you document at baseline?
Symptoms and complaints
26
How often should you monitor height, weight, eating, and sleeping patterns?
At baseline and q3m
27
Adequate trial of atomoxetine, viloxazine, and bupropion
6 weeks at the maximum tolerated dose
28
Monitoring for guanfacine and clonidine
BP and pulse; EKG isn't mandatory but often done
29
Adequate trial of guanfacine and clonidine
1-2 months