ADHD- Stimulants General Info

Question 1

First-line treatment in ADHD

Answer 1

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

Question 2

Stimulants in ADHD

Answer 2

Methylphenidate (MPH) and amphetamine (AMP)

Question 3

Which stimulant is more potent?

Answer 3

Amphetamines

Question 4

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

Answer 4

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

Question 5

Features of IR formulations of stimulants: frequency

Answer 5

BID-TID due to their short half-lives

Question 6

Features of IR formulations of stimulants: drug onset

Answer 6

15-30 minutes

Question 7

Features of IR formulations of stimulants: duration

Answer 7

2-6 hours

Question 8

Features of IR formulations of stimulants: advantages

Answer 8

Lower cost, less insomnia, fewer growth-related ADEs

Question 9

Features of LA/ER formulations of stimulants: frequency

Answer 9

QD

Question 10

Features of ER formulations of stimulants: duration of action

Answer 10

8-12 hours, may need another afternoon dose

Question 11

Features of ER formulations of stimulants: advantage

Answer 11

Increases adherence!

Question 12

Stimulant ADEs: psychiatric

Answer 12

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

Question 13

Stimulant ADEs: cardiac

Answer 13

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

Question 14

Stimulant ADEs: growth

Answer 14

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

Question 15

Will the weight loss go away when taking a stimulant?

Answer 15

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

Question 16

Which stimulant is more likely to have DDIs?

Answer 16

MPH

Question 17

Stimulant DDIs: combo with psychostimulants

Answer 17

Additive effects

Question 18

Stimulant DDIs: MAOIs

Answer 18

Don’t use an MAOI within 14 days

Question 19

Stimulant DDIs: MPH and TCA

Answer 19

MPH can increase TCA concentrations

Question 20

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

Answer 20

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

Question 21

Stimulant DDIs: antacids and PPIs vs. AMP

Answer 21

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

Question 22

Stimulant DDIs: Acidic agents and AMP

Answer 22

Acidic agents can lower AMP absorption

Question 23

Stimulant DDIs: 2D6 inhibitors and mixed AMP salts

Answer 23

2D6 inhibitors can increase mixed AMP salt exposure

Question 24

Stimulant DDIs: concomitant use with alcohol

Answer 24

Can result in stimulant dumping

Question 25

Monitoring/patient evaluation: what should you document at baseline?

Answer 25

Symptoms and complaints

Question 26

How often should you monitor height, weight, eating, and sleeping patterns?

Answer 26

At baseline and q3m

Question 27

Adequate trial of atomoxetine, viloxazine, and bupropion

Answer 27

6 weeks at the maximum tolerated dose

Question 28

Monitoring for guanfacine and clonidine

Answer 28

BP and pulse; EKG isn't mandatory but often done

Question 29

Adequate trial of guanfacine and clonidine

Answer 29

1-2 months