ADHDFC Flashcards
1
Q
methylphenidate IR
A
Ritalin, Methylin chewable, oral susp
2
Q
methylphenidate long-acting
A
Ritalin LA
3
Q
methylphenidate sustained release
A
Ritalin SR
4
Q
mehtylphenidate ext-release
A
Methylin ER, Metadate ER, Quillivant XR-ext rel oral susp
5
Q
methylphenidate IR-ext rel OROS system
A
Concerta
6
Q
methylphenidate IR-ext rel (beads that dissolve at different rates)
A
Metadate CD
7
Q
methylphenidate transdermal patch
A
Daytrana
8
Q
dexmethylphenidate IR
A
Focalin
9
Q
dexmethylphenidate ER
A
Focalin XR
10
Q
dextroamphetamine and amphetamine IR
A
Adderall
11
Q
dextroamphetamine and amphetamine ER
A
Adderall XR
12
Q
dextroamphetamine IR
A
Dexedrine, Dextrostat
13
Q
dextroamphetamine SR and IR
A
Dexedrine Spansules, ProCentra
14
Q
lisdexamfetamine
A
Vyvanse
15
Q
atomoxetine (not controlled)
A
Strattera (not controlled)
16
Q
guanfacine ext-rel (not controlled)
A
Intuniv (not controlled)
17
Q
clonidine ext-rel (not controlled)
A
Kapvay (not controlled)
18
Q
modafinil (C4)
A
Provigil (C4)
19
Q
armodafanil (C4)
A
Nuvigil (C4)
20
Q
methylphenidate IR
A
Ritalin, Methylin chewable, oral susp
21
Q
methylphenidate long-acting and dosing
A
Ritalin LA (1/2 IR, 1/2 SR in one capsule)
10-40mg LA caps
22
Q
methylphenidate sustained-release tab dose
A
Ritalin SR 20mg SR tab
23
Q
methylphenidate extended-release
A
Methylin ER, Metadate ER, Quillivant XR is oral susp
10-20mg ER tabs
24
Q
methylphenidate IR/XR dosing
A
Concerta
OROS system
18,27,36,54 mg ER tabs
25
advantage of Concerta OROS system
somewhat harder to abuse because harder to crush/chew
26
methylphenidate IR/XR beads dosing
Metadate CD
10-60 mg ER caps
beads dissolve at different rates
27
methylphenidate transdermal patch dosing
Daytrana
1.1mg/hr (10mg/9hr) - 3.3mg/hr (30mg/9hr)
28
dexmethylphenidate IR dosing dosing
Focalin 2.5-10mg tabs, BID 4+ hrs apart, w/ or w/out food
29
dexmethylphenidate ER dosing
Focalin XR
5-20mg caps QAM
30
dextroamphetamine and amphetamine IR dosing
Adderall
5-30mg scored tabs QAM or BID without regard to meals. 1st dose at awakening, additional dose 4-6hrs later
31
dextroamphetamine and amphetamine ER
Adderall XR
5-30mg ER caps QAM w/ or w/out food
32
dextroamphetamine IR dosing
Dexedrine, Dextrostat
5-10mg tabs QAM or BID w/ or w/out food
33
dextroamphetamine IR and SR
Dexedrine Spansules, ProCentra
5,10,15mg SR caps
QAM w/ or w/out food
34
lisdexamfetamine dosing
Vyvanse
30,50,70mg caps QAM w/ or w/out food
35
atomoxetine dosing
Strattera
40-80mg caps, occasionally up to 100mg daily or can divide BID
36
guanfacine extended release dosing
Intuniv
1-4mg tabs daily. Start at 1mg
37
clonidine extended release dosing
Kapvay
0.1-0.2mg tabs. Start at 0.1mg HS, titrate weekly, using BID dosing
38
modafinil dosing
Provigil 200mg daily
39
armodafinil dosing
Nuvigil 150-250mg daily
40
Moa aromodafinil dosing
R isomer of modafinil
41
BBW warnings for stimulants:
1. heart-related problems: increased BP and HR, stroke and heart attack in adults, sudden death in those who have existing heart problems/defects
2. psychiatric problems: new or worse behavior and thought problems, bipolar illness, aggressive behavior or hostility
3. Children and teens: new psychotic symptoms (hearing voices, believing this that are not real, suspicious)
42
Stimulants possible MoA
inhibit norepi and dopamine reuptake
43
Contraindications to stimulants use
glaucoma, history of tics, current MAOI use
44
Monitoring for stimulants
BP & HR (at least monthly), height/weight of children, symptom improvement, mood changes/worsening
45
Side effects of stimulants: GI, Eye, CV, Mood, etc
1. nausea, loss of appetite (lose wt, anorexia), insomnia, dizzy, HA, lightheaded (if child faints, SOB, chest pain - call doctor), irritable, blurry vision, difficulty with visual accomodation
2. Increase BP 2-4 mmHg, HR 3-8 bpm - monitor, caution in CV disease
3. Worsening of mixed/mania episodes if bipolar disorder
4. Withdrawal symptoms (hyper): must titrate UP and DOWN
5. Risk of seizures - caution in seizure history
46
What is unique about lisdexamfetamine?
Prodrug. Needs first pass metabolism to dextroamphetamine. Thus, may have decreased risk of abuse because cannot be injected or snorted
47
If Vyvanse caps are too big to swallow, what can be done?
Mix contents with some water, drink immediately (or else the coating with dissolve)
48
Should stimulants be taken with food?
W/ or w/out food. Although, advise eating good bfast since stimulants can cause loss of appetite
49
If a child on stimulant has trouble sleeping, what can be done?
1. Stop the evening dose
2. Give a long acting once daily formulation instead
3. diphenhydramine
4. sedating antidepressant
5. clonidine
50
Counseling for Daytrana patch
1. Apply new patch to hip area in AM 2hrs before desired effect
2. Avoid waistline on pants so it doesn't rub off.
3. Replace each AM.
4. Alternate L and R hip.
5. Hold patch on skin for 30sec and smooth down edges
6. If applied correctly, it will stay on during bathing/swimming.
7. When peeling off to discard, fold in half, throw in lidded trash can.
51
Strattera BBW
atomoxetine:
1. Risk of suicidal ideation in children
2. Monitor for possible liver injury, CV problems
3. MAOI use within 14days, narrow-angle glaucoma, Hx of pheochromocytoma, Hx of CV disorders where condition would deteriorate with BP or HR increases
52
Strattera contraindications
glaucoma, pheochromocytoma, MAOI use within 14 days
53
Strattera SEs
stomach upset, nausea, loss of appetite, trouble sleeping (same as stimulants)
fatigue (Main) , dry mouth, dizzy, menstrual cycle changes, mood changes, decrease libido, erectile dysfunction, orthostasis
rare: liver damage, priapism
54
If Strattera capsules cannot be swallowed, what can be done?
DO NOT open capsules - product is an ocular irritant. Must swallow capsules whole. If opened, wash hands immediately and do not touch eyes.
55
Does Strattera require tapering UP or DOWN?
No, ok to d/c abruptly.
56
Take Strattera w/ or w/out food?
Does not matter
57
Strattera DDIs
1. Decrease dose if on strong 2D6 inhibitors (eg Paxil, fluoxetine, quinidine) or if pt is known 2D6 poor metabolizer
2. 14day wash out period after MAOI use
58
What is the indication for generic guanfacine? Brand name?
hypertension; Tenex
59
Strattera MoA
selective NE reuptake inhibitor
60
Intuniv SEs
guanfacine:
overall well-tolerated
somnolence, hypoTN, bradycardia, HA, fatigue, upper GI pain, nausea, increase lethargy, fainting
61
Intuniv DDI
3A4 substrate; avoid use with 3A4 inducers/inhibitors
62
Is Intuniv ok with food?
As long not taken with high-fat meal (will increase absorption)
63
Kapvay SEs
clonidine extended-rel:
somnolence (higher incidence than Intuniv), bradycardia, dry mouth, fatigue, lethargy, depression, psychotic reactions, nasal stuffiness, impotence, exacerbate Parkinson's,
(IMP) rebound HTN (with sweating, anxiety, tremors) if stopped abruptly - do not become dehydrated
XR formulation supposed to have less SEs
64
MoA of Intuniv and Kapvay
central acting alpha2 adrenergic R agonists -> decrease sympathetic outflow from CNS -> decrease BP, HR, peripheral resistance
unknown MoA in ADHD
65
Provigil and Nuvigil require MedGuide due to..
risk of severe rash incl SJS/TEN (this is why Provigil was denied for use in ADHD in children). Stop use if rash occurs.
66
Provigil and Nuvigil SEs
HA, dizz, anxiety, agitation
nausea, diarrhea, insomnia, dry moth
67
Which medications require MedGuide
Stimulants incl Provigil, Nuvigil, Strattera non-stimulant (all have BBW)
68
Which do not need MedGuide
Intuniv, Kapvay - not controlled
(Stimulants CII, Provigil/Nuvigil are C IV)
69
Natural Products used in ADHD
Fish oil omega-3 ("possibly effective") at 6capsules daily with or without evening primrose oil omega-6.
Others: SAMe, St.John's wort, ginkgo
