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Flashcards in STIMULANTS Deck (47):
1

treatment failure for ADHD is the result of what?

inappropriate drug management rather than inactivity of the drug

2

do the serum drug levels correlate with the adequacy of response?

NO

3

what are the four phases of management in treating ADHD?

1. counseling
2. titration
3. maintenance
4. Potential termination

4

describe the counseling phase of adhd therapy?

1. explaining why pt needs meds and outlining the pros and cons
2. tell parents about behaviors to monitor, potential side effects and how to deal with them
3. advise that both dose and timing will change as treatment progresses; with adequate activity a move is made from short-acting to sustained release preparations

5

how do you usually figure out which stimulant to use?

trial and error b/c there's no real difference b/w the initial response of drugs

6

what are the most common side effects of stimulants?

appetite suppresion
delayed sleep onset
wearing off phenomenon
tics
depression
social withdrawal

7

what do you do if pt has intractable tics with stimulant therapy?

stop stimulant and consider adding or substituting another agent (like centrally acting alpha-agonist) with consult

8

describe the maintenance phase of stimulant therapy

less doc visits
still need to see doc every so often for refills
monitor med effects and progress

9

amphetamines MOA

releases DA & NE

10

atomoxetine MOA

Selective NE reuptake inhibitor centrally & peripherally

11

methylphenidate MOA

block reuptake of DA & NE

12

guanfacine MOA (as a stimulant)

believed due to regulation of NE release from locus ceruleus

13

clonidine MOA

shows improved prefrontal cortical function through post-synaptic alpha-2-receptor agonist effects in the PFC

14

haloperidol MOA

blocks post-synaptic D2 receptors (typical high potency anti-psychotic)

15

what is the clinical utility of short-acting amphetamines?

used as initial treatment in small kids

16

what is the clinical utility for longer acting amphetamines?

more convenient
confidential
greater adherence
more problems with appetite and sleep

17

describe the outcome of using drugs that alkalinize the urine (acetazolamide, NaBicarb) with amphetamine/dextroamphetamine

alkalinizing the urine favors reuptake of drug in renal tubules; increases the drug levels

18

using ammonium chloride can have what outcome with amphetamine thereapy?

acidifies the urine favoring renal elimination; decreases the serum drug levels

19

what is the outcome of using chlorpromazine/haloperidol with amphetamines?

dopamine receptor blockers diminish effects of amphetamines

20

what is the outcome of using dextromethorphan with amphetamine?

increasingly impaired judgmement, erratic euphoria

21

what is the outcome of using digoxin with amphetamines?

increasingly pro-arrhythmogenic

22

what is the outcome of using MAOIs with amphetamines?

increases serum drug levels and toxicity

23

which CYP enzyme can have an effect on amphetamines serum drug levels?

CYP2D6

24

what are the more common adverse effects of amphetamine therapy?

abdominal pain
headache
insomnia
loss of appetite

25

what is the effect of using albuterol with atomoxetine?

accentuates CV adverse effects

26

what is the outcome of using epinephrine with atomoxetine?

further increases in BP

27

what is the effect of using MAOIs with atomoxetine/methylphenidate?

increases toxicity; allow 2 week interval b/w drugs

28

what is the effect of using alcohol with methylphenidate?

increase production of toxic metabolites--> functional inability to concentrate (drive)

29

what is the outcome of using phenytoin with methylphenidate?

increases blood levels of phenytoin in some pts

30

what is the outcome of using ergotamine/pseudoephedrine with atomoxetine/methylphenidate?

exacerbates pressor agent effect on BP

31

which CYP enzyme can affect the serum drug levels of atomoxetine/methylphenidate?

CYP2D6

32

what are some of the adverse effects of atomoxetine?

dry mouth
headache
abd. pain
decrease appetite
cough
somnolence
vomiting
insomnia

33

what are some of the adverse effects of methylphenidate?

headahce
insomnia
decreased appetite
N/V
abd. pain

34

what are some of the absolute contraindications to stimulant use?

MAOIs
psychosis
glaucoma
underlying cardiac conditions (mild increases in pulse and BP)
existing liver disorders
a hx of stimulant drug dependence

35

what is the most common co-morbid condition encountered in people with tics and tourette syndrome?

ADHD

36

what is the 1st choice therapy for pts with tics and ADHD?

alpha-2 agonists

37

what is 2nd choice for pts with ADHD and tics/tourett'es?

stimulants have rapid activity against ADHD but no activity against tics

38

what is 3rd choice for pts with ADHD and tics/tourette's?

methylphenidate + alpha-2 agonist combo

39

which class of drugs has the greatest demonstrated effect of reducing tics in clinical trials?

antipsychotic agents (must base decision for treatment on risk/benefit analysis b/c of lost of adverse effects with antipsychotics)

40

which class of drugs demonstrated similar or slightly larger benefit in reducing tics, but only among subjects with comorbid ADHD?

alpha-2 agonists

41

what is the effect of using clonidine/guanfacine together with cyclosporine?

increased serum levels of interactant

42

what is the outcome of using clonidine/guanfacine with buproprion?

grand mal seizures

43

what cardiac adverse effect will you see if one of the metabolic pathways (CYP2D6/3A4, glucuronidation) for haloperidol metabolism is blocked and there are increased haloperidol concentrations?

QT prolongation

44

what are some of the adverse effects of clonidine/guanfacine?

skin rxns (patch)
dry mouth
somnolence
headache
fatigue
drowsiness
dizziness
anxiety
abd. pain

45

what are some of the clinical signs of amphetamine/methylphenidate toxicity?

mydriasis
tremor
agitation
hyperreflexia
combative behavior
confusion
hallucinations

46

describe the management of amphetamine/methylphenidate toxicity?

supportive, w/ judicious use of BNZs

47

describe the management of atomoxetine toxicity?

supportive, w/ focus on sedation and control of dyskinesias and seizures