Flashcards in STIMULANTS Deck (47):
treatment failure for ADHD is the result of what?
inappropriate drug management rather than inactivity of the drug
do the serum drug levels correlate with the adequacy of response?
what are the four phases of management in treating ADHD?
4. Potential termination
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
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
what are the most common side effects of stimulants?
delayed sleep onset
wearing off phenomenon
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
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
releases DA & NE
Selective NE reuptake inhibitor centrally & peripherally
block reuptake of DA & NE
guanfacine MOA (as a stimulant)
believed due to regulation of NE release from locus ceruleus
shows improved prefrontal cortical function through post-synaptic alpha-2-receptor agonist effects in the PFC
blocks post-synaptic D2 receptors (typical high potency anti-psychotic)
what is the clinical utility of short-acting amphetamines?
used as initial treatment in small kids
what is the clinical utility for longer acting amphetamines?
more problems with appetite and sleep
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
using ammonium chloride can have what outcome with amphetamine thereapy?
acidifies the urine favoring renal elimination; decreases the serum drug levels
what is the outcome of using chlorpromazine/haloperidol with amphetamines?
dopamine receptor blockers diminish effects of amphetamines
what is the outcome of using dextromethorphan with amphetamine?
increasingly impaired judgmement, erratic euphoria
what is the outcome of using digoxin with amphetamines?
what is the outcome of using MAOIs with amphetamines?
increases serum drug levels and toxicity
which CYP enzyme can have an effect on amphetamines serum drug levels?
what are the more common adverse effects of amphetamine therapy?
loss of appetite
what is the effect of using albuterol with atomoxetine?
accentuates CV adverse effects
what is the outcome of using epinephrine with atomoxetine?
further increases in BP
what is the effect of using MAOIs with atomoxetine/methylphenidate?
increases toxicity; allow 2 week interval b/w drugs
what is the effect of using alcohol with methylphenidate?
increase production of toxic metabolites--> functional inability to concentrate (drive)
what is the outcome of using phenytoin with methylphenidate?
increases blood levels of phenytoin in some pts
what is the outcome of using ergotamine/pseudoephedrine with atomoxetine/methylphenidate?
exacerbates pressor agent effect on BP
which CYP enzyme can affect the serum drug levels of atomoxetine/methylphenidate?
what are some of the adverse effects of atomoxetine?
what are some of the adverse effects of methylphenidate?
what are some of the absolute contraindications to stimulant use?
underlying cardiac conditions (mild increases in pulse and BP)
existing liver disorders
a hx of stimulant drug dependence
what is the most common co-morbid condition encountered in people with tics and tourette syndrome?
what is the 1st choice therapy for pts with tics and ADHD?
what is 2nd choice for pts with ADHD and tics/tourett'es?
stimulants have rapid activity against ADHD but no activity against tics
what is 3rd choice for pts with ADHD and tics/tourette's?
methylphenidate + alpha-2 agonist combo
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)
which class of drugs demonstrated similar or slightly larger benefit in reducing tics, but only among subjects with comorbid ADHD?
what is the effect of using clonidine/guanfacine together with cyclosporine?
increased serum levels of interactant
what is the outcome of using clonidine/guanfacine with buproprion?
grand mal seizures
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?
what are some of the adverse effects of clonidine/guanfacine?
skin rxns (patch)
what are some of the clinical signs of amphetamine/methylphenidate toxicity?
describe the management of amphetamine/methylphenidate toxicity?
supportive, w/ judicious use of BNZs