Stimulants

Question 1

ADHD is due to?

Answer 1

delayed brain maturation

esp. outer cortex compared to chronologic age

Question 2

Do stimulants cure ADHD?

Answer 2

NOPE

Question 3

Typical half-life? (long, medium, or short)

Answer 3

short

Question 4

What is the difference in efficacy between drugs?

Answer 4

very little

Question 5

What are the 4 phases of treatment?

Answer 5

1) counsel, 2) titrate, 3) maintenance, 4) termination

Question 6

What is the counsel phase all about?

Answer 6

counsel parents on AEs, tx outcomes, dose and regimen..trial and error to find drug that works

Question 7

What does it mean to titrate these drugs?

Answer 7

once you find a drug that works, switch to slow-release form for better regimen

Question 8

What schedule are these drugs? (1-5)

Answer 8

2

Question 9

AEs of stimulants?

Answer 9

appetite suppression (decreases with time), decreased sleep, wearing off (up and down with short acting), tics, depression/social withdrawal (check dosing/switch drug

Question 10

Absolute contraindications?!

Answer 10

MAOI, psychosis, glaucoma, CV dz, hepatic dz, addictive hx

Question 11

Amphetamines MOA?

Answer 11

release DA and NE

Question 12

List DDI for amphetamines?

Answer 12

acetazolamide, ammonium, typical antipsychotics, dextromethorphan, digoxin, MAOI, CYP2D6

Question 13

Acetazolamide & amphetamine DDI?

Answer 13

increase urine pH = reabsorption in kidney

Question 14

ammonium & amphetamine DDI?

Answer 14

decrease urine pH = excretion

Question 15

typical antipsychotics & amphetamine DDI?

Answer 15

decreases stimulant effect

Question 16

dextromethorphan & amphetamine DDI?

Answer 16

confusion

Question 17

digoxin & amphetamine DDI?

Answer 17

arrhythmia

Question 18

MAOI & amphetamine DDI?

Answer 18

increased drug levels

Question 19

Amphetamine AEs?

Answer 19

abd pain, HA, insomnia, decreased appetite, anxiety, tachyC, weight loss

Question 20

Amphetamine OD and treatment?

Answer 20

mydriasis, tremor, hyperreflexia, confusion, aberrant behavior, delirium, seizures, paranoia, etc. (neuro/CV/renal/pulm/GI/muscle effects)
*Treat with benzos and supportive tx

Question 21

Atomoxetine MOA?

Answer 21

NE reuptake inhibitor

Question 22

Dexmethylphenidate and Methylphenidate MOA?

Answer 22

DA & NE reuptake inhibitors

Question 23

List DDIs for Atomoxetine, Dexmethylphenidate and Methylphenidate.

Answer 23

albuterol, epi/ergots/pseudoephedrine, MAOI, EtOH, phenytoin, CYP2D6

Question 24

Albuterol & atomoxetine/dex-/methylphenidate DDI?

Answer 24

increased CV AE

Question 25

Epi/ergots/pseudoephedrine & atomoxetine/dex-/methylphenidate DDI?

Answer 25

increased BP

Question 26

MAOI & atomoxetine/dex-/methylphenidate DDI?

Answer 26

toxicity; wait 2 weeks

Question 27

EtOH & atomoxetine/dex-/methylphenidate DDI?

Answer 27

toxic metabolites

Question 28

Phenytoin & atomoxetine/dex-/methylphenidate DDI?

Answer 28

increased blood levels of pheytoin

Question 29

Amoxetine AEs?

Answer 29

xerostomia, HA, abd pain, cough, drowsiness, N/V, insomnia, decreased appetite

Question 30

Amoxetine/dex-/methylphenidate OD?

Answer 30

neuro/CV/renal/pulm/GI/muscle effects (pretty much same as amphetamine but more mild)

Question 31

Treatment of Amoxetine/dex-/methylphenidate OD?

Answer 31

benzodiazepines and supportive tx; sedate and prevent seizures

Question 32

Methyphenidate AEs?

Answer 32

HA, insomnia, N/V, abd pain, decreased appetite (patch formation)

Question 33

What is the most common comorbidity with tics and Tourettes?

Answer 33

ADHD

Question 34

What are the DOCs for Tourettes/tic and ADHD?

Answer 34

Alpha 2 agonists

Question 35

List the alpha 2 agonists.

Answer 35

Clonidine and ganfacine

Question 36

Clonidine and guanfacine MOA? Respective areas of action?

Answer 36

POST-synaptic a2 agonist clonidine--regulates locus ceruleus NE release guanfacine--prefrontal cortex

Question 37

DDI for a2 agonists?

Answer 37

cyclosporine (increased drug levels), bupropion (seizure). NO CYPs

Question 38

AEs of a2 agonists?

Answer 38

dry mouth, skin rash, somnolence, HA, fatigue, anxiety, abd. pain, dizziness

Question 39

OD of a2 agonists?

Answer 39

paradoxical HTN (give nitroprusside), then hypoTN (give atropine and dopamine)

Question 40

What are the DOC for tics w/o ADHD?

Answer 40

antipsychotics (like haloperidol)

Question 41

Haloperidol MOA?

Answer 41

high potency anti-psychotic (D2 blocker)

Question 42

Haloperidol ADEs?

Answer 42

CYP2D6/3A4, Long QT

Question 43

What is 3rd line for Tourettes/tic and ADHD combo?

Answer 43

methylphenidate and alpha2 agonist combo