Stimulants + Non stimulant ADHD meds

Question 1

note–a bunch of stimulant review is in the ADHD section (CADDRA guidelines)

Question 2

list the 3 formulations of amphetamines

Answer 2

dexedrine (dextroamphetamine)–> tablets (IR) or spansules (XR)

vyvanse (lisdexamphetamine)

adderall XR (dextropamphetamine)

Question 3

list the formulations of methylphenidate available

Answer 3

Ritalin (IR or SR)

Biphentin

Concerta (OROS)

Question 4

what assessments should be done before starting ANY stimulant

Answer 4

BP, HR

height, weight

(ECG only if cardiac history or other clinical concern)

Question 5

how quickly should you be adjusting stimulant doses

Answer 5

can do every 7 days

Question 6

side effects of stimulant medications

Answer 6

insomnia

irritability (?more with amphetamine rather than methylphenidate)

headache

anxiety

appetite suppression

weight loss

N/V/D

?worsened tics

tachycardia

HTN

growth delay (?1 inch with sustained stimulant use)

**in OSCE, mention cardiac risks/black box warning for monitoring for cardiac risks

**in OSCE, mention risk for diversion and misuse of stimulants

Question 7

max dose of adderall

Answer 7

30mg po daily

Question 8

max dose of vyvanse

Answer 8

60mg po daily

Question 9

max dose for dexedrine

Answer 9

30mg/day for kids

40mg/day for adults

Question 10

how long does vyvanse last

Answer 10

13-14 hours

Question 11

how long does dexedrine last

Answer 11

4 hours for tablets

6-8 hours for spansules

Question 12

how long does adderall XR last

Answer 12

12 hours

Question 13

how long does ritalin last

Answer 13

3-4 hours

Question 14

what is the max dose of ritalin

Answer 14

60mg /day

CADDRA says up to 100mg for adults

Question 15

how long does biphentin last

Answer 15

10-12 hours

Question 16

how long does concerta last

Answer 16

12 hours

must be swallowed whole

Question 17

how long does foquest last

Answer 17

up to 16 hours

Question 18

max dose of biphentin

Answer 18

60mg/day for kids

80mg/day for adults

Question 19

max dose of concerta

Answer 19

54mg/day for kids

72mg/day for adults

Question 20

other than ADHD, what is an indication for ritalin

Answer 20

depression in the medically unwell

Question 21

what is a black box warning/concern with atomoxetine

Answer 21

warn of risk of SI with atomoxetine

Question 22

you should use caution with atomoxetine in the setting of which medical comorbidity

Answer 22

asthma

Question 23

side effects of atomoxetine

Answer 23

tachycardia

HTN

anxiety

N/V/D

irritability

headache

weight loss

doesnt worsen tics

Question 24

in which population might atomoxetine be particularly useful

Answer 24

those with SUD history

cant be diverted/abused

Question 25

max dose of atomoxetine

Answer 25

1.4mg/kg/day or 100mg/day

Question 26

what is the mechanism of atomoxetine

Answer 26

selective norepinephrine reuptake inhibitor

Question 27

max dose of guanfacine

Answer 27

4mg/day in kids 7mg/day in adults

Question 28

max dose of clonidine

Answer 28

1.2mg/day

Question 29

guanfacine is first line for what disorder

Answer 29

tics

Question 30

side effects of guanfacine, clonidine

Answer 30

drowsiness dizziness fatigue bradycardia syncope hypotension dry mouth/eyes nausea constipation

Question 31

list indications for modafinil

Answer 31

1st line for hypersomnolence disorder and narcolepsy 2nd line for MDD adjunct 3rd line for ADHD used for fatigue caused by cancer, MS, OSA

Question 32

is modafinil recommended in peds

Answer 32

no