Sweatman: ADD drugs

Question 1

Name the drugs approved to treat ADHD

Answer 1

amphetamines
atomoxetine
clonidine
dexmethylphenidate
guanfacine
haloperidol
methylphenidate

Question 2

drug whose safety and efficacy is not established for children under 6 years old

Answer 2

Atomoxetine

Question 3

4 phases of stimulant prescription for ADHD

Answer 3

counselling
titration
maintainence
potential termination

Question 4

drug serum levels and adequacy of response

Answer 4

not correlated

Question 5

how do you deal with side effects of stimulants

Answer 5

reduce dose
timing alterations
adjunctive therapy such as an alpha 2 agonist

Question 6

side effects of stimulants

Answer 6

appetite suppression
delayed sleep onset
wearing off phenomenon
tics
depression
social withdrawl

Question 7

releases dopamine and NE

Answer 7

amphetamines

Question 8

selective NE reuptake inhibitor

*works centrally and in the periphery

Answer 8

atomoxetine

Question 9

blocks reuptake of Dopa and NE

Answer 9

dexmethylphenidate

methylphenidate (ritalin)

Question 10

regulates NE release from the Locus Ceruleus

*alpha 2 agonist

Answer 10

clinidine

catapres

Question 11

in animals it imporves prefrontal cortical function through post-synaptic alpha 2 receptor agonist effects i the pre-frontal cortex

Answer 11

guanfacine

Question 12

blocks post synaptic D2 (inhibitory) receptor and in soi doing increases cAMP

Answer 12

Haloperidol-a typical antipsychotic

Question 13

type of agent needed for initial treatment in small children <16 kg

Answer 13

short acting amphetamines

Question 14

disadvantage of short acting amphetamines

Answer 14

bid-tid dosing to control symptoms throughout the day

Question 15

advantage of the longer acting amphetamines

Answer 15

more convenient dosing, more confidential methodology,–> leads to greater adherence

Question 16

disadvantage of longer actingv amphetamines

Answer 16

greater problems with evening appetite and sleep

Question 17

acid-base state of the urine that promotes REUPTAKE IN RENAL TUBULES

Answer 17

alkaline-thus these drugs are weak bases that do NOT get trapped in alkaline urine

Question 18

DDI with acetazolamide and Na-bicarbonate when patient is taking amphetamines

Answer 18

alkaline urine favors reuptake in the tubules-> thus a high urine pH will lead to persistence of drug in the body and increased serum drug levels

Question 19

DDI with ammonium chloride when patient is taking amphetamines

Answer 19

acidic urine favors excretion–> greater elimination-> lower plasma drug levels

Question 20

DDI with chlorpramazine and haloperidol (typical antipsychotics) when patient is taking amphetamines

Answer 20

dopamine D2 blockers-> will diminish the effects of amphetamines

Question 21

DDI with dextromethorphan when patient is taking amphetamines

Answer 21

hallucinogenic, impaired judgement, erratic euphoria

Question 22

DDI with digoxin when patient is taking amphetamines

Answer 22

pro-arryhtmogenic properties of Digoxin are amplified

Question 23

DDI with MAOi’s when patient is taking amphetamines

Answer 23

increase serum drug levels and toxicity-because the endogenous eznyme that breaks down the NT that amphetamines release (NA and DOpa) is inhibited-> will increase serum plasma levels

Question 24

DDI with drugs that induce/inhibit CYP2D6 when patient is taking amphetamines

Answer 24

increase or decrease serum drug levels

Question 25

strong inhibitors of CYP2D6 that increase amphetamine and dextroamphetamine level in the blood

Answer 25

buproprion, SSRI's, quinidine, ritonavir

Question 26

strong inducers of CYP2D6 thus decreasing amphetamine levels in the blood

Answer 26

dexamethasone and rifampin

Question 27

adverse effects of amphetamines

Answer 27

abdominal pain, headache, insomnia, loss of appetite anxiety emotional lability, nervousness, tahcycardia, weight loss

Question 28

DDI with albuterol when patient is taking atomoxetine or methylphenidate

Answer 28

accentuates CV adverse effects

Question 29

DDI with epinephrine when patient is taking atomoxetine

Answer 29

further increase in BP

Question 30

DDI with MAOi (A+M) when patient is taking atomoxetine

Answer 30

increases toxicity, allow 2 week interval between drugs

Question 31

DDI with ETOH when patient is taking methylphenidate

Answer 31

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

Question 32

DDI with phenytoin when patient is taking methylphenidate

Answer 32

incrased blood levels of phenytoin in some patients

Question 33

DDI with ergotamine/pseudoephedrine when patient is taking methylphenidate

Answer 33

exacerbates pressor agent effect on BP

Question 34

DDI with CYP2D6 when patient is taking atomoxetine or methylphenidate

Answer 34

increase and decreased serum drug levels

Question 35

adverse effects of atomoxetine

Answer 35

``` dry mouth headache abdominal pain decreased apetitite cough somnolence vomiting insominia ```

Question 36

ade of methylphenidate

Answer 36

``` headache insomnia decreased appetite N/V abdominal pain ```

Question 37

absolute contraindications for stimulant use

Answer 37

concurrent MAOi psychosis glaucoma-dont want mydriasis underlying cardiac conditions famhx of early arrythmic death hx of structural abnormalities,palpations, CP, SOB ro syncope liver dz stimulant drug dependence hx

Question 38

most common comorbid condition encountered in people with tics and tourrettes

Answer 38

ADHD

Question 39

first choice to significantly improve tics and tourrettes

Answer 39

alpha 2 agonist-clonidien

Question 40

second choice for tic and adhd

Answer 40

stimulants have rapid actvivity against ADHD but noa ctivity against tics

Question 41

3rd choice for tics and ADHD

Answer 41

methylphenidate and alpha 2 agonist

Question 42

atipsychotics and tics

Answer 42

better than lpha 2 but with more side effects if they solely have tics-use an antipsychotic if they have tics and adhd-an antipsychotic agent wont reduce tics in patients with adhd

Question 43

high potential for hepatically mediated drug interactions

Answer 43

haloperidol

Question 44

DDI with cyclosporin and clonidine

Answer 44

increase serum levels of interactant

Question 45

DDI with buproprion and guanfacine

Answer 45

grand mall seizures

Question 46

cyp interactions with guanfacine and clonidine

Answer 46

none

Question 47

haloperidol metabolized by

Answer 47

glucuronidation cyp3a4 cyp2d6

Question 48

haloperidol-typical antipsychotic-potent-has increased risk of

Answer 48

qt prolongation

Question 49

overdose on adhd primarily neuro and CV effects-> but secondary complicaitons3 can involve

Answer 49

renal muscle pulmonary and gi mydriasis, tremor, agitaiton, hyperreflexia, combaitve behavior, confusion, hallucinations, delerium, anxiety, paranoia, movement, disorders, seizures

Question 50

buprpprion plus clonidien

Answer 50

grand mal seizures

Question 51

stimulant with milder toxicity

Answer 51

atomoxetine-but can cause seizures too

Question 52

overdose on clonidine

Answer 52

pradoxical hypertension, but eventuall and normally hypotension

Question 53

treat clonidine induced hypertenison with

Answer 53

nitroprusside

Question 54

treat clonidine induced hypotension with

Answer 54

atropine, dopamine, (pressors)

Question 55

intoxication causes mixed picture of central and peripheral effects

Answer 55

guanfacin

Question 56

drowsiness, lethargy dry mouth and diaphoresis maybe hypotensions or HTN

Answer 56

guanifacien supportive therapy focusing on blood pressuer