Week 1 Flashcards
ADHD Medications/Psychomotor stimulants (18 cards)
What is the MOA of Methylphenidate and Dexmethylphenidate?
Increase DA concentration by inhibiting reuptake
What is the clinical use of Methylphenidate and Dexmethylphenidate?
ADHD
Variety of routes of administration: oral suspension, chewable pill, oral solution, patch, sprinkle
Variety of duration
What are the side effects of Methylphenidate and Dexmethylphenidate?
Appetite suppression, insomnia, headaches
Black Box Warning: misuse can cause sudden death or serious cardiovascular adverse events
EKG prior to treatment if personal history of arrhythmia or family history of sudden unexplained death
What is the MOA of Amphetamine, Amphetamine-Dextroamphentamine Mixed Salts, Dextroamphetamine, and Lisdexamfetamine?
Increase DA release through VMAT inhibition (interfering with repackaging of DA into vesicles)
What is the clinical use of Amphetamine, Amphetamine-Dextroamphentamine Mixed Salts (Adderall), Dextroamphetamine, and Lisdexamfetamine?
ADHD
Variety of routes and durations
What are the side effects of Amphetamine, Amphetamine-Dextroamphentamine Mixed Salts, Dextroamphetamine, and Lisdexamfetamine?
Appetite suppression, insomnia, headaches
Black Box Warning: misuse can cause sudden death or serious cardiovascular adverse events
EKG prior to treatment if personal history of arrhythmia or family history of sudden unexplained death
Which brand of Amphetamine-Dextroamphentamine Mixed Salts has a higher risk of insomnia because of long duration and is not for kids under 12 due to side effects?
Mydayis
Which brand of Lisdexamfetamine is the prodrug of dextroamphetamine, has less abuse risk, and can also be used for binge-eating disorders?
Vyvanse
Which 2 non-stimulant ADHD medications are norepinephrine reuptake inhibitors?
Atomoxetine (PO/24hrs)
Viloxazine (PO/24hrs)
What are the side effects of Atomoxetine and Viloxazine?
Appetite suppression, insomnia, headaches, depression/irritability
Black Box Warning: suicidal thoughts in youth up to age 25
Atomoxetine can cause hepatotoxicity.
Which 2 non-stimulant ADHD medications are alpha-2 adrenergic agonists?
Clonidine and Guanfacine
Besides ADHD, what can Clonidine and Guanfacine be clinically used for?
Can be used for acute agitation in delirium
Clonidine: tends to be more sedating; FDA-approved for HTN in adults; used as adjunct in ADHD and anxiety
Clonidine ER: should be tapered off; FDA-approved for ADHD monotherapy or adjunct
Guafacine: tends to be less sedating than clonidine; used as adjunct in ADHD
Guafacine ER: should be tapered off; FDA-approved for ADHD mono therapy or adjunct
What are the side effects of Clonidine and Guanfacine?
sedation, hypotension, dizziness
What are first line medications for ADHD?
Stimulants are first line and have best evidence base for efficacy.
What do you do if one stimulant class doesn’t work?
Try a different class
How do you manage dosing for ADHD medication?
Aim for least frequent dosing possible (once/day) with extended-release agents, can fine-tune based on half-life
Can use immediate-release, short-acting agents to extend effect if needed.
Stimulants can be started and stopped without tapering.
*not true for clonidine and guanfacine Extended Release (ER)
Which two drugs are the only FDA-approved for ADHD monotherapy?
Clonidine and Guanfacine Extended Release (ER)
What is the FDA Black Box Warning for all psychomotor stimulants?
All psychomotor stimulants should be given cautiously to patients with history of drug dependence or alcohol use disorder.
Chronic abusive use can lead to marked tolerance and psychological dependence, with varying degrees of abnormal behavior.
