ADHD Therapeutics (Dr. Castro) flashcards |

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The AAP considers ADHD a _____ disease, and this by definition has _____.

No cure
(requires ongoing management)

Besides medications, it is important for patients with ADHD to undergo _______.

Behavioral interventions

ADHD is characterized by the DSM-V with 2 main things.

1. Inattention
2. Hyperactivity and impulsivity

How many symptoms of inattention are needed for a diagnosis?

6+ for at least 6 months
MUST have negative impact on activites

How many symptoms of hyperactivity/impulsivity are needed for a diagnosis?

6+ for at least 6 months
MUST negatively impact social/ other activities

What class are ADHD medication?

Class II

When considering ADHD it is important to rule out _____.


First degree relatives of an individual with ADHD are _____ times more likely to have ADHD.


What are the 3 types of ADHD?

1. Combined type
2. Hyperactive/Impulsive
3. Predominantly inattentive

Onset of symptoms must occur before _____.

7 years of age

Non-pharmacologic therapy for ADHD?

- Educational
- Cognitive
- Behavioral

Diet treatment for ADHD?

- Iron
- Zinc
- Omega 3
- Additive/Preservative- Free diet
- Oligoantigenic elimination diet

2 "classes" of pharmacological therapy for ADHD


Stimulant pharmacological therapy (5 options)

1. Methylphenidate
2. Dexmethylphenidate
3. Adderal
4. Dextroamphetamine
5. Lisdexanfetamine

Non-stimulant pharmacological therapy for ADHD (5 options)

1. Amoxetine
2. Central Alpha-2 Adrenergic agonists
3. Bupropion
4. Venlafaxine
5. TCAs

What pharmacological therapy is considered first line?


Which pharmacological therapy is considered second line?


What is considered the best option for treatment for a patient with ADHD?

Combination of behavioral therapy and pharmacological therapy

The desired outcomes of treatment must be _____.

(e.g. be able to sit an a chair for 20 mins, completes homework assignments)

Parent training and behavioral interventions examples:

Positive rewards for good behavior and structured limit setting are considered first line before meds in ages 3-5

There is a universal belief that avoidance of ____ and ____ improves ADHD symptoms.

Artificial sweeteners

Which mineral supplements are recommended in patient with ADHD?


MOA for methylphenidate and amphetamines?

- Block dopamine and norepinephrine reuptake
- Increase catecholamine release
- Inhibit monoamine oxidase

Stimulants are considered to be ______ over psychotherapy.


Which form of stimulants are the preferred treatment?

Delayed release drugs
(Once-daily formulations are preferred)

Benefits to once-daily stimulant formulations.

- Convenient
- Better medication adherence
- Lower cost
- Less insomnia
- Potentially fewer growth effects

Lisdexamfetamine brand name?


T/F: Lisdexanfetamine is a prodrug?


Lisdexamfetamine advantages?

- Longer time to onset of effectiveness
- May provide a smoother blood level compared with extended-release formulations
- It is intended to pose less abuse potential

Psych. adverse effects of stimulants.

Aggression or violent behavior
Severe anxiety/panic attacks
Tactile hallucinations

Cardiac adverse effects of stimulants

Sudden unexplained death has been added to ADHD stimulant drug labeling
- Increased heart rate
- Increased BP
- Caution in patients with known cardiac abnormalities
- Consider baseline ECG if history suggests cardiac abnormality

Growth adverse effects of stimulants

- ADHD stimulants can effect growth, but the effects are minimal/insignificant in children
- Amphetamines may be associated with more growth effects than methylphenidate
- Children should be given a drug-free trial every year
- Not considered a contraindication

T/F: Patients who have a history of schizophrenia have a contraindication to stimulant ADHD drugs?


Non-stimulant drug approved for use in ADHD in adults?


Amoxetine brand name?


Amoxetine MOA?


T/F: the therapeutic benefit of amoxetine may not be seen for 6-8 weeks.


Adverse effects of amoxetine?

- GI upset
- Psych/ cardiac side effects
- Warning for severe liver injury
- Fatigue, sedation
- FDA warning for -onset suicidality

Drugs that are central alpha-2 adrenergic agonists (2)

Guanfacine ER (Tenex)
Clonidine ER (Catapres)

Central Alpha-2 adrenergic agonist MOA?

Inhibit NE release presynaptically
Increase blood flow to the PFC postsynaptically

Side effects of guanfacine/ clonidine?

- Dose dependent sedation
- Hypotension
- Constipation

Side effects of IR clonidine?

- Bradycardia
- Syncope
- Rebound hypertension
- Heart block
- Sudden death

Bupropion brand name


Bupropion MOA?

- Weak DA and NE re-uptake inhibitor
- No significant effect on 5-HT or MAO

T/F: Bupropion is FDA approved for the treatment of ADHD?


T/F: Studies showed that patients experienced more side effects with buproprion than with methylphenidate.


TCAs used in the treatment of ADHD?

- Imipramine
- Despiramine
- Nortriptyline

TCAs are considered ____ line treatment for ADHD.


T/F: TCAs have the highest risk of cardiac side effects?


Bupropion adverse effects?

- Nausea
- Rash
- Should not be used in children (or any patient) with seizure disorder or eating disorder
- May exacerbate tics

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