ADHD Therapeutics (Dr. Castro) flashcards |

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

Chronic
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 _____.

Hyperthyroidism

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

4-8

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?

Psychotherapy
- 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

Stimulants
Non-stimulants

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?

Stimulants

Which pharmacological therapy is considered second line?

Non-stimulants

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 _____.

Specific
(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.

Sugar
Artificial sweeteners

Which mineral supplements are recommended in patient with ADHD?

Iron
Zinc

MOA for methylphenidate and amphetamines?

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

Stimulants are considered to be ______ over psychotherapy.

Superior

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?

Vyvanse

T/F: Lisdexanfetamine is a prodrug?

True

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.

Psychosis/Mania
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?

True

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

Amoxetine

Amoxetine brand name?

Strattera

Amoxetine MOA?

SNRI

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

True

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

Wellbutrin

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?

False

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

True

TCAs used in the treatment of ADHD?

- Imipramine
- Despiramine
- Nortriptyline

TCAs are considered ____ line treatment for ADHD.

Last

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

True

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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