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Drugs for ADHD
Question | Answer |
---|---|
This is a disorder that manifests in early childhood with symptoms of hyepractivity, impulsivity, and/or inattention. symptoms can be cognitive, academic, behavioral, emotional, social funcitoning | ADHD |
what is the first line DOC CLASS for school aged children (<6 years old ) and adolescents with uncomplicated ADHD | stimulants |
what schedule class do stimulants fall under? | schedule II |
schedule II stimulants can have what types of duration for drugs? | short, intermediate, and long acting |
is the exact MOA for stimulants in treatment of ADHD known? | no |
describe the different options for drugs for ADND | atomoxetine, alpha 2 adrenergic agonists, antidepressants, investigational |
this is not a controlled substance, and is not scheduled | Atomoxetine |
list the specific drugs that can be used to treat ADHD | methylphenidate, amphetamines,atomoxetine, guafacine, clonidine |
this drug has multiple lengths of action. can come in short acting, or long acting, and different formulations. | methylphenidate |
with short acting methylphenidate, how long does it take for effects to be seen, and what is the duration | 20-60 mins, duration is 3-5 hours. |
list the different forms of long acting amphetamines which are available | single pulse wax matrix sustained release, sustained release capsules, osmotic release tablets, oral suspension, patch |
these drugs are prescribed as a single salt (dextroamephetamine or a mixed salt (dextroamphethamine-amphetamine) salts | amphetamine. Also available in intermediate and long cting formulations: (intermediate acting up to six hours, longer acting up to ten hours) |
what is the mechanism of action of amphetamine? | blocks VMAT |
what is the mechanism of action of amphetamine? | blocks NET, reverses NET, blocks VMAT, reverses VMAT |
what is the frequency of adverse drug reactions comparing emphetamines and methylphenidate? | frequency is similar for both |
which has a greater decrease in weight over time, methylphenidate or mixed salt amphetamines | mixed salt amphetamines |
adverse drug reactions occur more frequently in pre-school children or older children? | pre-school children |
list some adverse effects of amphetamines | anorexia, weight loss, poor growth, slep disturbance, jitteriness, social withdrawal, development of tics, maybe CV effects. |
stimulants are black boxed for what? | abuse potential and drug dependence |
what are some contraindications to stimulants? | symptomatic CV disease, moderate to severe HTN, hyperthyroidism, known hypersensitivity or idiosyncrasy to sympathomimetic amines, motor tics and tourette syndrome, glaucoma, agitated states ,anxiety, history of drug abuse, concurrentusew/i2wks of MAOI |
what is the mechanism of action of atomoxetine | blocks the reuptake of NE |
when is atomoxetine used? | alternative to stimulants for children and adolescents when: substance abuse problems (patient or family) or severe side effects. |
what is the duration of action of atomexetine? | 10-12 hrs |
how long does it take for atomoxetine for initial response to occur? | 1-2 weeks, up to four weeks for maximal response. must be taken daily, no drug holidays |
dose of atomoxetine depends on what? | Patient weight |
atomoxetine metabolized by what CYP enzyme? | CYP2D6 |
list some adverse drug reactions for atomoxetine | weight loss, decreased appetitie, N/V, abdominal pain, dyspepsia, headache, dizziness, somnolence, irritability, CV?, tics, liver disease? |
atomexatine is black boxed for what? | suicidal thinking |
list some contraindications to atomexetine | hypersensitivity to atomexatine or any component, concurrent use/or within 2 weeks of MAOIs, glaucoma, current/past hisotry of pheochromocytoma, severe CV disorders that elevate blood pressure or HR |
extended release clonidine or extended release guanfacine are part of what drug class? | alpha 2 adrenergic agonist |
alpha 2 adrenergic agonists are reserved for use in which population? | children/adolescents who respond poorly, have unaccpetable side effects or comorbid conditions that preclude the use of stimulant or atomoxetine. may take up to 2 weeks for initial response. |
this type of clonidine formulation may be used as stimulant adjunct therapy for over-aroused, easily frustrated, highly active, or aggressive individuals. | clinidine Extended release |
what are some side effects for clonidine extended release? | sedation, depression, bradycardia, headache, and possible hypotesion |
what are some side effects of ER clonidine | sedation, depression, bradycardia, headache, and possible hypotension |
extended release guafacine can be used for what? | ADHD or adjunct for stimulation therapy. (once daily dosing) |
what are some adverse effects of alpha 2 adrenergic agonists? | headache, fatigue, abdominal pain, and sedation |
alpha 2 adrenergic agonists improve what conditions? | ADHD and comorbid tics |
what is an off label antidepressant that can be used for ADHD? | dopamine reuptake inhibitors (buproprion) |
how does buproprion work? | blocks the reuptake of NE and Dopamine. modest efficacy in decreasing hyperactivity and aggressive behavior. a |
what are some adverse effects of buproprion | irritability, anorexia, insomnia, motor tics |
what is another off label drug for ADHD | tricyclic antidepressants: inhibits reuptake of NE and seratonin, associated with adverse CV effects and anticholinergic effects |
what are the drugs for investivational treatment of ADHD | donepezil, nicotinic analogues, modafanil (while useful compared to placebo, induces serious dermatologic (s-J) and psychological hallucinations. |
modafinil is never used in what population? | children |
what is the ADHD treatment drug of choice for adults? | stimulants are mainstay, but abuse potential encourages the trial of a non-stimulant first. |
stimulants are more effective in adults or children? | children |
cognitive functions may imnprove in adults taking this drug regardless of ADHD diagnosis | methylphenidate |
what is an adverse drug reaction of stimulants in adults? | sleep disturbances (delayed onset of sleep)-common in ADHD adults that are untreated. there can also be sudden unexplained death/CV concerns |
what is the first medication approved for adults that has no risk of suicide for adults? | atomoxetine |
this drug class has limited data for use in adults with ADHD | antidepressants (buproprion and TCAs)but they have off label use |