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Pharm for ADHD
From ANCC Review
| Question | Answer |
|---|---|
| For management of ADHD - Inattentiveness, Impulsivity, Hyperactivity, recommend | medication management + behavioral treatment |
| First line for ADHD | stimulants |
| stimulants do this | make more DA and or NE avilable |
| second line for ADHD | antidepressants |
| antidepressants do this | make more 5HT, DA, NE available |
| which antidepressant is used for ADHD | strattera also buproprion, venlafaxine |
| third line for ADHD | antihypertensives - alpha 2 agonists |
| these are alpha 2 agonists | clonidine or guanfacine |
| when would an alpha 2 agonist be the first line choice | with ADHD + Tics |
| how do you know what release dosage to give a pt | tailor to individual |
| immediate release compounds last | 2-4 hours |
| older sustained release compounds last | 4 hours |
| newer sustained release offer | longer coverage |
| duration of concerta | 12 hrs |
| duration of metadate CD | 8 hr |
| duration of ritalin LA | 8-12 hr duration |
| duration of adderall XR | up to 9 hr duration |
| duration of dexedrine spansule | 6-9 hr duration |
| monitor these with stimulants | BP, weight, height, periodic CBC, platelets and liver function may consider drug holidays during summer months to allow catch up from growth suppression. |
| educate parents to do this with stimulants | monitor height and weight give with or right after meals to minimize appetite suppresion |
| short acting stimulants can cause this | rebound hyperactivity |
| psychostimulants can | increase motor or phonic tics or stereotypic behavior |
| before starting a stimulant, evaluate | hx of cardiac problems (LVH, syncope) family history of sudden death EKG before starting |
| LVH is | left ventricular hypertrophy |
| psychostimulants can improve these three things but not this | inattention, hyperactivity and impulsiveness not interpersonal relationships |
| atomoxetine (Strattera) dosage | 0.5-1.2mg/kg/day |
| strattera falls under this class | norepinephrine reuptake inhibitor |
| buproprion dosing for ADHD | SR 3-6mg/kg/day useful in comorbid depression, but may exacerbate tics |
| dosage for adolescents | follow adult pattern |
| max dose for children using buproprion | 300mg/day |
| venlafaxine xr dosing for adhd | 1-3mg/kg/day useful in comorbid anxiety and depression |
| antihypertensives for adhd | clonidine and guanfacine |
| monitor this with antihypertensives | BP |
| antihypertensives can be effective with | ADHD plus tics, hyperactivity, impulsiveness and aggression |
| side effects of antihypertensives | sedation, headaches, depression and potentially rebound hypertension |
| clonidine dosing | 0.0003-0.1mg/kg/day |
| guanfacine dosing | 0.015-0.05 mg/kg/day |
| options for med management of aggressive behavior | antipsychotics, anticonvulsants antidepressants, lithium, benzos, propranolol |
Created by:
jonquil
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