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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 |