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Pharm for ADHD

From ANCC Review

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