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CNS Disorders
ADHD
| Definition/Description | Term |
|---|---|
| ____________ DA & NE levels contributes to developing ADHD | ↓extracellular |
| Dysfunction of brain reward system drives engagement in activities to increase DA | Reward Deficiency Syndrome |
| Adverse effects: abuse potential (CV box warning), hypertension, tachycardia, serotonin syndrome (w/ other serotonergic agents), insomnia, headache, reduced appetite, weight loss | Methylphenidates |
| BLOCKADE or __________ of DAT and NET reuptake transporters | reversal |
| ↑extracellular DA and NE levels | Amphetamine & Methylphenidate |
| selective NET inhibitor for NE transporter | Atomoxetine |
| Adverse effects: *suicidal ideation, cardiovascular, psychosis, aggression, N/V, abdominal pain, hepatotoxicity, priapism | Atomoxetine |
| NET inhibitor; SNMA | Viloxazine |
| 5HT/NE modulating agent, ↑NT in PFC | SNMA |
| NON-SELECTIVE agonist at postsynaptic ⍺2A-adrenergic receptors in PFC | Clonidine (ER) |
| Adverse effects: Drowsiness, headache, dizziness, rash, dry mouth, upper abdominal pain | Clonidine (ER) |
| MOA: SELECTIVEE agonist at postsynaptic α2A-adrenergic receptors | Guanfacine (ER) |
| α2A subtype concentrated in PFC | Guanfacine (ER) |
| Adverse effects: Drowsiness, headache, fatigue, insomnia decreased appetite, abdominal pain | Guanfacine (ER) |
| Hyperactive DAT/NET function or expression | Dopamine & Norepinephrine deficit |
| Sub-sensitive postsynaptic receptor (decreased post synaptic signaling) | Dopamine & Norepinephrine deficit |
| Divide dose, give with food, give analgesic | Headache |
| Longer-acting stimulant trial, atomoxetine, antidepressant | Rebound Symptoms |
| Assess for co-morbid condition, reduce dose, consider mood stabilizer or atypical antipsychotic | Irritability, Jitteriness |
| Monitor pulse and blood pressure during initiation of treatment and periods | Chronotropic and pressor effects |
| 6 BPM and 5 mmHg on average | Chronotropic and pressor effects |
| High-calorie meal when stimulant effects are low (breakfast, dinner) | Reduced Appetite/Weight Loss |
| Give on full stomach, lower dose if possible | GI |
| Dose earlier in day, lower last dose of day or give earlier, consider sedating med at bedtime | Insomnia |
| preferred for patients weighing < 16 kg due to limited low-dose availability of long-acting stimulants | IR |
| dosage forms should be given at least twice daily | IR |
| Late afternoon symptoms may require | Use longer-acting formulation |
| Avoid giving dose too late in morning, may give an after-school immediate release dose | controlled release |
| Child with inattentive type may need medication | only on school days |
| Child with peer relationship difficulties may need medication | daily |
| Child who participates in after-school activities may require | XR formulations/more frequent dosing |
| atomoxetine dose for children/adolescents up to 70 kg | 0.5 mg/kg, increased after a minimum of 3 days to a target total daily dose of approximately 1.2 mg/kg QD or BID. |
| atomoxetine contraindicated in | liver dysfunction (BBW for hepatotoxicity) |
| atomoxetine | Selective norepinephrine reuptake inhibitor |
| Don't smoke, strong CYP1A2 inhibitor | viloxazine |
| Selective norepinephrine reuptake inhibitor, some serotonin increases | viloxazine |
Created by:
CaristW