Term
What is first line for ADHD ?
Name the 4 drugs considered first line
What period of no response warrants trial of a new drug ? |
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Definition
Psychostimulants are first line for ADHD
The 4 first line psychostimulants: Dextroamphetamine, lisdexamfetamine, & mixed salt amphetamines.
3-4 weeks of no response warrants switching to an alternate stimulant |
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Term
Which stimulants are long acting formulations (include brand names)?
What is the benefit of long acting stimulants ?
How are SR stimulants regularly dosed?
Which drugs are SR stimulants?
When should a drug holiday be taken? |
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Definition
long acting Methylphenidate (Adderall XR, Biphentin, Concerta) & Lisdexamfetamine (Vyvanse) are long acting formulations
Long acting only require once daily dosing
SR are usually dosed more than once per day.
Methylphenidate SR (Ritalin SR), and dextroamphetamine (dexedrine) are sustained release
Drug holidays should be taken when weight is reduced by 10% of initial weight |
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Term
| What concern is there about using stimulants and atomoxetine in patients with underlying cardian anomilies ? |
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Definition
| Cardiac events can occur such as sudden cardiac death. |
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Term
Atomoxetine
Is it a stimulant ?
Is it approved for ADHD ?
Is it a controlled substance ?
What is the minimum age requirement for use?
Efficacy comprable to psychostimulants?
Who is a good candidate for therapy with atomoxetine ? |
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Definition
Atomoxetine
It is NOT a stimulant
It IS approved for ADHD
It is NOT a controlled substance
Atomoxetine should be used in anyone 6 or older
Efficacy IS comparable to psychostimulants
Those with ADHD, and are unresponsive to stimulants, or those who have substance abuse, or depression. |
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Term
Antidepressants
Are they as effective as stimulants?
What comorbid conditions would make a patient a good candidate for therapy with antidepressants for ADHD ?
What 'line' is bupropion ?
When should TCAs be used ? |
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Definition
Antidepressants
NOT as effective as stimulants
Comorbid conditions such as depression, tic disorders, anxiety or enuresis
Bupropion is 2nd line to stimulants, along with atomoxetine
TCAs can be used when stimulants, bupropion and atomoxetine have failed or are contraindicated. |
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Term
Clonidine
When should it be used?
What does it primarily do? what does it NOT do for ADHD pts? |
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Definition
Clonidine
2nd or 3rd line
Reduces symptoms of aggression and hyperactivity, but does NOT improve attention span |
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Term
SGAs
When should they be used?
What does it primarily do? what does it NOT do for ADHD pts? |
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Definition
2nd or 3rd line
Reduces symptoms of aggression and hyperactivity, but does NOT improve attention span actually can WORSEN attention |
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Term
| What drugs CAN be used for ADHD ? |
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Definition
ADHD drugs
Stimulants, Antidepressants, clonidine, SGAs |
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Term
Stimulants
Side effects (common, transient, significant)
Drug interactions
Counseling points |
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Definition
Stimulants
Side effects
COMMON: Anorexia, insomnia, irritability, HA, abdominal pain
TRANSIENT: zombie like effects, agitation, growth failure, rebound hyperactivity, leukopenia
SIGNIFICANT: Cardiac death, seizures, exacerbation of tics, hyperthyroidism
OVERDOSE: Glassy eyes, insomnia, hyperactivity
Drug interactions
MAOIs, P450 inhibitor and subtrate
Counseling points: no later dose than 4pm to avoid insomnia. |
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Term
Atomoxetine
Adverse events
Drug interactions |
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Definition
Atomoxetine
Adverse events: HA, insomnia, abdominal pain, decreased of decreased appetite vs stimulants,
SIGNIFICANT: suicide ideation, liver toxicity, sudden cardiac death
Drug interactions
Metabolized by 2D6 |
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Term
Bupropion
Side effects
Drug Interactions |
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Definition
Bupropion
Side effects - similar to those of stimulants, anticholinergic effects, increased risk of seizure AVOID in patients with seizure disorders
Interactions
2D6, 3A4
Avoid use with MAOIs |
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Term
Clonidine
Adverse effects
Interactions |
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Definition
Clonidine
Adverse effects:
HoTN, sedation, worsen depression, dry mouth
Interactions:
AVOID CNS depressants & TCAs |
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Term
| What medications are used to treat ADHD or some of its symptoms ? |
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Definition
Meds that can be used for ADHD
stimulants, atomoxetine, bupropion, TCAs, Clonidine, SGAs |
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