Which two neurotransmitters are involved in ADHD?
Dopamine and norepinephrine
Symptoms must have occurred before:
Age 12
and occur in >/= settings
Diagnosis of ADHD in children
>/= 6 symptoms of inattention and or
>/= 6 symptoms of hyperactivity-impulsivity
Diagnosis of ADHD in adults (17 and older)
>/= 5 symptoms of inattention and or
>/= 5 symptoms of hyperactivity-impulsivity
Two symptom domains of ADHD
Hyperactivity/impulsivity
Inattention
Treatment goal in ADHD
Reduction in the core symptoms of
- Inattention
- Impulsivity
- Hyperactivity
When is atomoxetine used in ADHD
If no efficacy to stimulant
When are alpha1-adrenergic agonist used in ADHD?
1. Partial efficacy to stimulant
2. No efficacy to stimulant
Non-pharm therapy:
1. Behavioral parent training
2. School-focused intervention
Stimulants have to be tapered off?
False
CI to stimulants: (eight)
1. Moderate/sever HTN
2. Advancer arteriosclerosis
3. Heart failure
4. Arrhythmia
5. Hyperthyroidism
6. Glaucoma
7. MAOI use within 14 days
8. HX of drug abuse
Which two agents are FDA approved for children </= 3 yo
Mixed amphetamine salts IR
Dextroamphetamine IR
Initiation of methylphenidate should be with LA?
False
start with short acting to determine proper dose
then once on a stable dose can switch to LA form
When should stimulants be taken?
Before school and at lunch
Brand names of methylphenidate:
Ritalin
Concerta
Metadate
Quillivant XR
Daytrana
Brand name of dexmethylphenidate:
Focalin
Focalin is a less active and potent enantiomer of methylphenidate?
False
more active and potent
Aztarys is a long-acting stimulant?
true
Focalin is a long acting stimulant?
False
Which stimulant requires renal adjustment?
Vyvanse (brand name only)
Vyvanse is a long acting stimulant?
True
What are the BBW associated with all stimulants?
- HIGH POTENTIAL FOR ABUSE AND DEPENDENCE
- INCREASED RISK OF CV EVENTS
Which 2 alpha-2-adrenergic agonist are used for ADHD
- Clonidine ER
- Guanfacine ER
Which A2A targets postsynaptic A2A stimulation?
- Clonidine ER
What is the BBW associated with Clonidine ER
Hemodynamic instability with epidural use
What is the BBW associated with the norepinephrine Reuptake inhibitors:
suicidal ideation
When should norepinephrine Reuptake inhibitors be used?
When stimulants are:
- Contraindicated
- Side effects are intolerable
- Co-occurring substance use disorder (SUD)
- Anxiety disorder
- Tic disorder
CI of Strattera (atomoxetine)
- MAOI use in the last 14 days
- Narrow angle glaucoma
- Severe cardiac disorders
CI of Qelbree (viloxazine)
- MAOI use in the last 14 days
- CYP1A2 substrate drugs
Which agent can leave a ghost tablet in stool?
Methylphenidate OROS (Focalin)
How many weeks after initiation of a stimulant should a patient follow-up with their doctor?
2-3 weeks