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58 Cards in this Set

  • Front
  • Back
A disorder that manifests itself in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention.
Attention Deficit Hyperactivity Disorder (ADHD)
______ _____ include effects in cognitive, academic, behavioral, emotional and social functioning.
ADHD symptoms
Stimulants are a ____ ___ drug that have short, intermediate, and long acting effects.
schedule II
Atomextine is not a ______ _____.
controlled substance
_____ _____ are used when stimulants or atomextine are ineffective.
A2 agonists
______ are used when other meds are ineffective or if there are comorbid conditions.
antidepressants
______ are first line drugs for school aged children (>6 y/0) and adolescents with uncomplicated ADHD.
stimulants
Adderall, vyvanse, dexedrine, procentra, and zenzedi are _______ stimulants.
amphetiamines
_______ _______ are methylphenidate stimulants.
concerta and ritalin
______ is an atomexetine drug used to treat ADHD.
strattera
______ _______ are alpha 2 adrenergic agonists.
guafacine and clonidine
______ _____ ____ have an onset and duration that is dependent on formulation.
long acting methylphenidate
______ ______ ____ effects are seen in 20-60 min, 3-5 hour duration, and available in multiple formulations (tabs, chew, liquids).
short acting methylphenidate
Sustained release methylphenidate tablets last ___ ___.
8 hours
Sustained released methylphenidate capsules last ___ ___.
9 hours
_____ ____ methylphenidate tablets last 12hours and can be placed on food.
osmotic release
_____ ____ methylphenidate lasts 12 hours
oral suspension
Methylphenidate patch lasts approximately ____ ___, effects seen 2-3 hours post patch removal.
12 hours
______ acting amphetamines are capsules with an onset of 20-60 min and a duration of up to 10 hours.
long
______ acting amphetamines are mixed salt formulations that have an onset of 20-60 min and a duration of up to 6 hours.
intermediate
The drug interacts with VMAT enzymes to enhance release of DA and 5-HT from vesicles. It may also directly cause the reversal of DAT and SERT.
amphetamines MOA
Dextroamphethamine-amphetamine is a ____ ___ amphetamine.
mixed salt
_______ single salt amphetamine.
dextroamphetamine
_______ are prescribed as a single salt or as a mixed salt.
amphetamines
Pharmacologically active post ingestion, lisdexamfetamine is designed to _____ ____.
discourage misuse
________ is a pro drug of dextroamphetamine.
lisdexamfetamine
Frequency effects with amphetamines and methylphenidate.
- *mixed salt amphetamines* greater decrease in weight over time compared to *methylphenidate*
- these occur in pre-school children compared to older children

***Abuse potential and drug dependence***
Anorexia, poor growth, sleep disturbance, jitteriness, Social withdrawal, development of tics, CV
Stimulants' Adverse Reactions
______ is the transfer of medication from the patient for whom it was prescribed to anyone else.
Diversion
Combining stimulants with illicit drugs or alcohol and taking higher doses than prescribed to achieve euphoria are signs of _____.
misuse
*stimulant actions similar to sympathomimetics*
Symptomatic CV disease
Moderate to severe HTN
hyperthyroidism
Known hypersensitivity or idiosyncracy to sympathomimetic amine
Motor tics or tourettes
Agitated States
Anxiety
Hx of drug abuse
Concurrent use within 2 weeks of MAOIs
Stimulants contraindications:
Max response of atomextine may take up to ___ ____.
4 weeks
Atomextine is dosed based on the _____ _____.
patient weight
______ ______ for atomextine include duration of 10-12 hours, 1-2 weeks for initial response, must be taken daily.
administration guidelines
Atomextine is metabolized by _______.
CYP2D6
_____ ____ of atomextine have fewer side effects, and better initiation.
evening doses
Once a day dosing of atomextine should be in the ______.
morning
Atomextine is an alternative to stimulants for children and adolescents who exhibit ____ ___ problems (pt/family) or ____ ____ ___.
substance abuse, severe side effects
______ blocks the reuptake of norepinephrine.
atomextine
Weight lossed, decreased appetite, N/V
Abdominal pain, dyspepsia
Headache, dizziness, somnolence, irritability
CV?
*suicidal thoughts* (moreso in children)
Tics
Liver disease?
Atomoxetine Adverse Effects
Hypersensitivity to atomoxetine or any component
Concurrent use/within two weeks of MAOIs
Glaucoma
Hx of pheochromocytoma
Severe CV disorders that elevate blood pressure or heart rate
Atomoxetine contraindications
Extended release *Clonidine* or extended release *Guanfacine*
- Reserved for children/adolescents who respond poorly, unacceptable side effects of *comorbid conditions* that *preclude the use of stimulants and atomoxteine.* up to two weeks for initial response

Clonidine ER can be used as stimulant adjunct therapy
- may be useful in over-aroused, easily frustrated, highly active, or aggressive individuals
- Side effects: sedation, depression, bradycardia, headache, and possibly hypotension

Extended-release guanfacine can be used for ADHD or adjunct for stimulant therapy - once daily dosing

Alpha 2 adrenergic agonists *improve ADHD symptoms and comorbid tics*
Alpha-2 adrenergics Agonists
Headache, fatigue, abdominal pain, and sedation
Alpha 2 adrenergic agonists Adverse Effects
Bupropion, a dopamine reuptake inhibitor, used as off label treatment has shown modest efficacy in decreasing ______ ______.
hyperactivity and aggressiveness
Tricyclic antidepressants work through inhibition of ________ _______ reuptake.
norepinephrine and serotonin
Tricyclics are associated with adverse _________ ________.
cardiovascular and anticholinergic
Imipramine and notriptyline are ______ antidepressants used as off-label treatment of ADHD.
tricyclic
Irritability, anorexia, insomnia, and motor tics
Antidepressant adverse effects
________ induces serious dermatologic and psychological problems.
modafinil
Donepzil, nicotinic analogues, modafinil are ____ _____ and are absolutely never used with children.
investigational drugs
_______ _____ are common in untreated adult ADHD.
sleep disturbances
______ ______ functions may improve in adults taking methylphenidate.
cognitive functions
Stimulants for ADHD are ____ ____ in adults than in children.
less effective
Because of _____ ____, a trial of non-stimulant is 1st line treatment.
abuse potential
Stimulants are a mainstay of _____ ___ ___.
adult ADHD treatment
Atomoxetine poses ___ ___ __ ___ in adults.
no risk of suicide
________ is the first medication approved for treatment of adult ADHD.
atomoxetine
_______ _______ are antidepressants used as off label treatment of adult ADHD, very limited data on efficacy.
bupropion and TCAs
_____ can be given to prevent sleep disturbances in children receiving stimulant therapy.
Melatonin