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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.
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Attention Deficit Hyperactivity Disorder (ADHD)
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______ _____ include effects in cognitive, academic, behavioral, emotional and social functioning.
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ADHD symptoms
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Stimulants are a ____ ___ drug that have short, intermediate, and long acting effects.
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schedule II
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Atomextine is not a ______ _____.
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controlled substance
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_____ _____ are used when stimulants or atomextine are ineffective.
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A2 agonists
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______ are used when other meds are ineffective or if there are comorbid conditions.
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antidepressants
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______ are first line drugs for school aged children (>6 y/0) and adolescents with uncomplicated ADHD.
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stimulants
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Adderall, vyvanse, dexedrine, procentra, and zenzedi are _______ stimulants.
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amphetiamines
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_______ _______ are methylphenidate stimulants.
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concerta and ritalin
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______ is an atomexetine drug used to treat ADHD.
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strattera
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______ _______ are alpha 2 adrenergic agonists.
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guafacine and clonidine
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______ _____ ____ have an onset and duration that is dependent on formulation.
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long acting methylphenidate
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______ ______ ____ effects are seen in 20-60 min, 3-5 hour duration, and available in multiple formulations (tabs, chew, liquids).
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short acting methylphenidate
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Sustained release methylphenidate tablets last ___ ___.
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8 hours
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Sustained released methylphenidate capsules last ___ ___.
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9 hours
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_____ ____ methylphenidate tablets last 12hours and can be placed on food.
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osmotic release
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_____ ____ methylphenidate lasts 12 hours
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oral suspension
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Methylphenidate patch lasts approximately ____ ___, effects seen 2-3 hours post patch removal.
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12 hours
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______ acting amphetamines are capsules with an onset of 20-60 min and a duration of up to 10 hours.
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long
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______ acting amphetamines are mixed salt formulations that have an onset of 20-60 min and a duration of up to 6 hours.
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intermediate
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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.
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amphetamines MOA
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Dextroamphethamine-amphetamine is a ____ ___ amphetamine.
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mixed salt
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_______ single salt amphetamine.
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dextroamphetamine
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_______ are prescribed as a single salt or as a mixed salt.
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amphetamines
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Pharmacologically active post ingestion, lisdexamfetamine is designed to _____ ____.
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discourage misuse
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________ is a pro drug of dextroamphetamine.
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lisdexamfetamine
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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
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______ is the transfer of medication from the patient for whom it was prescribed to anyone else.
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Diversion
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Combining stimulants with illicit drugs or alcohol and taking higher doses than prescribed to achieve euphoria are signs of _____.
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misuse
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*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:
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Max response of atomextine may take up to ___ ____.
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4 weeks
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Atomextine is dosed based on the _____ _____.
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patient weight
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______ ______ for atomextine include duration of 10-12 hours, 1-2 weeks for initial response, must be taken daily.
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administration guidelines
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Atomextine is metabolized by _______.
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CYP2D6
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_____ ____ of atomextine have fewer side effects, and better initiation.
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evening doses
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Once a day dosing of atomextine should be in the ______.
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morning
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Atomextine is an alternative to stimulants for children and adolescents who exhibit ____ ___ problems (pt/family) or ____ ____ ___.
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substance abuse, severe side effects
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______ blocks the reuptake of norepinephrine.
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atomextine
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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
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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
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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
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Headache, fatigue, abdominal pain, and sedation
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Alpha 2 adrenergic agonists Adverse Effects
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Bupropion, a dopamine reuptake inhibitor, used as off label treatment has shown modest efficacy in decreasing ______ ______.
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hyperactivity and aggressiveness
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Tricyclic antidepressants work through inhibition of ________ _______ reuptake.
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norepinephrine and serotonin
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Tricyclics are associated with adverse _________ ________.
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cardiovascular and anticholinergic
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Imipramine and notriptyline are ______ antidepressants used as off-label treatment of ADHD.
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tricyclic
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Irritability, anorexia, insomnia, and motor tics
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Antidepressant adverse effects
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________ induces serious dermatologic and psychological problems.
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modafinil
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Donepzil, nicotinic analogues, modafinil are ____ _____ and are absolutely never used with children.
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investigational drugs
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_______ _____ are common in untreated adult ADHD.
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sleep disturbances
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______ ______ functions may improve in adults taking methylphenidate.
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cognitive functions
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Stimulants for ADHD are ____ ____ in adults than in children.
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less effective
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Because of _____ ____, a trial of non-stimulant is 1st line treatment.
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abuse potential
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Stimulants are a mainstay of _____ ___ ___.
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adult ADHD treatment
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Atomoxetine poses ___ ___ __ ___ in adults.
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no risk of suicide
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________ is the first medication approved for treatment of adult ADHD.
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atomoxetine
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_______ _______ are antidepressants used as off label treatment of adult ADHD, very limited data on efficacy.
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bupropion and TCAs
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_____ can be given to prevent sleep disturbances in children receiving stimulant therapy.
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Melatonin
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