Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
70 Cards in this Set
- Front
- Back
|
what are the stimulants for ADHD?
|
amphetamine(short and slow release forms), triple bead mixed amphetamine salts(MAS) XR-extended release, lisdexamfetmaine dimesylate(pro drug), methylphenidate, methylphenidate hydrochloride(transdermal)
|
|
|
what are the non stimulants from ADHD?
|
atomoxetine, bupropion SR, guanfacine XR
|
|
|
what are some of the co-morbidities of ADHD?
|
anxiety, substance abuse, mood disorders
|
|
|
what are the symptoms of ADHD?
|
inattentive symptoms(selective attention, sustained attention, problem solving), hyperactive symptoms, impulsive symptoms
|
|
|
where do the abnormalities in ADHD arise from?
|
VARIOUS PARTS OF PREFRONTAL CORTEX: hyperactive-prefrontal motor cortex and impulsive from orbital frontal cortex
|
|
|
what are the criteria for diagnosis?
|
symptoms must cause impairment, present before age of 7, present in two or more settings, not accounted for by another mental disorder, can coexist with learning disorders, oppositional defiant disorder, conduct disorderm anxietym OCD, PTSD, depression, bipolar, Tics
|
|
|
what area regulates selective attention?
|
dorsal anterior cingulate cortex - make careless mistakes, not listening, losing things, being distracted, forgetting things
|
|
|
what area regulates sustained attention?
|
dorsolateral prefrontal cortex, difficulty sustaining mental effort, disorganization, trouble finishing tasks
|
|
|
what area regulates motor hyperactivity?
|
prefrontal motor cortex, fidgeting, leaving one's seat, running, constantly on the go
|
|
|
what area regulates impulsivity?
|
orbital frontal cortex, linked to nucleus accumbens, links emotions to actions, talks excessively, blurts things out
|
|
|
what are the symptoms of ADHD caused by?
|
result of and compensation for low tonic dopamine and NEPI firing
|
|
|
what order should disorders be treated in?
|
alcohol/stimulant/substance abuse->mood disorders->anxiety->ADHD->nicotine dependence
|
|
|
what stimulants have a consistent efficacy and safety record?
|
methylphenidate and dextroamphetamine, 70-80% children show improved attention
|
|
|
what are the A/E of these drugs?
|
appetite suppression, stomach ache and headache, delayed onset of sleep may be meds or disorder, normal growth
|
|
|
what measurements should be followed while on meds?
|
blood pressure, pulse, height, weight
|
|
|
are there any cardiovascular events common with people on these drugs?
|
no
|
|
|
what are 2 new formulations of ADHD drugs?
|
lisdexamfetamine and methylphenidate delivered in transdermal formulation
|
|
|
how can euphoria be avoided with these drugs?
|
use long acting preps
|
|
|
what should be used with adolescents or adults with history or current substance abuse issues?
|
lisdexamfetamine(can't be injected, snorted, or smoked)
|
|
|
which drug is not approved for adults?
|
methylamphetamine patch
|
|
|
what is atomoxetine?
|
non stimulant, NE reuptake inhibitor, not a controlled substance, rare adverse event of reversible liver injury
|
|
|
what is bupropion?
|
non stimulant, effective in adults and children, not approved
|
|
|
what is guanfacine XR?
|
works like CLONIDINE, agonist at alpha receptors more selective for CNS alpha 2 receptors
|
|
|
what happens to symptoms in adults?
|
prevalence in adults is half that of children, adults are difficult to diagnose
|
|
|
what do slow dose drug stimulants do?
|
increase the NEPI and dopamine tone in prefrontal cortex and nucleus accumbens and change the communication flow
|
|
|
what do fast onset stimulants do?
|
deplete the presynaptic neuron
|
|
|
how do non stimulant drugs work?
|
increase actions of noradrenergic system, no affect on nucleus accumbens
|
|
|
what is the D:L ratio of amphetamine?
|
3:1
|
|
|
what are the brand name amphetamine drugs?
|
adderall and adderall XR(1 day)
|
|
|
what is the drug class of amphetamine?
|
stimulant , schedule 2 drug
|
|
|
what is the MOA of amphetamine?
|
increases dopamine and NEPI tone by blocking their reuptake and facilitating their release
|
|
|
what are the main effects of amphetamine?
|
improve attention, concentration, execution, wakefulness, hyperactivity
|
|
|
what are the A/E of amphetamine?
|
insomnia, headache, exacerbation of tics, nervousness, irritability, overstimulation, decreased appetite
|
|
|
what are some dangerous but rare A/E?
|
psychotic episode, seizures, palpitations, tachycardia, hypertension
|
|
|
what are some precautions/CI of amphetamine??
|
hyperthyroid, hypertension, history of drug abuse
|
|
|
what are some drug interactions of amphetamines?
|
MAO inhibitors(antidepressants) slow absorption rate and potentiate their actions, increase incidence of headache and hypertension
|
|
|
what are the therapeutic applications of amphetamines?
|
approved for ADHD in children and adults
|
|
|
what is the brand name of lisdexamfetamine?
|
vyvanse
|
|
|
what is the drug class of lisdexamfetamine?
|
stimulant, schedule 2
|
|
|
what is the MOA of lisdexamfetamine?
|
once converted to dextroamphetamine it increases dopamine and NEPI tone by blocking their reuptake and facilitating their release
|
|
|
what is the main pharmacological effect of lisdexamfetamine?
|
improve attention, concentration, execution, wakefulness, hyperactivity
|
|
|
what are the pharmacokinetics of lisdexamfetamine?
|
works as prodrug, must be absorbed by intestinal tract and converted to active drug dextroamphetamine, one a day dosing, effects immediate, optimize over several weeks
|
|
|
what are the A/E, C/I, and therapeutic application of lisdexamfetamine?
|
same as amphetamine
|
|
|
what is the brand name of methylphenidate?
|
concerta, ritalin LA, daytrana
|
|
|
what is the drug class of methylphenidate?
|
stimulant schedule 2
|
|
|
what is the MOA of methylphenidate?
|
increases dopamine and NEPI tone by blocking their reuptake and facilitating their release
|
|
|
what are the main effects of methylphenidate?
|
improve attention, concentration, execution, wakefulness, hyperactivity
|
|
|
what are the pharmacokinetics of methylphenidate?
|
improved sustained release formula, concerta works 12 hrs, daytrana transdermal 9 hrs
|
|
|
what are the A/E of methylphenidate?
|
insomnia, headache, exacerbation of tics, nervousness, irritability, overstimulation
|
|
|
what are the therapeutic actions of methylphenidate?
|
approved for ADHD in children and adults, some forms for narcolepsy
|
|
|
is atomoxetine a stimulant or non stimulant?
|
non stimulant
|
|
|
what is the brand name of atomoxetine?
|
strattera
|
|
|
what is the drug class of atomoxetine?
|
selective NEPI reuptake inhibitor
|
|
|
what is the MOA of atomoxetine?
|
boosts NT NEPI and may increase dopamine in prefrontal cortex
|
|
|
what are the main effects of atomoxetine?
|
improve attention, concentration, execution, wakefulness, hyperactivity, can see effects on first day, may continue to improve over 8-12 weeks
|
|
|
what are the pharmacokinetics of atomoxetine?
|
once daily dosing, metabolized by liver, inhibitors increase plasma levels
|
|
|
what are the A/E of atomoxetine?
|
sedation, fatigue(esp children), decreased appetite, rare but life threatening are increase HR and HTN, orthostatic HTN, liver damage
|
|
|
what are the C/Is of atomoxetine?
|
tramadol increased risk of seizures, dont use with MAOI
|
|
|
what are the brand names of bupropion?
|
wellbutrin SR and XL and zyban(SR)
|
|
|
what drug class is bupropion?
|
antidepressant, NEPI dopamine reuptake inhibitor, smoking cessation treatment
|
|
|
what are the main effects of bupropion?
|
boosts NEPI and dopamine, blocks reuptake sites, FDA approved for major depression, seasonal affective disorder and nicotine addiction, found to help ADHD
|
|
|
what are the PK of bupropion?
|
XL formulation would be best for ADHD , inhibits P450
|
|
|
what are the A/Es of bupropion?
|
common are peripheral NEPI effects(dry mouth, constipation, weight loss, anorexia, nausea, Dopamine: insomnia, headache, agitation, anxiety
|
|
|
what is the brand name of gaunfacine XR?
|
intuniv
|
|
|
what is the drug class of gaunfacine XR?
|
centrally acting alpha 2A agonist
|
|
|
what is the MOA of gaunfacine XR?
|
central actions at postsynaptic alpha 2A receptors in the prefrontal cortex
|
|
|
what are the main effects of gaunfacine XR?
|
improves attention, concentration, execution, wakefulness, hyperactivity, not a stimulant, often used when too activated or oppositional, with tics and emotional outbursts
|
|
|
what are the PK of gaunfacine XR?
|
XR, dont crush or chew, phenobarbital or phenytoin may decrease plasma levels
|
|
|
what are the A/Es of gaunfacine?
|
somnolence, headache, fatigue, upper ab pain, sedation, hypotension, dry mouth, constipation
|
|
|
what are the C/Is of gaunfacine?
|
dont put with other sedative drugs, caution with drug inducers and inhibitors
|
