Attention Deficit Hyperactivity Disorder

Front 1

Rationale for stimulants in ADHD?

Back 1

To raise dopamine levels

In ADHD it is thought that there is a lack of functioning dopamine receptors or some defect in the dopamine pathway
Research is focused on the catecholamine system - dopamine is catalyzed to the norephinephrine and epinephrine

Front 2

First line treatment:

What option is used next or if the prescriber is concerned about the possibility of abuse?

Back 2

Stimulants

Atomoxetine (Strattera)

Front 3

Which stimulant is typically tried first?

Back 3

Methylphenidate or lisdexamfetamine (Vyvanse) = prodrug of dextroamphetamine

Front 4

What adjunct therapies exist for ADHD?

Back 4

Guanfacine (Intuniv)
Clonidine (Kapvay)
Anti-depressants

Front 5

What natural products are used for ADHD?

Back 5

Fish oils (omega-3 fatty acids) with or without primrose oil (omega-6 fatty acids) - These are rated as possibly effective to improve cognitive function and behavior in children - study used 6 capsules per day
Gingko biloba

Front 6

Methylphenidate Formulations:

Back 6

Methylphenidate IR (Ritalin, Methylin chewable, oral susp)
Methylphenidate long-acting (Ritalin LA)
Methylphenidate sustained release (Ritalin SR)
Methylphenidate extended release (Methylin ER, Metadate ER, Quillivant XR-ext release oral suspension)
Methylphenidate IR - ext rel (Concerta)
Methylphenidate IR ex rel (Metadate CD) - Beads
Methylphenidate transdermal patch (Daytrana)

Front 7

Contraindications to methylphenidate use:

Back 7

MAOI use (current)
Glaucoma
History of tics

Front 8

Adverse effects of methylphenidate:

Back 8

Nausea, loss of appetite, insomnia
Increased blood pressure and heart rate
Exacerbation of mania episodes if bipolar
Withdrawal reactions (titrate down and up)
Seizure risk

Front 9

Where is daytrana applied?

Back 9

To alternating hips 2 hours before desired effect every AM

Front 10

What is focalin?

Back 10

Dexmethylphenidate

same effects as methylphenidate

Front 11

Dextroamphetamine and amphetamine formulations:

Back 11

Dextroamphetamine and amphetamine IR (Adderall)
Dextroamphetamine and amphetamine ER (Adderall XR)
Dextroamphetamine IR (Dexedrine, Dextrostat)

Front 12

What is lisdexamphetamine?

Back 12

Vyvanse - prodrug of dextroamphetamine
May have decrease risk of abuse (cannot snorted or injected)
Can mix in water
All have same adverse effects and warnings as methylphenidate

Front 13

How long is the washout period for MAOI use and stimulants?

Back 13

14 days

Front 14

What is typically used if the child cannot sleep at night?

Back 14

Diphenhydramine
Sedating anti-depressant
Clonidine

***Some children develop tics, some experience a personality change appearing flat without emotion***

Front 15

Which formulations can be mixed in applesauce?

Back 15

Capsule formulations

Vyvanse in water

Front 16

Atomoxetine (Strattera) black box warning:

Back 16

Suicidal ideation in children
Possibility of liver injury and cardiovascular problems
MAOI use in last 14 days

Front 17

Adverse effects:

Back 17

Stomach upset
Fatigue
Menstrual cycle changes
Mood changes
***Do not open capsule - irritant***

Front 18

Guanfacine and Clonidine adverse effects:

Back 18

Guanfacine is well tolerated - not interchangeable with other guanfacine formulations

Clonidine: Bradycardia, dry mouth, somnolence (QHS), rebound hypertension if stopped abruptly
Ext-rel formulation supposed to have fewer side effects

Front 19

What is modafinil (Provigil) and Armodafinil (Nuvigil) used for?

Back 19

Stimulants used to improve wakefulness in adult patients with excess sleepiness associated with narcolepsy, obstructive sleep apnea/hypoapnea syndrome, and shift work sleep disorder

Front 20

What schedule are these medications?

What are their adverse effects?

Back 20

C IV

Risk of rash (both require medguide)
Headache, dizziness, anxiety, agitation, risk of severe rash, insomnia, dry mouth