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23 Cards in this Set

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How long should you trial a stimulant before confering treatment failure?
3 months
What are the 2 formulations of dextroamphetamine?

What are their durations?
How are they dosed?
Adderall IR (3-5 hours) Bid-Tid

Adderall XR (8-12 hours) QAM
What are the 7 formulations of methylphenidate?
Ritalin
Ritalin XR
Ritalin LA
Metadate ER
Metadate CD
Concerta
Daytrana patch
What are their respective durations of action and dosing?
3-5 hours Bid-Tid
3-8 hours Bid - Tid
8-12 hours (QD)
3-8 hours Bid-Tid
8-12 hours QAM
8-12 hours QAM
8-12 hours QAM
If you fail one stimulant class, can other class have efficacy?
Yes
What are the common side effects of ADHD treatment?
Insomnia
Headaches
Appetite suppression
Increased HR
Tic disorder
What is Strattera?
When is it used?
Atomoxetine (SNRI)
First line if patient has a contraindication to stimulant therapy or unable to tolerate side effects.
Not a controlled substance. Less abused
24 hour duration of action
***Takes 4 weeks to see adequate benefit***
What are the side effects of Strattera?
Hepatotoxicity, Sedation
Black Box warning: Suicidal Ideation
Must monitor LFTs
Name another non-stimulant agent.
Bupropion (Blocks reuptake of Dopamine and Norepi)
2nd line agent
Not FDA approved for ADHD
Only modest efficacy in decreasing. Doesnt work well in hyperactive individuals.
CI: Seizure disorders, Head Trauma, Bulemia
3rd line agents
TCA's - block reuptake of serotonin and norepi
Not FDA approved
Shown to be just as effective as stimulants, but side effects are substantial
Adjunctive treatment
Alpha Agonists - Clonidine, Guanfacine
Can be alternative to stimulants in patients at risk for abusing stimulants.
MOA: Prevent norepi from being released
FDA approved for ADHD
Hypotension, Sedation
What would happen if you took off a clonidine patch abruptly?
Rebound Hypertension - Must taper dose
ADHD can cause insomnia. What could you do for a patient who is experiencing ADHD related-insomnia?
Ambien - Studies looking at these patients with ADHD insomnia. Worsened insomnia!
Do not use this.
You could use Clonidine or Guanfacine at bedtime.
Melatonin - Works well in patient with ADHD.
What are the criteria for a tic disorder?
1) Vocal/motor tic > 1 year
2) Younger than 18 yo at diagnosis
3) Tics occur many times per day nearly every single day
4) You can have tic free periods but they don't last longer than 3 months
What are the tourette treatment options?
Alpha-2 agonists - Less side effects (Clonidine is most commonly prescribed, but is about as effective as Risperidone)
D-2 Antagonists (Risperidone) - Have a high rate of efficacy
Clonidine - Greater sedation
Guanfacine - Greater HA, Agitation
Don't need to know doses
Don't need to know scales, but there are scales that evaluate symptom severity.
What do you want to assess in a patient every time you see them?
Weight
Height
Blood Pressure
Heart Rate
Sleeping Patterns
How long before bedtime do you want the last dose of a stimulant to be?
6 hours for an IR formulation

Remember to counsel on sprinkling long acting formulations in apple sauce and to not chew it.
If it is less than 6 hours (IR) or 10 hours (ER) product, skip the dose and take it the next morning
Lifestyle modifications with ADHD on stimulant therapy.
Limit or eliminate caffeine intake
Avoid using cold medications such as pseudo-ephedrine
Avoid diet pills
Side effects to tell physician about?
HA
Abdominal pain
Difficulty sleeping
Loss of appetite
Weight loss
Current data suggests that growth delay will eventually catch up. What can you do to increase appetite?
Increase activity
Take medication after they eat
Big snacks in the evening
How can you assess therapy other than rating scales?
Drug Holiday's will show you if the medication is effective

Long-term cardiovascular risks (Baseline ECG (if there is a family history of cardiac abnormalities), BP, HR)