DSA23 - Treatment of ADHD and Autism

Amphetamine MoA

Reverses action of reuptake transporter at Catecholamine synapses --> Elevated DA & NE in Synapse

Amphetamine Tx

ADHD --> less propensity to be involved w/ substance abuse + Calming Hyperactive Behavior

Amphetamine S/E

HIGH ABUSE POTENTIAL/POTENTIAL FOR DIVERSION (SCHEDULE II) + EUPHORIA (high dose and/or IV from DA release), Insomnia (intense alertness), Appetite suppression --> Wt Loss, More Paranoid thinking (emotional lability from high doses in Adults)

Methylphenidate MoA

Amphetamine - stimulant effects related to faciltation of release of centra DA and NE

Methylphenidate Tx

ADHD; Requires dosing in morning & during school hours (t1/2 = 2.5 hrs)

Methylphenidate S/E

Schedule II (High Abuse Potential); INSOMNIA, APPETITE SUPPRESSION, Long Term = Wt Loss & Growth Retardation

Why does the abuse potential of Methylphenidate NOT match that of cocaine or amphetamine?

B/c CNS penetration is SLOWER

Methylphenidate ER MoA

Amphetamine - stimulant effects related to faciltation of release of centra DA and NE

Methylphenidate ER Tx

ADHD for 12-14 hr (avoids need to administer during school hours)

Methylphenidate Transdermal MoA

Amphetamine - stimulant effects related to faciltation of release of centra DA and NE

Methylphenidate Transdermal Tx

ADHD; SLOW Onset (delayed 1 hr compared to oral ER --> good alt for difficulty swallowing; provides 8-10 hr of effect + produces lower, more sustained drug conc in plasma

Amphetamine Combination (d-amphetamine saccharate, amphetamine aspartate, amphetamine sulfate, d-amphetamine sulfate) MoA

Amphetamine + Salts --> More SUSTAINED EFFECT b/c salts have different rates of going into solution in GI tract

Amphetamine Combination (d-amphetamine saccharate, amphetamine aspartate, amphetamine sulfate, d-amphetamine sulfate) Tx

ADHD

Amphetamine Combination (d-amphetamine saccharate, amphetamine aspartate, amphetamine sulfate, d-amphetamine sulfate) S/E

ABUSE DIVERSION (most likely of all formulations)

Lisdexamfetamine MoA

Pro-drug of Amphetamine (decreases abuse potential of d-amphetamine --> covalently bound to lysine ==> no "rush")

Lisdexamfetamine Tx

ADHD - in children and adults

Lisdexamfetamine S/E

Minimal abuse potential (unless taken orally) b/c less capacity to produce euphoria

Atomoxetine MoA

NON-STIMULANT - NE selective reuptake inhibitor

Atomoxetine Tx

ADHD (childhood & adult) - long acting (once daily)

Atomoxetine S/E

C/I for BPH (anticholinergic effects) + Nausea, Dry mouth, APPETITE SUPRRESION, INSOMNIA

Viloxazine ER MoA

NON-STIMULANT - NE reuptake inhibitor + Releases Serotonin

Viloxazine ER Tx

ADHD

Viloxazine ER S/E

Periphery = elevated BP/HR, CNS = Insomina, Irritability; Mania (5-HT) in Bipolar; Increased suicidal ideation

Clonidine MoA

Alpha 2 agonist

Clonidine Tx

ADHD in children (liquid), Nighttime dosing

Clonidine S/E

Drowsiness, Severe Rebound HTN (if used in HTN Tx)

What should be done to reduce likelihood of Severe Rebound HTN w/ Clonidine Tx?

Tapering drug slowly

Guanfacine MoA

Alpha 2 + 5-HT2b Agonist

Guanfacine Tx

ADHD in children (ages 6-17); May be used w/ stimulants for greater effect on ADHD while offsetting insomnia; Also TOURETTE'S

Guanfacine S/E

Sleepiness, Low BP

Risperidone MoA

Atypical Antipsychotic; D2 ANTAGONIST - HIGHEST D2 receptor affinity

Risperidone Tx

ADHD, Hyperactivity, lack of impulse control; Esp used if self harm probability high

Aripiprazole MoA

Atypical Antipsychotic; D2 Partial Agonist

Aripiprazole Tx

ADHD, Depression (esp if self harm probability high)