Attention Deficit Hyperactivity Disorder (ADHD)

What patients develop ADHD

Children

What are the symptoms of ADHD

Inattention (difficulty focusing, easily distracted)
Hyperactivity (trouble staying still)
Impulsivity (can't control impulsive behavior)

What is the primary treatment for ADHD (and why)

Stimulants (raid DA and NE levels)

When are ADHD medications considered 1st line (think of the patient population it develops in)

6 years or older

How is inattention diagnosed

>6 symptoms of inattention for children up to age 16 for at least 6 months

How is hyperactivity/impulsivity diagnosed

>6 symptoms of hyperactivity impulsivity for children up to age 16 for at least 6 months

What are two diagnosis requirements for both inattention and hyperactivity/impulsivity

Present before age 12
Present in two or more settings (home and school)

What are natural products that can be used in ADHD

Fish oils
Melatonin (for sleep onset if on stimulants)

What type of formulations are preferred for children with ADHD

Long -acting (formulations have been made easier for children)

What can be used to treat ADHD if stimulants do not work well enough

Atomoxetine (non-stimulant)

What is a monotherapy or add option for ADHD

Guanfacine ER (Intuniv)
Clonidine (Kapvay)

What are the formulations for ADHD medications

Capsule
Chewable tablet
ODT
Patch
Suspension

What capsules can be put on applesauce

Adderall XR
Ritalin LA

What capsule can be mixed with water/orange juice/yogurt)

Vyvanse

What are the first line stimulants

Methylphenidate
Lesdexamfetamine
Dextroamphetamine/amphetamine

What can be given to help sleep at night

Melatonin
Clinidine IR
Diphenhydramine

What is the control class of all stimulants

C-II

What is the BBW with all stimulants

High potential for dependence/abuse

What is a CI with stimulants

Use within 14 days of MAOI (HTN crisis)

What are the warnings with stimulants

Increased HR
Increased BP
Serious CV events (in children and adult)
Priapism
Exacerbation of preexisting psychosis (mixed.manic episode)
Risk of seizure
Loss of appetite (causing a decrease in growth trajectory)
Serotonin syndrome

What is the MOA of stimulants

Blocks reupatake of NE and DA

How are stimulants dosed

Titrated up every seven days (but does not need to be tapered)

What is the brand name for IR methylphenidate

Ritalin

What is the starting dose of Ritalin

5mg BID

What is the brand name for ER tablet methylphenidate

Concerta

What is the dose of Concerta

18-38mg QAM

What is the brand name for ER capsule methylphenidate

Ritaline LA

What is the brand name for patch methylphenidate

Daytrana

What are the side effects of methylphenidate

Insomnia
Decrease appetite/weight loss
Headache
Irritability

What should be monitored while a patient is on methylphenidate

ECG prior
BP
HR
Height and weight (in children)

How is Concerta delivered

OROS (outer coat dissolves fast and rest is released slowly)

What is unique about Jornay PM

Dosed in the evening (because it releases product 10 hours later)

How should Daytrana be applied

Put on 2 hrs before desired effect and remove after 9 hours (alternate hips daily)

What is the relationship between Dexmethylphenidate and Methylphenidate

Dexmethylphenidate is the active isomer of Methylphenidate

What is the brand name of IR Dextroamphetamine/amphetamine

Adderall

What is the brand name of ER Dextroamphetamine/amphetamine

Adderall XR

What is the brand name of Lisdexamfetamine

Vyvanse

What are the formulations of lisdexamfetamine

Capsule
Chewable tablet

What is an important note with lisdexamfetamine

Low abuse potential (because it is prodrug and if injected or snorted the fast effect is muted)

When can non-stimulants be given as first-line

Concerned with abuse potential

What is the MOA of Atomoxetine

Selective NE reuptake inhibitor

What is the brand name of Atomoxetine

Strattera

What is the BBW with Strattera

Suicidal ideation

Wha tis a CI with Strattera

Use within 14 days of MAOIs

What are the side effects of Strattera

Decrease appetite
Somnolence
Dry mouth
HTN
Tachycardia

What is an important administration counseling point with Strattera

Do not open the capsule

What is the MAO of clonidine and Guanfacine

Central alpha-2A adrenergic receptor agonists

What is the brand name of Clonidine ER

Kapvay

What is the brand name for clonidine IR (for HTN)

Catapres

What is the brand name of Guanfacine ER

Intuniv

What are the warnings with Intuniv and Kapvay

Dose dependent CV effects, sedation and drowsiness
Do not discontinue abruptly (rebound HTN)

What are the side effects of Intuniv and Kapvay

Dry mouth
Somnolence
Fatigue
Dizziness
Constipation
Decrease HR
Hypotension