ADHD

ADHD inattention DSM5 criteria

At least 6 sx of inattention

Sx present for at least 6 months

ADHD hyperactivity and impulsivity DSM5 criteria

At least 6 sx of hyperactivity or impuslivity

Sx present for at least 6 months

DSM5 conditions that must be met

Sx present before age 12

Sx present in 2 different environments

First line ADHD tx

stimulants

Preferred formulation of stimulants for children

long acting

When to use non-stimulant medications

when stimulants do not work after 2-3 medication trials

ADHD capsules that can be opened

long acting (Adderall XR, Ritalin LA)

Vyvanse

Chewable capsule

vyvase

Methylphenidate patches

Daytrana

Drug schedule of stimulants

C-II

Boxed warning of stimulants

abuse potential

Stimulant CI

Do not use within 14 days of MAO-I due to hypertensive crisis risk

Stimulant warnings

Increase HR and BP

Vascular problems (priapism)

New onset/exacerbation of psychosis

Serotonin syndrome

Visual disturbances

Decreased seizure threshold

Stimulant MOA

block reuptake of norepinephrine and dopamine

When can stimulant doses be titrated

every 7 days

Do stimulants need to be tapered off

no

Methylphenidate brands

Ritalin (IR)

Ritalin LA

Concerta (OROS delivery)

Jornay PM

Daytrana (patch)

Ritalin dosing

5 mg BID

Concerta dosing

18-36 mg QAM

Jornay dosing

20 mg QPM

Daytrana dosing

10 mg/9 hr patch QAM

Methylphenidate side effects

insomnia

decreased appetite/weight

HA

irritability

Methylphenidate monitoring

ECG prior

BP

HR

Height and weight (children)

Daytrana application instructions

apply to hip 2 hrs prior to desired effect

remove after 9 hrs

alternate hips daily

discard by flushing down toliet

What is concerta OROS delivery

outer coating dissolves fast for quick action, rest is released slowly and can have ghost tablet

Active isomer of methylphenidate

dexmethylphenidate

Amphetamine/dextroamphetamine and combination brands

Adderall

Adderall XR

Prodrug of dextroamphetamine

lisdexamfetamine

lisdexamfetamine brand

vyvanse

Vyvanse formualtion

capsule

chewable tablet

Benefit of vyvanse

low abuse potential

Second line ADHD drugs

non-stimulants

Non-stimulant drugs

atomoxetine

viloxazine

atomoxetine brand

strattera

strattera boxed warning

suicidal ideation

strattera CI

MAO inhibitor use within last 14 days

glaucoma

cardiovascular issues

strattera side effects

decreased appetite

insomnia

somnolence

dry mouth

increased BP and HR

can you open strattera capsules

no

adjunct adhd meds

clonidine ER

guanfacine ER

list centrally acting alpha 2 agonists

clonidine ER

guanfacine ER

clonidine ER brand

Kapvay

guanfacine ER bran

intuniv

alpha-2 agonists warnings

dose dependent cardiovascular effects

sedation/drowsiness

do not d/c abruptly, must taper due to rebound htn

alpha-2 agonists SE

dry mouth

somnolence

fatigue

dizziness

constipation

decreased HR

hypotension