ADHD Meds

Stimulant

Are stimulant or nonstimulant ADHD medications being described?

-MOA: block presynaptic DA and NE reuptake; amphetamines also increase DA release and inhibit MAO

-First line

-Methylphenidate, amphetamine, dextroamphetamine, lisdexamfetamine, and methamphetamine

psychosis, increase, suppression

Stimulant ADRs

-Psychiatric → _________, mood disturbances, severe anxiety or panic attacks

-Cardiac → ________ HR/BP

-Growth delays, insomnia, appetite ___________, tics

MAOIs, cardiac, anxiety, tic

Stimulant Contraindications

-Use with _______

-Avoid in patients with known ________ abnormalities due to increased risk of sudden death, specifically, some agents are contraindicated in patients with HF, recent MI, arrhythmia, or moderate-severe HTN

-Most are CI in patients with marked _______, tension, agitation, glaucoma, hyperthyroidism, or hx of a ___ disorder

-Do not prescribe to someone with a history of methamphetamine abuse

abuse, death, suicidality, serotonin

Stimulant Warnings

-Boxed Warning: High potential for ______ and dependence

-Boxed Warning (amphetamines): misuse may cause sudden ______ and serious CV events

-Warnings: severe CV events and other vascular problems, increased _________, exacerbate pre-existing psychiatric disorders, seizures, stunted growth, _________ syndrome

Atomoxetine

MOA: SNRI

-Indicated for adults and children >6 y/o, second line

-Nonstimulant

growth, sedation, sexual, glaucoma, MAOI

Atomoxetine: ADRs and Contraindications

-ADR: similar to stimulants (cardiac, GI, psychiatric), less potential for ________ suppression, greater risk of fatigue, _________, and dizziness

-Urinary hesitation/retention, _________ dysfunction

-CI: _________, pheochromocytoma, severe CVD, _____ use within 14 days

suicidal, aggression, priapism, growth

Atomoxetine Warnings

-Boxed Warning: risk of ________ ideation

-Warnings: psychiatric (__________, psychotic sx), orthostasis, syncope, allergic reactions, __________, hepatotoxicity, serious CV events, _______ issues `

Guanfacine, Clonidine

What agents are being described?

-MOA: stimulate alpha-2A receptors on presynaptic neurons in the CNS to inhibit NE release, also work at postsynaptic receptors to increase blood flow in the prefrontal cortex, which has been shown to enhance working memory and executive functioning

-Class: Central alpha2 adrenergic agonists

-Indications: ADHD in kids > 6 y/o

sedation, constipation, syncope, HTN, rash

Central Alpha2 Adrenergic Agonists ADRs and Warnings

-ADRs: dose-dependent _________, hypotension, ___________

-Warnings: dose dependent CNS events (bradycardia, hypotension, orthostasis, -_______), sedation, drowsiness

-Abrupt D/C can cause rebound _____, nervousness, anxiety

-Guanfacine: skin ______