Medications for ADHD

A comprehensive set of flashcards covering medications for ADHD, their dosages, contraindications, warnings, and interactions.

What medications are used for ADHD?

CNS stimulant meds, norepinephrine reuptake inhibitors, alpha-2 adrenergic agents (non-stimulants), adjuvant medications.

What are the norepinephrine reuptake inhibitors used in ADHD?

Atomoxetine and Viloxazine.

What are the alpha-2 adrenergic agents (non-stimulants) used in ADHD?

Guanfacine and Clonidine.

What are the adjuvant medications used in ADHD?

Serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, norepinephrine-dopamine reuptake inhibitors.

What are the CNS stimulant medications?

Amphetamine, dextroamphetamine, dextroamphetamine mixed salts + amphetamine (Adderall), methamphetamine, lisdexamfetamine, methylphenidate, dexmethylphenidate, serdexmethylphenidate & dexmethylphenidate.

What are the contraindications (CIs) of CNS stimulant medications?

Severe cardiovascular disease, severe hypertension, glaucoma, hyperthyroidism, history of substance abuse, MAOI use within 14 days.

What is the generic name of amphetamine?

Evekeo.

What is the generic name of dextroamphetamine?

Zenzedi, Dexedrine.

What is the generic name of dextroamphetamine mixed salts + amphetamine?

Adderall.

What is the generic name of methamphetamine?

Desoxyn.

What is the generic name of lisdexamfetamine?

Vyvanse.

What is the generic name of methylphenidate?

Focalin.

What is the generic name of serdexmethylphenidate & dexmethylphenidate?

Azstarys.

What are the warnings associated with CNS stimulant medications?

High abuse potential, sudden death and serious cardiovascular events, pregnancy and lactation, history of seizures, MI, mental disorders (anorexia, depression, bipolar), age less than 6 years.

What are the adverse drug reactions (ADRs) of CNS stimulant medications?

Highly addictive, tachycardia, palpitations, hypertension, irritability, insomnia, anorexia, weight loss, hyperactivity, arrhythmia, MI & sudden death, headache, dizziness, tremors, seizures.

What are the drug-drug interactions (DDIs) of CNS stimulant medications?

Amphetamines antagonize adrenergic blockers, 1st generation antipsychotics antagonize stimulant effects, increase analgesic effects with meperidine, MAOIs.

What is the dose used for atomoxetine (Strattera)?

(Under 70kg) 0.5-1.2 mg/kg to max 1.4 mg/kg; (Over 70kg) 40-80 mg daily to max 100 mg/day.

What is the maximally tolerated dose (extended periods) of atomoxetine (Strattera)?

1.2-1.8 mg/kg/day; decrease dose in liver disease and strong CYP2D6 inhibitors.

What age group is Viloxazine (Qelbree) used for?

6-17 years old.

What is the usual dosing for Viloxazine (Qelbree)?

6-11 years old = 100 mg PO daily; 12-17 years old = 200 mg PO daily.

What are the contraindications of norepinephrine reuptake inhibitors?

Pheochromocytoma, narrow-angle glaucoma, MAOI use within 14 days, pregnancy category C/lactation unknown.

What is the black box warning for norepinephrine reuptake inhibitors?

Increased risk of suicidal ideation in both adults and children.

What are the warnings of using norepinephrine reuptake inhibitors?

Suicide, hepatotoxicity, sudden death, stroke & MI, increased BP, mania, orthostasis, Raynaud’s exacerbation, aggression, urinary retention, priapism, effects on growth (especially in children), strong CYP2D6 inhibitors.

What are the ADRs of norepinephrine reuptake inhibitors?

Decreased appetite, insomnia, dysuria, hot flushes, nausea/vomiting, dysmenorrhea, dry mouth.

What are the DDIs of norepinephrine reuptake inhibitors?

Strong CYP3A4 inhibitors (e.g. paroxetine, fluoxetine, quinidine).

What 'stimulant' medications are considered non-stimulants?

Alpha-2 adrenergic (agonist) agents.

What is the dosing of clonidine?

0.1-0.2 mg PO BID-QID, max 0.4 mg PO daily.

What is clonidine?

Centrally acting alpha 2A-adrenergic receptor agonist for ADHD (monotherapy or adjunct).

What is the MOA of clonidine?

Pre-frontal cortex activation paradoxically lowers sympathetic output of norepinephrine.

What is the dosing of Guanfacine?

1-4 mg PO daily to max 0.12 mg/kg daily (avoid admin with fatty foods).

What are the contraindications of alpha-2 adrenergic (agonist) agents?

Allergy.

What are the warnings of alpha-2 adrenergic (agonist) agents?

Hypotension, bradycardia, syncope, sedation, somnolence.

What are the ADRs of alpha-2 adrenergic (agonist) agents?

Somnolence, fatigue, nausea, lethargy, hypotension, insomnia, dizziness, abdominal pain.

What are the DDIs of alpha-2 adrenergic (agonist) agents?

Additive effects with other CNS depressants like strong CYP3A4 inhibitors (max 2 mg/day) or strong CYP3A4 inducers (e.g., rifampin) (max 4 mg/day).

What are the other CNS stimulants?

Modafinil (Provigil) and Armodafinil (Nuvigil).

What is the dosing of modafinil (Provigil)?

200 mg-400 mg PO QAM (decrease dose in severe hepatic disease).

What is the dosing of armodafinil (Nuvigil)?

150-250 mg PO QAM (decrease dose in severe hepatic disease).

What are the indications for other CNS stimulants?

Increase wakefulness in adults with excess sleepiness associated with narcolepsy, obstructive sleep apnea, and shift work sleep disorder.

What are the contraindications of other CNS stimulants?

Allergy, pregnancy category C, lactation unknown.

What are the warnings of other CNS stimulants?

Serious rash (SJS, TEN), not for pediatrics (under 17 years), psych symptoms.

What are the ADRs of other CNS stimulants?

Headache, nausea, dizziness, insomnia.

What are the DDIs of other CNS stimulants?

Decreased effectiveness of oral contraceptives, caution with MAOIs.

What are serotonin-norepinephrine reuptake inhibitors (SNRIs)?

Potent inhibitors of neuronal serotonin and norepinephrine reuptake.

What are the types of adjuvant medications?

Duloxetine (Cymbalta), Venlafaxine (Effexor), Desvenlafaxine (Pristiq), Milnacipran (Savella).

What is the dosing of duloxetine (Cymbalta)?

30 mg PO daily to max 120 mg/day (depending on indication).

What is the dosing of venlafaxine (Effexor)?

75 mg PO daily to max of 350 mg PO daily.

What is the dosing of desvenlafaxine (Pristiq)?

50 mg PO daily (50 mg PO QOD in ESRD).

What is the dosing of milnacipran (Savella)?

50 mg PO BID to max 200 mg/day (decrease dose in ESRD).

What are the contraindications of adjuvant medications (SNRIs)?

MAOI use within 14 days, narrow-angle glaucoma.

What is the pregnancy category of adjuvant medications (SNRIs)?

Category C, lactation unknown.

What are the warnings of adjuvant medications (SNRIs)?

Suicidal ideation, serotonin syndrome or neuroleptic malignant syndrome, seizures, hepatotoxicity, increased BP and HR, increased bleeding risk, mania activation, withdrawal syndrome with abrupt discontinuation.

What are the ADRs of adjuvant medications (SNRIs)?

Nausea, headache, insomnia, constipation, dry mouth, hypertension, decreased appetite, anxiety, male sexual dysfunction.

What are the DDIs of adjuvant medications (SNRIs)?

CYP2D6, CYP1A2 substrates may affect duloxetine, hyponatremia with SSRIs.

What is the most likely MOA of adjuvant medications (TCADs)?

Blocks uptake of norepinephrine at nerve terminals.

What are the types of adjuvant medications (TCADs)?

Desipramine, imipramine, nortriptyline, bupropion (norepinephrine and dopamine reuptake inhibitor).

What are CIs of adjuvant medications (TCADs)?

MAOI use within 14 days, during acute recovery phase of acute MI.

What are the pregnancy cautions with adjuvant medications (TCADs)?

Risk inconclusive, avoid nursing.

What are the warnings of adjuvant medications (TCADs)?

Suicidal ideation, serotonin syndrome, exacerbation of mania, deaths from overdose.

What are the ADRs of adjuvant medications (TCADs)?

Orthostatic hypotension, sedation, arrhythmia, anticholinergic effects, withdrawal symptoms with abrupt discontinuation.

What is serotonin syndrome?

Potentially life-threatening condition when there is too much serotonin in the body.

What are the general symptoms of serotonin syndrome?

Hyperthermia, muscle rigidity, sweating, myoclonus, mental status changes.

What are the mild-moderate serotonin syndrome symptoms?

Fever, seizure, tremor, twitching, diarrhea, nausea, nervousness, agitation.

What are the severe serotonin syndrome symptoms?

Confusion and disorientation, rapid heart rate, high blood pressure, abnormal heartbeat (can occur within a few hours of dose).

What is the risk of serotonin syndrome?

Risk with combining antidepressants and other medications with serotonergic or MAOI properties, which are frequently combined in clinical practice.

What should be avoided to prevent serotonin syndrome?

Avoid MAOIs and double SSRIs.

What symptoms of serotonin syndrome indicate the need to seek emergent medical care?

Sweating, high fever and chills, racing heart/arrhythmia, anxiety, confusion and disorientation, vomiting and diarrhea, seizures, tremors, fall unconscious.