Drugs for Attention Deficit Hyperactivity Disorder 1-10

what is ADHD?

A disorder that manifests in early childhood with symptoms of hyperactivity, impulsivity, and/or inattention Symptoms affect: Cognitive Academic Behavioral Emotional Social functioning

Describe the following for Amphetamines: 1. mechanism of action 2. pharmacokinetics 3. adverse drug reactions 4. contraindications

1. 2. pharmacologically active after oral ingestion intermediate & long acting 3. *potential for abuse & drug dependence* Anorexia, weight loss Poor growth Sleep disturbance Jitteriness Social withdrawal Development of tics 4. Symptomatic CV disease Moderate to severe HTN Hyperthyroidism Known hypersensitivity or idiosyncrasy to sympathomimetic amines Motor tics or Tourette syndrome Glaucoma Agitated states Anxiety History of drug abuse Concurrent use/within 2 weeks of MAOIs

Describe the following for Methylphenidate: 1. mechanism of action 2. pharmacokinetics 3. adverse drug reactions 4. contraindications

1. 2. multiple lengths of action (short & long) sustained release = 9hrs duration osmotic release tablet, oral suspension, patch = 12hrs duration

Describe the following for Clonidine & guanfacine extended release (ER): 1. mechanism of action 2. pharmacokinetics 3. adverse drug reactions 4. contraindications 5. clinical use

1. alpha-2 adrenergic agonists 2. may take up to 2 weeks for initial response 3. sedation, depression, bradycardia, headache, and possible hypotension, fatigue 4. Reserved for children/adolescents who respond poorly, have unacceptable side effects or comorbid conditions that preclude the use of stimulants or atomoxetine May be useful in over-aroused, easily frustrated, highly active, or aggressive individuals ADHD or adjunct for stimulant therapy

Describe the following for Atomoxetine: 1. mechanism of action 2. pharmacokinetics 3. adverse drug reactions 4. contraindications

1. blocks reuptake of norepinephrine alternative to stimulants for children & adolescents 2. takes 1-2 weeks for initial response. wt dependent dose, duration of action ~11hrs, metabolized by CYP2D6 3. wt loss, decreased appetite, N/V *suicidal thinking* headache, dizziness, dyspepsia, tics, irritability 4. hypersensitivity Concurrent use/or within 2 weeks of MAOIs Glaucoma Current/past history of pheochromocytoma Severe CV disorders that elevate blood pressure or heart rate

List the drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD)

Methylphenidate Amphetamines Atomoxetine Guafacine Clonidine

Which drugs are used to treat ADHD in children & adolescents?

stimulants atomoxetine Clonidine/Guanfacine antidepressants

Which drugs are used to treat ADHD in adults?

stimulants (can cause sleep disturbances) Atomoxetine