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kyleannkelsey
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What are the cons of ER Stimulant formations?
- Decreased appetite
- Insomnia
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What are the ER Stimulant formations?
- Ritalin SR, Metadate ER
- Dexedrine Spansule
- Concerta
- Ritalin LA®, Adderall XR®
- Metadate® CD
- Daytrana®
- Quillivant™ XR
- Vyvanse®
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What are the kinetics of Ritalin SR, Metadate ER?
- Delayed release by 60-90 minutes
- Peak concentration at 4 hours
- 6-8 hours of effect
- (Do not break or crush)
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What are the kinetics of Dexedrine Spansule?
5-10 hours of effect
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Describe the release system of Concerta?
- OROS® delivery system (multiple drug reservoirs in a plastic capsule)
- Back-loaded formulation
- 22% immediate release, 78% released beginning 4 hours after ingestion
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What drug do you need to counsel patients on “plastic capsule in the feces”?
Concerta
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Describe the release system for Ritalin LA®, Adderall XR®?
- 50/50 beaded formulations
- Closely mimics two doses of immediate release products
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Describe the release formulation for Metadate® CD?
- 30%-70% beaded system
- 30% now, 70% is released later
- Mimics two doses of immediate release product
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What is Daytrana®?
Transdermal methylphenidate
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How should Daytrana be used?
Worn on the hip for about 9 hours
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What is Quillivant™ XR?
- Extended release methylphenidate suspension
- 5 mg/mL
- Meant for toddlers
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What is Vyvanse®?
- D-amphetamine pro-drug
- Lysine moiety cleaved off in the GI tract
- Can’t crush and abuse because it has to get to the GI tract to work
- Less abuse potential
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What are the AE of stimulants?
- Decreased appetite
- Decreased growth
- Insomnia
- Rebound
- SUDDEN CARDIAC DEATH
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What are the non-stimulant medications for ADHD?
- Atomoxetine (Stratterra®)
- Guanfacine (Intuniv®)
- Modafinil (Provigil®)
- Bupropion (Wellbutrin® SR)
- Venlafaxine (Effexor® XR)
- Clonidine (Catapres®)
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What is the brand name for Atomoxetine?
Stratterra
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What is the brand name for Guanfacine?
Intuniv
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What is the brand name for Modafinil?
Provigil
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What is the brand name for Bupropion?
Wellbutrin® SR
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What is the brand name for Venlafaxine?
Effexor® XR
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What is the brand name for Clonidine?
Catapres
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What is the generic name for Stratterra?
Atomoxetine
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What is the generic name for Intuniv?
Guanfacine
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What is the generic name for Provigil®?
Modafinil
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What is the generic name for Wellbutrin® SR?
Bupropion
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What is the generic name for Effexor® XR?
Venlafaxine
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What is the generic name for Catapres®?
Clonidine
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What is the MOA of Atomoxetine (Stratterra®)?
- Selective norepinephrine uptake inhibitor
- Not a stimulant
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What non-stimulant is First-line agent with stimulants?
Atomoxetine (Stratterra®)
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What are the pros of Atomoxetine (Stratterra®)?
- Apparent lack of abuse potential
- Once-a-day dosing
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What are the Cons of using Atomoxetine (Stratterra®)?
- Effects may not be seen for 2-4 weeks
- Liver toxicity
- Suicide
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What is the MOA of Guanfacine (Intuniv®)?
Selective alpha-2a agonist
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What are the pros of Guanfacine (Intuniv®)?
- Once-a-day dosing
- Not controlled
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Can Tenex®be substituted for Guanfacine (Intuniv®) on a mg-mg basis?
No
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What are the SE of Guanfacine (Intuniv®)?
Hypotension and bradycardia (since it is a BP drug as well)
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What is the MOA of Modafinil (Provigil®)?
- CNS arousal agent
- Produces euphoric effect
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What is the level of controlled substance of Modafinil (Provigil®)?
C-IV
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What are the pros of Modafinil (Provigil®)?
- Low abuse potential
- Small studies have shown benefit
- Minimal AEs (Headache and nausea)
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What are the second line agents for ADHD?
- Bupropion (Wellbutrin® SR)
- Venlafaxine (Effexor® XR)
- Clonidine (Catapres®)
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What is the MOA of Clonidine (Catapres®?
Central alpha2 agonist
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When is Clonidine (Catapres®) useful?
- Useful at night if insomnia occurs
- Stimulant during day and this at night works well for patients with insomnia
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When would you use a 2nd line agent for ADHD?
- Stimulant failures -Lack of response after titrating up until adverse effects occur to get adequate trail
- Intolerable adverse effects
- High risk of abuse
- Co-morbid disorder
- Contraindications
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