NR 546 WEEK 7 ADHD Medication Table

NR 546 WEEK 7 ADHD Medication Table. Drug Name (include if IR, XR, ODT, LA) Indication (include approved ages) Neurotransmitter(s) Affected Target Symptoms Short-acting, intermediateacting or long-acting. Duration of action, peak (if noted) Notable side effects /Patient education instructions Methylphenidate (D/L) (Concerta, Ritalin) -Dopamine, norepinephrine inhibitor and releaser (DNRIRe), stimulant, FDA approved for ADHD in children and adults (ages vary based on formulations), narcolepsy. Off-label for treatmentresistant depression. Enhancement DA and NE in certain areas of the brain (dorsolateral prefrontal cortex, medial prefrontal cortex). Primary target symptoms: concentration, attention span, motor hyperactivity, impulsiveness, physical and mental fatigue, daytime sleepiness, depression -Ritalin IM tablets 5, 10 20 mg, Ritalin LA up to 8 hours duration of action. Ritalin SR duration action 4- 6 hours Available in immediate release (IR) and extended release (XR) Available in beads that may be sprinkled on food for children who cannot swallow pills Concerta SR sustain release. Concerta up to 12 hours duration of actions; initial dose 18 mg/day in am. Biphasic – combined immediate and delayed release in one medication Concerta has less of an early peak but longer duration up to 12 hr The average half-life in adults is 3.5-hours (1.3-7.7 hours). The average half-life in children is 2.5 hours (1.5 – 5 hours). Metabolism is not extensive -Insomnia, headache, exacerbation of tics, nervousness, irritability, overstimulation, tremor dizziness, anorexia, nausea, abdominal pain, weight loss, slow normal growth in children (controversial), blurred vision, Rare: priapism, psychotic episodes, seizures, palpitations, hypertension, neuroleptic malignant syndrome, hypomania, SI, cardiovascular issues Before tx assess for the presence of cardiac disease, prior EKG is recommended for children, BP is monitored regularly, and periodic CBC and platelet counts are considered during prolonged therapy (rare leukopenia or anemia) in children monitor weight and height. -Not recommended while breastfeeding. Can cause fetal harm Useful for treatment of depressive symptoms. -Useful for treatment of post-stroke depression -Concerta is preferred for ADHD patients who work in the pm or do homework up to 12 hours after the morning dose. Newest SR technologies are truly once a day dosing system Dexmethylphenidate (Focalin) (D) -Treatment of ADHD. CNS stimulant: blocks the reuptake of norepinephrine and dopamine and increases their release into the extra neuronal space -Onset of action occurs within 1 to 2 hours -Insomnia, headache, jitteriness, decreased appetite, xerostomia, abdominal pain, dizziness, nausea, dyspepsia, pharyngolaryngeal pain, nasal congestion Jornay PM -Treatment of attentiondeficit/hyperactivity disorder (ADHD). Symptomatic management of narcolepsy. Mild CNS stimulant; blocks the reuptake of norepinephrine and dopamine into presynaptic neurons; appears to stimulate the cerebral cortex and subcortical structures like amphetamines -Initial absorption is delayed with about 5% of total drug available within first 10 hours after dosing. -Insomnia, headache, irritability, weight loss, xerostomia, nausea, tachycardia, palpitations, increased blood pressure and heart rate, emotional lability, anxiety, jitteriness, tic disorder, dizziness, psychomotor agitation, depressed mood, nervousness, restlessness, aggressive behavior, agitation, depression, hypertonia, lack of emotion, vertigo, confusion, sedated state, tension, paresthesia