Inquire through: | Professional | Confidential Support
Pharm Quiz 2 - ADHD, Neuro, Anxiety,
Depression Verified and Updated Questions
and Answers (100% Correct Answers)
What is considered first-line therapy for a pediatric patient with ADHD? adult?
Answer: Stimulants for both b/c they tend to be the preferred treatment over other
medications for several reasons.
o Stimulants have a rapid onset of action, long record of data, and established
efficacy in improving core symptoms of ADHD.
o At least 80% of school-aged children and adolescents will respond to one of the
stimulants if the stimulants are tried in a systematic way.
o The response rate to a specific stimulant is approximately 70%.
o Exact MOA of stimulants? Not totally clear, but we know stimulation of CNS
activity, NE and dopamine have roles
Two main kinds of stimulants:
Answer: Methylphenidate & Drugs containing amphetamine
o Methylphenidates (Ritalin, Ritalin LA, Concerta, Metadate)
o Dextroamphetamine/Amphetamine (Adderall, Adderall XR)
o Lisdexamfetamine (Vyvanse)
Should we give a Methylphenidate or Amphetamine Stimulant?
Answer: • According to a study, although amphetamines may be slightly more
efficacious, methylphenidate is usually better tolerated.
• A systematic review and meta-analysis recommends preference for
methylphenidate over amphetamine as initial therapy for pediatric patients (when
appropriate)
• At least 1/2 that don't respond to one will respond to the other type
Potential Adverse Effects of Stimulants:
Answer: • Anorexia, weight loss, reduced height?
,Inquire through: | Professional | Confidential Support
o Deceleration may occur (over first couple years?), appears to attenuate over time,
adult height does not appear to be affected
• Sleep disturbance
• Jitteriness
• Emotional lability
o Rare reports of psychotic symptoms, such as hallucinations, delusional thinking,
mania
• Increased heart rate and blood pressure
• Headache, dizziness
• Gastrointestinal symptoms
• Tics (new or worsening)
• Priapism- rare, but is a medical emergency*
Considerations regarding adverse effects and stimulants
Answer: • Patients may have unique responses
• Many AE are mild, of short duration
• Consider how can be reversed with adjustment to dose or timing
Possible strategies to consider if AE occur w/ stimulants:
Answer: • Change the class
o Ex: Methylphenidate vs Amphetamine or Stimulant vs Non-stimulant
• Change to another drug within that class (ex: Ritalin LA to Concerta)
• Change the dose
o Ex: reduce the dose if increased anorexia, insomnia, or irritability
, Inquire through: | Professional | Confidential Support
What is usually monitored in the clinic for stimulant therapy for ADHD?
Answer: • Routinely monitor for efficacy- improvement in core symptoms and
adverse effects and the medication dose adjusted as indicated
• May use parent and teacher feedback and/or ADHD rating scales
• Stimulant Monitoring
o Routine (may be weekly, then monthly, then every 3 months)
o Blood pressure
o Pulse
o Weight
o Height (pediatric)
Which pharmacologic therapy for ADHD is controlled?
Answer: • Stimulants (Ritalin, Ritalin LA, Concerta, Metadate, Adderall, Adderall XR,
Vyvanse)
What are some alternative treatment options for a pediatric patient with ADHD and
how do they compare to stimulants?
Answer: • Non-Stimulants Treatment Options: Atomoxetine (Strattera), Guanfacine
ER (Intuniv); Clonidine ER (Kapvay),
o Bupropion (Wellbutrin) as well for adults
• They don't work as well
Atomoxetine (Strattera)
Answer: •It does have some efficacy; may be less than stimulants; is generally well
tolerated
•Some potential AE: fatigue and somnolence, decreased appetite, nausea, vomiting,
abdominal pain, weight loss, hypertension, tachycardia; priapism- medical
emergency
o Black box warning: suicidality for children and adolescents, especially during the
first months of treatment
Pharm Quiz 2 - ADHD, Neuro, Anxiety,
Depression Verified and Updated Questions
and Answers (100% Correct Answers)
What is considered first-line therapy for a pediatric patient with ADHD? adult?
Answer: Stimulants for both b/c they tend to be the preferred treatment over other
medications for several reasons.
o Stimulants have a rapid onset of action, long record of data, and established
efficacy in improving core symptoms of ADHD.
o At least 80% of school-aged children and adolescents will respond to one of the
stimulants if the stimulants are tried in a systematic way.
o The response rate to a specific stimulant is approximately 70%.
o Exact MOA of stimulants? Not totally clear, but we know stimulation of CNS
activity, NE and dopamine have roles
Two main kinds of stimulants:
Answer: Methylphenidate & Drugs containing amphetamine
o Methylphenidates (Ritalin, Ritalin LA, Concerta, Metadate)
o Dextroamphetamine/Amphetamine (Adderall, Adderall XR)
o Lisdexamfetamine (Vyvanse)
Should we give a Methylphenidate or Amphetamine Stimulant?
Answer: • According to a study, although amphetamines may be slightly more
efficacious, methylphenidate is usually better tolerated.
• A systematic review and meta-analysis recommends preference for
methylphenidate over amphetamine as initial therapy for pediatric patients (when
appropriate)
• At least 1/2 that don't respond to one will respond to the other type
Potential Adverse Effects of Stimulants:
Answer: • Anorexia, weight loss, reduced height?
,Inquire through: | Professional | Confidential Support
o Deceleration may occur (over first couple years?), appears to attenuate over time,
adult height does not appear to be affected
• Sleep disturbance
• Jitteriness
• Emotional lability
o Rare reports of psychotic symptoms, such as hallucinations, delusional thinking,
mania
• Increased heart rate and blood pressure
• Headache, dizziness
• Gastrointestinal symptoms
• Tics (new or worsening)
• Priapism- rare, but is a medical emergency*
Considerations regarding adverse effects and stimulants
Answer: • Patients may have unique responses
• Many AE are mild, of short duration
• Consider how can be reversed with adjustment to dose or timing
Possible strategies to consider if AE occur w/ stimulants:
Answer: • Change the class
o Ex: Methylphenidate vs Amphetamine or Stimulant vs Non-stimulant
• Change to another drug within that class (ex: Ritalin LA to Concerta)
• Change the dose
o Ex: reduce the dose if increased anorexia, insomnia, or irritability
, Inquire through: | Professional | Confidential Support
What is usually monitored in the clinic for stimulant therapy for ADHD?
Answer: • Routinely monitor for efficacy- improvement in core symptoms and
adverse effects and the medication dose adjusted as indicated
• May use parent and teacher feedback and/or ADHD rating scales
• Stimulant Monitoring
o Routine (may be weekly, then monthly, then every 3 months)
o Blood pressure
o Pulse
o Weight
o Height (pediatric)
Which pharmacologic therapy for ADHD is controlled?
Answer: • Stimulants (Ritalin, Ritalin LA, Concerta, Metadate, Adderall, Adderall XR,
Vyvanse)
What are some alternative treatment options for a pediatric patient with ADHD and
how do they compare to stimulants?
Answer: • Non-Stimulants Treatment Options: Atomoxetine (Strattera), Guanfacine
ER (Intuniv); Clonidine ER (Kapvay),
o Bupropion (Wellbutrin) as well for adults
• They don't work as well
Atomoxetine (Strattera)
Answer: •It does have some efficacy; may be less than stimulants; is generally well
tolerated
•Some potential AE: fatigue and somnolence, decreased appetite, nausea, vomiting,
abdominal pain, weight loss, hypertension, tachycardia; priapism- medical
emergency
o Black box warning: suicidality for children and adolescents, especially during the
first months of treatment
