Level 3
Medications are a valuable tool in the management of adhd and nice guidance recommends medication patients with severe or moderate impairment when non drug measures have either been ineffective or cannot be attempted they will tend to be used together with the previous supportive measures and the most commonly used ones are the stimulants methylphenidate dex
Amphetamine and a toxin mateen other medications such as emmitt firming and group iron they used off-label for the management of adhd if the commonly used medications have been ineffective or not tolerated now an area for concern for patients is abuse potential and addiction of stimulant medication paste parents also worried about subsequent risk of other drug
Abuse however there’s no evidence that adhd medication is addictive or that taking stimulants will cause someone to try illicit drugs when they’re older in fact taking medication can be protective as patients are less likely then to self-medicate so if we just look through some of these medications so methylphenidate is the most commonly used stimulant medication
For the management of adhd a tensor response rate between 70 to 85 percent and as therefore regarded as highly effective it works by blocking the reuptake of dopamine and possibly noradrenaline into the nerve endings in the brain they work very quickly in a matter of hours but their full effects may take a few weeks methylphenidate does have maximum licensed
Daily doses but higher doses can be used off-label and it is actually supported by nice guidance if it’s required modified little release tablet preparations need to be solid whole they compose a problem for younger patients who find it difficult to swallow solid dosage forms the captial pips that preparations may be swallowed whole but for patients swallowing
Difficulties that can be opened and the contents emptied into a small amount of soft food such as yogurt or applesauce and then taken immediately patients mustn’t chew it and it’s a good practice to drink some fluids afterwards to ensure the patient gets the full dose now due to the differences in release profile of the modified release medication these capsule
Preparations must be prescribed by and they’re not equivalent the 12-hour tablet preparations are deemed to be by equivalent but some patients and parents notice the difference if they switch between them so they must be prescribed by brand if the prescription for modified release preparation is written generically the pharmacy team must ascertain the patient’s
Usual brand where possible the parents should be sorry the patient should be maintained on a modified release preparation the advantages of once daily administration and therefore removing the need for an afternoon dose in school which can be problematic for school and patients now the next medication that can be used is dix and feta means it’s another stimulant
Medication and it’s indicated for refractory adhd and therefore reserved as a second-line treatment it is effective since 80 percent of patients who fail to respond to methylphenidate will respond to text and feta mean it works by blocking the reuptake of dopamine and drop nor draining back into the nerve endings in the brain and stimulates the release of those
Two neurotransmitters into the synapse the onset of action is 1 to 2 hours and the duration of action is up to 13 hours there are various strengths of the capsules and the capsules can be swallowed whole for patients with swallowing difficulties the capsule can be opened similarly and emptied onto soft food and the usual maximum daily dosage of det smurfette amin
Is 20 milligrams although some older patients have needed 40 milligrams the maximum daily dosage of another type of dex effort amin known as this dex amphetamine is 70 milligrams atomic satine which is a brand name of the brand name is strattera is a non stimulant medication it works by inhibiting the reuptake of nora and the advantages it provides up to 24 hours
Of cover and therefore lowers the risks of ticks and less potential for drug use the side-effect profile can be more favorable compared to stimulants the major drawback is that it can take four weeks to start working and may take up to three months to healthful effect so during the start of the treatment the clinician may decide to overlap with methylphenidate
And as withdraw the methylphenidate but some patients maybe on the combination treatment continuously combination treatment is off-label and the patient will need to be carefully monitored atomoxetine is available in capsules of various strengths and also is raw solution so because of its long duration of action it should only be given once daily in the morning
If tolerability tolerability response is not satisfactory the dose can be split to be given in the morning and late afternoon or early evening and the last medication you’ll most probably see is melatonin and that’s a hormone produced by the pineal gland the production of which is suppressed by light and stimulated by darkness it’s thought to regulate the awake
Sleep pattern so melatonin may be prescribed in patients with adhd if their insomnia is causing daytime impairment it has been shown to reduce sleep onset latency so the time taken to go to sleep by around 20 minutes and increases sleep duration by 15 to 20 minutes but studies have really failed to demonstrate how this translates into better daytime adhd central
Control behavior or quality of life despite that it is widely used in adhd it should however be used after careful consideration on a case-by-case basis it is available as a licensed product it’s used in children and in adolescence is off-label where possible clinicians will use the modified release tablet as it carries the least prescribing risks to it to being
A licensed preparation all other preparations are unlicensed if we consider the side effects and monitoring so there’s considerable overlap and side effect profiles and monitoring requirements between medications overall adhd medications are well tolerated most the side effects occur during initiation and with dose increase it increases and they tend to subside
After a week or two so it’s very important with these side effects that they’re explained to patients and parents and advice given on what to do if they occur so they can persevere through them if possible firstly suicide related behavior has been reported more frequently in patients taking atomoxetine although it’s still an uncommon occurrence parents and patients
Should be warned to look out for any warring thoughts behavior and seek help soon or there have been some very rare reports of liver injury liver function tests are not routinely carried out before initiation of atomoxetine but parents and patients should be consult council to look out for signs of potential liver injury for example unexplained nausea vomiting
Abdominal pain dark urine again on discoloration and they should ruby reporting any suspicious findings as soon as possible parents often concern about the long-term effects on growth so weight and height but adhd medications should have a negligible effect growth may be slightly less than expect in some patients but weight and height should be monitored at
Least every six months so any changes could be picked up and act upon studies have shown the patients treated with adhd medication and no more risk of sudden death compared to the general population a routine ecg is not required for starting adhd medication unless physical examination or family history warrants further investigation and stimulant and non stamina
Medication can increase blood pressure and heart rate therefore blood pressure should be measured and plotted on centaur charts after initiation dose increases and routinely every three months according to nice for sale patients some areas may have an arrangement with primary care to do the three-month blood pressure measurement under shared care arrangements
Others may opt to measure blood pressure for their stable patients every six months which is the recommendation from the manufacturers of methylphenidate and and atomoxetine preparations now transition is an important part of a patient’s care in this field so cutoff will transition to adult services can vary across the country but usually preparations tend to be
Made when the patient is around sixteen years of age and adolescents then transition from around 18 years of age before an adolescent is transitioned it is important to explore they’ve used degree of impairment and future plans and also trying a medication break if deemed clinically appropriate now medication breaks or holidays they tend to be a controversial area
So some collisions will attempt this while others will not entertain the idea some parents tend to medicate their children or adolescents every day of the year while others choose to medicate only during school time medication breaks and holidays can have advantages as well as drawback so there should be a discussion with the parent or possibly the patient around
There so during a transition a medication break may be used whilst they are going from one care setting or care provider to another
Transcribed from video
Part II: ADHD Medication By Pharmacy Education
