Week 12 Wrap-up: ADHD Medications

Overview

• Focus on ADHD medications, preparing for Exam 4.
• Legal ramifications aren't covered as they vary by state.
• Approach: Link symptoms to brain pathways and neurotransmitter actions.

ADHD Symptoms and Brain Pathways

• Symptoms:
  • Inattentive
    • Selective: Dorsal Anterior Cingulate Cortex
    • Sustained: Dorsolateral Prefrontal Cortex
  • Hyperactive: Prefrontal Motor Cortex
  • Impulsive: Orbitofrontal Cortex

ADHD Over Time

• Preschool/Young Children: Impulsive and hyperactive symptoms are prominent.
• School Age: Hyperactivity and impulsivity remain prominent.
• Adulthood: Inattention increases, impulsivity and hyperactivity decrease.

Neurotransmitter Roles

• Norepinephrine & Dopamine:
  • Key neurotransmitters in ADHD.
  • Too little leads to distraction, disorganization; too much can lead to mania or psychosis.
  • Optimal levels are necessary for proper symptom management.

Neurotransmitter Mechanisms

• Norepinephrine: Increases signal, enhances connections (alpha 2a receptors).
• Dopamine: Decreases noise, prevents inappropriate connections.
• Firing Types: Tonic (optimal) vs. Phasic (potentially problematic if excessive).

ADHD Medication Categories

• Stimulants:
  • Long-acting/Slow-dose: Enhance tonic norepinephrine and dopamine firing.
  • Short-acting/Immediate release: Can lead to misuse/abuse due to potent bursts of dopamine.
• Non-stimulants:
  • Stratera, guanfacine, and clonidine work on norepinephrine and dopamine.

Treatment Planning

• Address comorbid conditions first, especially substance use.

ADHD Medications

• Amphetamines (Adderall): Increase dopamine and norepinephrine by inhibiting dopamine transporter and VMAT.
• Methylphenidate (Ritalin): Blocks reuptake of dopamine and norepinephrine, increasing their availability.

Side Effects and Warnings

• Stimulants can cause cardiovascular issues, exacerbate mood disorders, and cause tics.
• Blood pressure and heart rate monitoring is crucial.
• History taking is essential to screen for cardiac issues.

Non-Stimulant ADHD Medications

• Stratera: Blocks norepinephrine reuptake, not prone to abuse.
• Alpha-2a Receptor Agonists: Guanfacine and clonidine, affecting hyperactivity more than attention.
  • Guanfacine: More selective, fewer side effects.
  • Clonidine: Affects multiple receptors, more side effects.

Recommendations

• Assess history for cardiac issues before prescribing stimulants.
• No baseline EKG required for healthy individuals.
• Stratera considered safer due to lower abuse potential.

Interesting Facts

• Guanfacine absorption increases with a high-fat meal.

Conclusion

• ADHD treatments focus on managing norepinephrine and dopamine levels in the brain to address symptoms effectively.