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Dextroamphetamine (Dexedrine) | Stimulant *indicated for ages 3-16 *duration: 4-6 hours *schedule: 2-3 times/day |
Methylphenidate (Ritalin, Concerta) | Stimulant *indicated in ages 6-12 *duration: 3-5 hours *schedule: 2-3 times/day |
Mixture of salts and L-amphetamine (Adderall) | Stimulant *indicated for ages 6 and older *duration: 4-6 hours *schedule: 2 times/day |
Lisdexamfetamine dimesylate (Vyvanse) | Stimulant *indicated for ages 6-12 *duration: 10-12 hours *schedule: once/day |
Dexmethylphenidate (Focalin) | Stimulant *indicated in ages 6 and older *duration: 4-5 hours *schedule: 2 times/day |
Important note about the stimulants | - can quickly increase attention and task-directed behavior; reduces impulsivity, restlessness, and distractibility -treat w/ minimum effective dose and increase (as needed) - do NOT administer later than 1600 - SE: insomnia, appetite suppression, headache, abdominal pain, lethargy -may take 6 wks. for therapeutic response *RISK FOR ABUSE POTENTIAL |
Atomoxetine (Strattera) | Non-stimulant *indicated for ages 6-65 *duration: 24 hrs. *schedule: once/day |
Important note about non-stimulants | -therapeutic response may develop slowly (~6 wks.) -SE: GI disturbances, reduced appetite, weight loss, urinary retention, dizziness, fatigue, insomnia *Risk for liver injury, increase in blood pressure and heart rate --> ongoing monitoring of VS and liver fxning needed *USE W/ CAUTION: increased risk of suicidal ideation |
Tacrine (Cognex) | Cholinesterase inhibitor **No longer used, due to hepatotoxicity |
Donepezil (Aricept) | Cholinesterase inhibitor -dosage: once daily **Better tolerated than others (preferred) |
Rivastigmine (Exelon) | Cholinesterase inhibitor -available as once-daily patch -most common SE: N/V, weight loss, decreased appetite **ALWAYS TAKE W/ FOOD TO DECREASE GI EFFECTS |
Galantamine (Razadyne) | Cholinesterase inhibitor -prescribed in first and second stages of AD |
Mechanism of action ~ cholinesterase inhibitors | ACTION: prevents the breakdown of acetylcholamine and thereby increases its availability at cholinergic synapses |
Indications for cholinesterase inhibitors | Modestly improves cognition, behavior, and function; slows progression of dementia *Use w/ caution when pts. are taking NSAIDs |
Side effects of cholinesterase inhibitors | N/V, diarrhea, insomnia, fatigue, muscle cramps, incontinence, bradycardia, and syncope |
Memantine (Namenda) | N-methyl D-aspartate (NDMA) inhibitor |
Mechanism of action ~ NMDA inhibitors | Normalizes levels of GLUTAMATE, which in excessive quantities contributes to neurodegeneration *Used during moderate to severe stages of AD |
Indications for NDMA inhibitors | Treatment of moderate to severe Alzheimer's disease (h/e, no evidence that it modifies the underlying disease) |
Side effects of NMDA inhibitors | Dizziness, agitation, headache, confusion, and constipation **Clearance is reduced w/ renal impairment (use w/ caution in mild to moderate renal impairment; do not use w/ severe) |
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