ADD

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ADD ADHD
Anthony Hawkins
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What is ADD?

• Attention-Deficit Disorder
• Hyperactive/Impulsive
• Inattentive
• Combined
• Residual
• most researched childhood behavioral disorder

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Where did it come from?

• World War I
• Encephalitis epidemic
• Surviving
• Adults developed Parkinsons
• Children developed behavioral traits

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Possible Causes

• Neurotransmitters
• Underproduction or altered function of
  norepinephrine dopamine
• Family Genetics
• Distraught family hereditary/males
• Maturation Lag
• Explains why they grow out of it
• Hormones
• Hyperthyroidism rare strains of ADD
• Food Sensitivity
• Yellow food coloring and sugar proved to have
  effect on attention span

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Victims

• Anyone ages 6 and up
• Doctors will not make diagnosis prior to
• Adults not as regularly
• 8 of school aged children have some form

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Symptoms

• Inattentive
• Easily distracted
• Blurts out answers
• Hyperactive/Impulsive
• Unorganized
• Doesnt complete tasks
• Avoids activities requiring mental effort

• Difficult to keep friends
• Clumsy
• Destructive
• Difficulty sleeping
• Mood Swings
• Low tolerance for frustration
• Poor academics
• Low Self Esteem

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Diagnosis Controversy

• 6 months of symptoms
• Surveys
• Teachers and parents
• Lack of Parenting
• Need a good butt whippin
• Learning Disability
• ADD Inattention is 1 deficiency
• LD 2 and result of difficulty processing
  information

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Treatment Options

• Therapy
• Behavioral
• control impulsiveness
• Family
• alter parenting punishment
• Social
• interact well w/ others
• Psychological
• Better self-esteem better deal w/ stress
• Educational
• Modified learning and lower studentteacher
  ratio
• Drug
• Control Symptoms

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Medications

• Benzedrine
• amphetamines
• Methedrine
• methamphetamine
• Dexedrine
• dextroamphetamine
• Ritalin/LA
• methylphenidate HCl
• Concerta
• methylphenidate HCl
• Focalin/XR
• dexmethylphenidate HCl
• Adderall/XR
• amphetamine salts
• Strattera
• atomoxetine HCl
• Daytrana
• methylphenidate HCl
• Vyvanse

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Controlled Substances Act

• Drug scheduling (I V)
• Potential for abuse, safety, dependence
• Currently accepted for medical use
• Nine of the ten drugs used for treatment are
  Schedule II
• Same Schedule as Percocet, Oxycontin, and
  Methadone

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Medications

• Benzedrine
• racemic amphetamines
• Methedrine
• methamphetamine
• Dexedrine
• dextroamphetamine
• Ritalin/LA
• methylphenidate HCl
• Concerta
• methylphenidate HCl
• Focalin/XR
• dexmethylphenidate HCl
• Adderall/XR
• amphetamine salts
• Strattera
• atomoxetine HCl
• Daytrana
• methylphenidate HCl
• Vyvanse

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Structures HCl
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Stimulants

• All but Strattera
• Same biological effects
• Differences
• Active ingredient
• Stereochemistry
• Form/Administration
• Method of Release

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Stereochemistry

• Benzedrine (1928)
• amphetamines
• Methedrine
• methamphetamine
• Dexedrine
• dextroamphetamine
• Adderall/XR (1996)
• mixed amphetamine salts
• Vyvanse (2007)
• lisdexamfetamine dimesylate

• Ritalin/LA (1950s)
• methylphenidate HCl
• Concerta (2000)
• methylphenidate HCl
• Daytrana
• methylphenidate HCl
• Focalin/XR
• dexmethylphenidate HCl

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Administration/Form

• Benzedrine - inhaler, later tablet
• amphetamines
• Vyvanse - capsule
• lidexamfetamine dimesylate
• Concerta - tablet
• methylphenidate HCl
• Daytrana - patch
• methylphenidate HCl

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Method of Release
Concerta

• Adderall/XR
• d-amphetamine saccharate
• d-amphetamine sulfate
• dl-amphetamine aspartate monohydrate
• dl-amphetamine sulfate

• lisdexamfetamine
• ?
• dextroamphetamine l-lysine

Daytrana directly into blood, no 1st pass
Vyvanse prodrug video
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Plasma concentration-time profile
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Mechanism

• Specific mechanisms is unknown
• Block reuptake of NE dopamine into
  pre-synaptic neurons
• Increase release into extra neuronal space
• Paradoxical Effect
• Stimulate Inhibition
• Sympathomimetic Response
• Connection between surviving adults and children

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Strattera

• Only non-controlled, non stimulant drug
• SNRI
• Selective NE reuptake inhibitor
• Not dopamine, so good for mild cases

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Contraindications

• Hypertension
• Physical heart abnormality
• Tachycardia
• Glaucoma

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Drug-Drug Interactions

• MAO inhibitors
• Alcohol
• Enhance and abuse
• Decongestants
• Vasoconstriction

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Side Effects

• Mild hypertension
• Slight increase in HR
• Abdominal pain
• Constipation
• Appetite suppressed
• Nausea
• Insomnia
• Headaches
• Mood Swings
• Irritability

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Other Interests and Info
Interview ADD medications for
Parkinsons How does medication selectively
stimulate parts of brain?

• Methylphenidate causes same response but by
  different means.

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References

• Moghadam, H., Joel Fagan. Attention Deficit
  Disorder. Calgary Detselig Enterprises, 1994.
• Rafalovich, Adam. Framing ADHD Children. Oxford
  Lexington Books, 2004.
• Thomas, Shawn. Drug Reference for FDA Approved
  Psychiatric Drugs. Last visited 10 Mar 2008.
  Updated 12 June 2006. http//www.neurotransmitter.
  net/drug_reference.html
• Grcevich, Stephen. Mixed amphetamine salts
  extended release a clinical review of its use in
  the treatment of attention-deficit hyperactivity
  disorder. Future Neurology. Sep2006, Vol. 1
  Issue 5, p525-534, 10p.
• Methylphenidate CONCERTA (generic) (BRAND).
  Brown University Child Adolescent
  Psychopharmacology Update. Nov2006, Vol. 8 Issue
  11, following p8-8, 2p
• Drug inserts for Adderall, Concerta, Daytrana,
  Focalin, Vyvanse.