(Pharmaceutical )

1. ADHD
Attention deficient hyperactivity disorder

3. Présentation contents:
 Definition of the disease
 Disorder of the CNS
 Classes of drugs for treatment
 New agents

4. Definition :
 One of the most common childhood disorders and can continue through
adolescence and adulthood
 There are three types :
Predominantly
hyperactive-
impulsive
• Symptoms of
inattention may be
present
Predominantly
inattentive
• They may sit
quietly, but they are
not paying attention
to what they are
doing
Combined
hyperactive-impulsive
and inattentive
• Most children have
the combined type
of ADHD.

5. Symptoms
Inattention Symptoms Hyperactivity Symptoms Impulsive Symptoms
• Is easily distracted
• Doesn't follow directions
or finish tasks
• Doesn't appear to be
listening
• Doesn't pay attention and
makes careless mistakes
• Forgets about daily
activities
• Has problems organizing
daily tasks
• Doesn’t like to do things
that require sitting still
• Often loses things
• Tends to daydream
• Often squirms, fidgets, or
bounces when sitting
• Doesn't stay seated
• Has trouble playing
quietly
• Is always moving, such as
running or climbing on
things (In teens and
adults, this is more
commonly described as
restlessness.)
• Talks excessively
• Is always “on the go” as if
“driven by a motor”
• Has trouble waiting for his
or her turn
• Blurts out answers
• Interrupts others

6. Disorder in CNS
decrease

7. Classes of Drugs
 Drugs used :They can help manage symptoms, such as:
 Short attention span.
 Impulsive behaviour.
 Hyperactivity.
 Classes :
 Stimulant Drugs
 Non Stimulants
Short Acting
Long Acting
Intermediate
Acting

8. Short acting stimulants
Amphetamine Dextroamphetamine Methylphenidate
Increase synaptic conc. Of
DA,NE
By enhancing the release
and inhibiting the uptake
Same MOA Threo-isomers pair are the
active enantiomer
Racemic mixture
Blocks the reuptake of
NE,DA

9. Intermediate and long acting Stimulants
Intermediate acting agents Long acting agents
1) Amphetamine Sulphate Lisdexamfetamine : Amphetamine acylated
with lysinyl fuction
Prodrug slowly Hydrolysed to
amphetamine
2) Dexmethylphenidate (dextro isomer of
threopair more motent than the racemic
mixture)

10. Pimoline
Potent CNS stimulant. Has 4 weeks delayed
action.

11. Non Stimulants (generally less effective in
treating ADHD than stimulants.)
Atomoxetine Clonidine Guanfacine
selective inhibitor of the
presynaptic norepinephrine
transporter (R enantiomer
more active)
Alpha 2 agonist (
presynaptic)
Alpha 2 agonist (
presynaptic)
-Indicated for patients for
whom stimulants are
contraindicated.
- Drug doses should be
slowly titered
-second-line agent in the
treatment of ADHD
result in Marked improved
attentional abilities

12. Cont .
Atomoxetine Clonidine Guanfacine
Advantag
es
Atomoxetine does not
have an abuse potential
useful in some patients with
comorbidity, particularly in
the treatment of patients
with comorbid ADHD
Guanfacine is safe
and well tolerated in
children and adults
with ADHD .
- Guanfacine is less
sedating and has a
longer duration of
action than
clonidine
Disadvan
tages
insomnia, slightly
increased diastolic blood
pressure and heart rate,
decreased libido,
sweating, and dysuria
Dry mouth, sedation,
drowsiness, dizziness, and
constipation

13. Despiramine
Tricyclic Antidepressants are Third-Line of
treatment for ADHD
MOA:
1)NE-reuptake inhibitors
2)increasing activation of the alpha(2)-adrenergic
autoinhibitory receptor

14. New Agents
Newly Discovered

15. New Agents
4-(5-Methyloxazolo[4,5-b]pyridin-2-yl)-1,4-
diazabicyclo[3.2.2]nonane (CP-810,123)
Vortioxetine 1-[2-(2,4-
Dimethylphenylsulfanyl)phenyl]piperazine
α7 Nicotinic Acetylcholine Receptor Agonist
for the Treatment of Cognitive Disorders
Multimodal Compound
• Potent
• Selective
• excellent brain penetration
• 5-HT3, 5-HT7 and 5-HT1D receptor
antagonist,
• 5-HT1B receptor partial agonist,
• 5-HT1A receptor agonist and
• 5-HT transporter (5-HTT) inhibitor

16. In June 2017, the
FDA approved 2 new
ADHD medications
Contempla XR-ODT and Mydayis.

17. Contempla XR-ODT and Mydayis.
Contempla XR-ODT Mydayis
The first methylphenidate-based extended-
release orally disintegrating tablet for the
treatment of ADHD
Mydayis extended-release capsules
contain mixed salts of a single-entity
amphetamine , four salts:
1)dextroamphetamine sulfate
2)amphetamine sulfate,
3)dextroamphetamine saccharate and
4)amphetamine aspartate monohydrate

18. Cont .
Contempla XD-ODT Mydayis
• block the reuptake of norepinephrine
and dopamine
• increase the release of these
monoamines into the extraneuronal
space.
• Amphetamines sympathomimetic
amines with CNS stimulant activity..
• Amphetamines block the reuptake of
norepinephrine and dopamine
• increase the release of these
monoamines into the extraneuronal
space.
For the treatment of ADHD in children
between the ages of 6 and 17.
Approved for the treatment of ADHD in
adolescents and adults aged 13 years or
older.