LK is an 18-year-old female that comes into your community pharmacy to pick up her new prescription of Strattera. LK was recently diagnosed with ADHD. She begins college in one month and has never taken this medication before. LK has plenty of questions and concerns regarding the medication.

PMH:

ADHD

Medications:

Strattera 40 mg one tablet by mouth once daily

Junel Fe 1/20 one tablet by mouth once daily

Which of the following is true regarding Strattera and can be discussed with LK? (Select all that apply)

A. Strattera is a stimulant and LK and her physician should monitor her blood pressure and heart rate regularly.

B. Strattera has a boxed warning for increased risk of suicidal ideation in children and young adults.

C. Strattera has an immediate (several days) therapeutic effect compared to other classes of ADHD medications.

D. Strattera is efficacious for ADHD most likely due to its presynaptic norepinephrine transport inhibitor properties.

E. Strattera can cause hepatotoxicity and LK should monitor for any signs of liver damage and regularly follow up with her physician to monitor liver function tests.

Attention Deficit Hyperactivity Disorder (ADHD) is a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development. ADHD mostly affects children and young adults with an estimated prevalence of 11% in children and 4% in adults. ADHD has two main pathophysiological manifestations: norepinephrine dysfunction that leads to an inability to control mood or attention and a decrease in the dopamine reward pathway that leads to the brain being unable to maintain attention, resist distraction or regulate mood. There are two main classes of medications used in the treatment of ADHD, stimulants and non stimulants. Most stimulants are controlled medications and work through increasing dopamine and norepinephrine. Non stimulants vary in mechanisms of action and are typically considered second line therapy. Let's see how you did on this question involving Strattera. 

Answer A is incorrect: Strattera is NOT a stimulant, however increased blood pressure is a rare side effect that can be seen.

Answer B is correct: Strattera was seen to cause an increased risk in suicidal ideation in children and adolescents. This is a rare but serious adverse effect that should be discussed with the patient.

Answer C is incorrect: Strattera takes 2-4 weeks for therapeutic onset and up to 6 weeks for full effect.

Answer D is correct: Strattera has a mechanism of action of inhibiting norepinephrine reuptake.

Answer E is correct: Although it is rare, Strattera can cause severe liver injury and should be monitored on a regular basis by the patient and prescribing physician.

Brand/Generics covered: Ethinyl Estradiol/Norethindrone (Junel Fe), Atomoxetine (Strattera)

NAPLEX Competencies covered:

Area 1 – Obtain, Interpret, or Assess Data, Medical, or Patient Information

1.4 - From medical records: treatment adherence, or medication-taking behavior; chief complaint, medication history, medical history, family history, social history, lifestyle habits, socioeconomic background

Area 2 – Identify Drug Characteristics

2.1 - Pharmacology, mechanism of action, or therapeutic class

2.2 - Commercial availability; prescription or non-prescription status; brand, generic, or biosimilar names; physical descriptions; or how supplied

Area 3 – Develop or Manage Treatment Plans

3.5 - Drug route of administration, dosage forms, or delivery systems

3.7 - Adverse drug effects, toxicology, or overdose

3.8 - Drug interactions

3.9 - Therapeutic monitoring parameters, monitoring techniques, monitoring tools, or monitoring frequency