102b - ADHD Flashcards
Which areas of the brain are affected by ADHD?
- Prefrontal cortex
- Executive function and planning
- Striatum
- Reward, reinforcement
- Motivation for behavior and activities
- smaller overall brain volume that is maintained through development
What is the mechanism of action of atomoxetine (Strattera) in the treatment of ADHD?
In which patients is it indicated?
- Atomoxetine (Strattera) is a selective NE reuptake inhibitor that takes longer to see its effects (4 wks)
Works as an antidepressant to treat ADHD + anxiety
takes longer to see its effects
**Black box warning: increased suicidal thoughts in teenagers**
What comorbididities should we be aware of in children with ADHD? (4)
- Behavior or conduct problem — oppositional defiant disorder (ODD)
- Anxiety
- Depresssion and othermood disorders
- Autism spectrum disorder
- Learning and/or speech disorders
- Tourette syndrome
- Substance use disorder
- Obesity
What environemtal exposures contribute to risk of ADHD?
- Smoking, alcohol, or drugs during pregnancy
- Lead exposure
- Brain injury
- Premature delivery + low birth weight
What causes ADHD?
Strong genetic component
(multiple genes + gene-environment interaction)
Environmental risk factors
- Smoking, alcohol, drugs during pregnancy
- Lead exposure
- Brain injury
- Premature delivery + low birth weight
- May confound with other factors
What is the role of therapy in the treatment of ADHD?
Therapy alone is less affective than medication alone
However, combination treatment may be good for other areas of functioning:
- Anxiety
- Academic performance
- Parent-child relationships
- Social skills
What is the mechanism of action of stimulant medications in the treatment of ADHD?
-
Stimulants are the first line medication option.
- MOA: stimulate portions of the brain that are underactive by blocking reuptake of DA and NE and facilitating its release into the synapse
- Methylphenidate stimulants (Ritalin)
- Amphetamine mixed salts (Adderall)
- Side effects: decreased appetite, insomnia and is contraindicated in ppl w/ cardiac issues
- black box warning related to potential abuse and cardiovascular events/death w/ missuse
What is the most effective treatment for ADHD?
pharmacological management
Stimulants are first line (methylphenidate, amphetamine)
Non-stimulants: Atomoxetine (Strattera) and alpha-2 blockers (clonidine, guanfacine) are second line
What is the mechanism of action for guanfacine in the treatmnet of ADHD?
What are the indications and side effects?
- Clonidine and Guanfacine are alpha 2 agonists that reduce CNS sympathetic activation by reducing NE release
- common side effects are sedation, drowsiness, and depression; most serious side effects are low blood pressure, dizziness, and fainting
- these are often used in addition to the stimulants
What is the DSM-5 criteria for ADHD?
-
DSM5 Criteria:
- persistent pattern of inattention and/or hyperactivity that interferes w. functioning or development and have persisted for at least 6 months
- need 6+ symptoms from the inattentive category or the hyperactive category
- several symptoms have to occur before age 12 and in at least two settings (home, school, extracurricular activities, etc)
- persistent pattern of inattention and/or hyperactivity that interferes w. functioning or development and have persisted for at least 6 months
In how many settings do ADHD symptoms ahve to occur in order to diagnose ADHD?
At least 2
What are the contrindications to stimulants for the treatment of ADHD?
Significant cardiac history
Before what age must ADHD symptoms present to meet criteria for formal diagnosis?
Before age 12
What are the side effects of stimulants to watch out for in the treatment of ADHD?
- Decreased appetite
- Insomnia
- Headache
- Nausea
- Less common
- Irritability
- Lability
- Tics
- Heart racing
- Emotional blunting
- Hallucinations
What is the prevalence of ADHD?
3-11% of school-aged children
M>F
F more likely to have the inattentive type
