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PEBC > 3 - ADHD > Flashcards

3 - ADHD Flashcards

1
Q

What are the 3 hallmark symptoms?

A
  • hyperactivity
  • impulsivity
  • inattention
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2
Q

When do symptoms present?

A

usually before age 12, can persist into adulthood

*late-onset ADHD can also occur

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3
Q

For the diagnosis of ADHD, what do the symptoms need to cause and where do they need to be present and for how long?

A
  • need to cause interference with normal development
  • present in 2 or more settings (home, school, sports, etc.)
  • present for > 6 months
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4
Q

Medications are as effective as therapy, so why bother with therapy?

A
  • Therapy provides coping methods for both child and parent/caregiver
  • Gives the child tools to practise and use in the future when they potentially come off of ADHD medication
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5
Q

What are non-pharms?

A
  • Therapy!! (very important)
  • exercise
  • sleep
  • dietary restrictions (reduce sugars, dyes, preservatives) - this is not based on evidence but observation
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6
Q

What are the two MAIN classes of drugs for ADHD?

A

Stimulants:

  • dextroamphetamine (Dexedrine)
  • methylphenidate (Concerta, Ritalin)
  • mixed salts amphetamine (Adderall)
  • lisdexamfetamine (Vyvanse)

Non-stimulants:

  • atomoxetine
  • guanfacine
  • clonidine
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7
Q

What is first line for ADHD?

A

stimulants

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8
Q

What are some contraindications to stimulant use?

A
  • CV disease
  • MAOi use
  • History of drug abuse
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9
Q

How long should a trial of stimulants be?

A

3-4 week trial is reasonable

improvement in symptoms observed in the first week

reasonable to continue for 6-12 months

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10
Q

If no response at 3-4 weeks, then what?

A

switch stimulants

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11
Q

Can stimulants affect weight and height?

A
  • Yes - long term stimulants may decrease height and weight

- Get a baseline measurement and then need to monitor growth every 3-6 months (dose-dependent s/e)

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12
Q

Are drug holidays a good idea?

A

Yes - good way to reassess need - do this for a few weeks in the summer.

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13
Q

If diversion of stimulants is suspected, what do you do?

A

Switch to a non-stimulant:

  • Atomoxetine (Straterra)
  • Guanfacine (Intuniv)

**lower abuse potential

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14
Q

Out of the stimulants, what is first line?

A

long-acting agents should be first line

  • amphetamine, methylphenidate, lisdexamfetamine
  • once daily dosing, less abuse potential
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15
Q

What is atomoxetine and who is it used for?

A
  • NE reuptake inhibitior
  • used for those > 6 yo with ADHD
  • not a stimulant, not a controlled substance
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16
Q

How long do you need to treat for with atomoxetine to assess efficacy?

A
  • 6-12 weeks

- may take 3-4 weeks too see benefit

17
Q

Contraindications to atomoxetine?

A
  • CV problems
  • narrow angle glaucoma
  • MAOi use
18
Q

List the alpha 2 agonists used for ADHD

A
  • clonidine

- guanfacine

19
Q

What ADHD symptoms do alpha 2 agonists help with?

A
  • less benefit for inattention

- help with aggression, hyperactivity, impulsivity

20
Q

Compare clonidine and guanfacine

A

Guanfacine has more selective neuronal activity and longer DOA, resulting in less sedation and less hypotension

21
Q

Antidepressants role in ADHD?

A

2nd or 3rd line or adjunctive tx

22
Q

What antidepressants can be used in AHDD?

A
  • Buproprion (NDRI) - moderately effective for ADHD
  • Venlafaxine (some evidence for it)
  • TCAs (short term) - less effective than stimulants
23
Q

Out of the antipsychotics, which one can be used for ADHD?

A

low doses of risperidone (does not help with inattention)

24
Q

What stimulants are safe in pregnancy?

A

amphetamine and dextroamphetamine
*one study with 1.8 million pregnancies showed they were not associated with increase risk of congenital malformations or cardiac malformations

25
Q

Caution which stimulant in pregnancy, especially 1st trimester?

A

methylphenidate (Concerta, Ritalin)

*may be associated with elevated risk of cardiac malformations

26
Q

What are other options for ADHD in pregnancy?

A

TCAs, venlafaxine, bupropion

  • appear to be safe
  • but less effective for ADHD
27
Q

For breastfeeding, is methylphenidate safe?

A
  • transfer of methylphenidate into breast milk appears to be low, but effects on neurological development have not been studied
  • monitor baby for agitation and poor weight gain
28
Q

For breastfeeding, are amphetamines safe?

A
  • they are transferred into breast milk
  • but use appears to be safe, although neurological impact on the infant is also unknown
  • monitor for insomnia, agitation, irritability and poor weight gain in the infant
29
Q

Is atomoxetine safe in breastfeeding?

A

no studies done

30
Q

Are alpha 2 agonists safe in breast-feeding? (clonidine and guanfacine)

A
  • they may decrease milk production

- may cause side effects (ex. hypotension) in the infant so other options are preferred

31
Q

Can risperidone be used in breastfeeding?

A

limited information about this, use other agents instead

32
Q

Can you use TCA, bupropion or venlafaxine in breastfeeding?

A

yes, monitor baby for sedation, weight gain and irritability

33
Q

Which one can be mixed in water?

A

Vyvanse

34
Q

Which ones can be opened and sprinkled into soft foods?

A

Adderall XR
Dexedrine spansules
Vyvanse and Biphentin capsules

35
Q

stimulants can exacerbate ___ in some individuals

A

tics

36
Q

____ alone or in combination with stimulants is also effective in improving both ADHD and tic symptoms in patients with both conditions

A

clonidine

PEBC (130 decks)

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