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PHRM 845 > 4.9 Pharmacotherapy of pediatric psychiatry > Flashcards

4.9 Pharmacotherapy of pediatric psychiatry Flashcards

1
Q

How does the DSM5 define tourette’s disorder?

A

Tics may wax and wane in frequency, but have been present for >1 year

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2
Q

According to the DSM5, when does tourette’s disorder start?

A

Onset before age 18

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3
Q

How does the DSM5 define persistent (chronic) motor or vocal tic disorder?

A
  • Single or multiple motor or vocal tics present, but not both
  • Tics may wax and wane in frequency, but have been present for >1 year
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4
Q

Can persistent (chronic) motor or vocal tic disorder be attributable to substance use or another medical condition?

A

No

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5
Q

How does the DSM5 define provisional tic disorder?

A

Sxs as persistent (chronic) motor or vocal tic disorder, but present for <1 year

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6
Q

Pts w tic disorders also have what other conditions?

A

75% also have ADHD, 50% also have OCD

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7
Q

What is the rule of thirds for progression of tic disorders?

A
  • 1/3 resolve, 1/3 improve, 1/3 stay the -same
  • 10% have persistent sxs as adults
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8
Q

What is the 1st line pharmacologic tx of tics?

A
  • Alpha 2 agonists: clonidine, guanfacine, ER guanfacine
  • For tics of mild-moderate severity
  • 30% reduction
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9
Q

What is the 2nd line pharmacologic tx of tics?

A
  • Atypical antipsychotics: aripriprazole, risperidone
  • 30-60% reduction
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10
Q

What is the 3rd line pharmacologic tx of tics?

A
  • Typical antipsychotics: haloperidol, pimozide
  • 80% reduction
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11
Q

Aripiprazole is approved for what age range?

A

FDA approved for 6-17 yo

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12
Q

What is the dosing if a pt taking aripiprazole is <50 kg?

A
  • 2 mg daily x 2 days, increase to 5 mg daily
  • Max: 10 mg
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13
Q

What is the dosing if a pt taking aripirazole is >50 kg?

A
  • 2 mg daily x 2 days, 5 mg daily x days
  • Target 10 mg once daily
  • Max: 20 mg
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14
Q

What can use of amphetamine-based stimulants exacerbate?

A

Exacerbate motor and vocal tic sxs

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15
Q

What must be treated along w Tourette’s?

A

ADHD

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16
Q

If a pt doesn’t tolerate or want to take amphetamine based stimulants, what are the other options?

A

Can d/c amphetamine based stimulants and give a trial of atomoxetine or a tricyclic antidepressant

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17
Q

After trying atomoxetine or a tricyclic antidepressant and it doesn’t work, what are next steps?

A

If ADHD sxs are not well controlled, can resume amphetamine based stimulant and adjust dose of antipsychotic to better control Tourette’s sxs

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18
Q

What are common behaviors in conduct disorder?

A
  • Destruction of property
  • Deceitfulness or theft
  • Serious violations of rules
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19
Q

What must be specified for conduct disorder?

A

Specify whether:
- Childhood-onset type: <10 yo
- Adolescent-onset type: >10 yo (no sxs under 10 yo)
- Unspecified onset: unclear info to determine age onset

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20
Q

For tx of ODD and CD, what is pharmacotherapy is considered as?

A
  • Pharmacotherapy is considered adjunctive, palliative, non-curative
  • Should only be used after baseline sxs/behaviors have been determined
  • Other interventions have failed and/or aggression has escalated to dangerous levels
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21
Q

What can atypical antipsychotics be used for regarding ODD and CD?

A

May be used to tx severe persistent aggression, serious oppositional behaviors, defiance

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22
Q

For treatment of ODD and CD, when do we often see combination stimulant/alpha agonist tx?

A

If ADHD w impulsivity or need for sedation for sleep

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23
Q

What is 1st line for tx of mild separation anxiety disorder?

A

Psychotherapy

24
Q

What is 1st line for tx moderate to severe mild separation anxiety disorder?

A

Combination therapy of psychotherapy + SSRIs

25
Q

What is the 1st line medication choice for separation anxiety disorder?

A

SSRIs

26
Q

How does the DSM5 define autism spectrum disorder?

A
  • Persistent deficits in social comm and social interaction across multiple contexts
  • Restricted, repetitive patterns of behavior, interests, activities
27
Q

What are the associated behavior sxs of ASD?

A

Aggression, hyperactivity, inattention, irritability, mood instability, poor frustration tolerance, self-harm, severe temper tantrum, sleep disturbances, OCD sxs, hypersensitivity of senses

28
Q

What are the associated medical problems of ASD?

A

Seizure disorder (up to 30% have at least one seizure by age 20) and GI disorders

29
Q

Are there any meds that tx the core ASD sxs?

A

No

30
Q

What is the 1st line tx for disruptive behaviors in ASD?

A

Behavioral interventions (applied behavioral analysis)

31
Q

What meds are used for tx of disruptive behaviors in ASD?

A

Atypical antipsychotics:
- Aripiprazole (6-17 yo) and risperidone (5-16 yo) are FDA approved for mgmt of irritability/aggression and are considered 1st line agents
- May have efficacy for stereotypy and hyperactivity

32
Q

What meds have no effect on disruptive behaviors of ASD?

A

Lamotrigine/levetiracetam have no significant effect on irritability

33
Q

What is the tx for repetitive behaviors?

A

Antipsychotics: haloperidol, risperidone, aripiprazole

34
Q

What is the tx for ADHD?

A
  • Stimulants: methylphenidate preferred
  • Clonidine/guanfacine: modest effect on irritability and explosive behavior
35
Q

What is the tx for sleep?

A

Melatonin reduced sleep latency and increased time asleep: 1-6 mg nightly

36
Q

How does the DSM5 define disruptive mood dysregulation disorder?

A

Severe recurrent temper outbursts manifested verbally that are out of proportion w intensity/duration of situation

37
Q

According to the DSM5, where must disruptive mood dysregulation disorder be present?

A

Present in at least 2 out of 3 settings (home, school, w peers) and are severe in at least 1

38
Q

When should diagnosis of disruptive mood dysregulation disorder not be made?

A

Diagnosis should not be made before age 6 or after age 18

39
Q

What must disruptive mood dysregulation disorder be differentiated from?

A

Need to differentiate from bipolar disorder - both for using antidepressants as well as evaluating need for mood stabilizers

40
Q

What is considered 1st line tx for disruptive mood dysregulation disorder?

A

SSRIs and stimulants

41
Q

What are sxs of pediatric depression in children?

A

Physical complaints, irritability, conduct problems, can have suicidal ideation

42
Q

What are sxs of pediatric depression in adolescents?

A

Express feelings of depression and suicidal behaviors than more younger children

43
Q

Is pediatric depression more short or long term?

A
  • More chronic than episodic, instability in mood common
  • May be a marker for bipolar disorder
44
Q

What is 1st line tx for depression?

A
  • Nonpharm is 1st line; need motivation of family/caregivers for success
  • Cognitive behavioral therapy: remission rates of 70%
45
Q

What is the black box warning for antidepressants?

A

Black box warning for suicidality:
- Highest risk in first 3 months of tx
- Med guide w each prescription
- Antidepressants may lower completed suicide rate

46
Q

What is the use of fluoxetine for depression?

A

Only antidepressant FDA approved t tx kids down to 8 yo

47
Q

What is the use of escitalopram for depression?

A

For 12-17 year olds

48
Q

What is the paroxetine for depression?

A

1st antidepressant w suicidal thinking warning - avoid in kids

49
Q

What are the preferred drug options for bipolar 1, mixed or maniac, w/o psychosis?

A

Lithium, valproate, carbamazepine, olanzapine, risperidone, quetiapine; may augment w 2nd agent if needed after 4 weeks

50
Q

What are the preferred drug options for bipolar 1, mixed or maniac, w psychosis?

A

Lithium, valproate, carbamazepine, W any atypical antipsychotic, consider d/c of atypical if remission for 12-24 months

51
Q

What are the preferred drug options for bipolar, depressed?

A

1st line - lithium, SSRI/bupropion for depression that continues w lithium tx (adjunct to lithium)

52
Q

What is 1st line nonpharm tx for PTSD?

A

Trauma focused psychotherapy

53
Q

What is 1st line pharm tx for PTSD?

A

SSRIs

54
Q

What is childhood onset schizophrenia not explained by?

A

Not explained by substance use or PDD/autism

55
Q

What is more common in childhood onset schizophrenia?

A

Visual hallucinations more common than in adults

56
Q

When does sxs onset in childhood onset schizophrenia?

A

Onset of sxs before age 13

57
Q

What is the prevalence of childhood onset schizophrenia?

A

Rare in children, adolescent prevalence reaches adult prevalence of 0.05-1%

PHRM 845 (48 decks)

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