66. ADHD Flashcards
ADHD is the most common neurodevelopmental disorder in ____, occurring almost twice as often in boys compared to girls
children
ADHD is characterized by symptoms of __
inattention, hyperactivity, and impulsivity
The primary treatment for ADHD is ___ medications because they raise ___ levels
stimulant meds (e.g. methylphenidate, amphetamine)
raise dopamine and NE levels
ADHD medications are considered first line in pts ≥ ___ yo and should be used with behavioral interventions when available
≥6yo
DSM-5 Dx criteria for ADHD
Inattention:
≥ 6 symptoms of inattention for children up to age 16 (≥5 symptoms for ages 17 or older)
Symptoms must have been present for at least 6 months and are inappropriate for the developmental level
Symptoms:
Fails to pay attention, has trouble holding attention, dose not pay attention when someone is talking, does not follow through on instructions, fails to finish schoolwork, has difficulty organizing tasks, avoids or dislikes tasks which require mental effort, loses things, is easily distracted, is forgetful
Hyperactive + Impulsivity:
≥6 symptoms of hyperactive-impulsivity for children up to age 16 (≥5 symptoms for ages 7 and older)
Symptoms must have been present for at least 6 months and are inappropriate for the developmental level
Symptoms:
Often fidgets or squirms, leaves seat unexpectedly, runs about when no appropriate, unable to play quietly, is “on the go” as if “driven by a motor”, talks excessively, blurts out answers, has trouble waiting his/her turn, interrupts or intrudes on others
Following conditions must be met:
- several inattentive or hyperactive-impulsive symptoms were present before age 12
- symptoms must have been present in 2 or more settings (e.g. at home, school, work, with friends, relatives, or babysitters)
- symptoms interfere with functioning and are not caused by another disorder
Natural products used for ADHD
Fish oil
Melatonin used to help with sleep onset in individuals taking stimulants
Why are long-acting formulations of stimulants preferred for children?
To maintain more steady symptom control and avoid need for dose during day at school
___, a non-stimulant med, can be tried when stimulants do not work well enough (After trials of 2-3 meds) for ADHD. Can be used first line when prescribers are concerns about possibility of abuse by pt or family.
Atomoxetine (Strattera)
____ and ___ are non-stimulant meds that can be used alone or in combo with stimulants for ADHD
Guanfacine ER (Intuniv) and clonidine ER (Kapvay)
Patient-friendly formulations for stimulants used in ADHD
Capsule
- some can be sprinkled on a small amount of applesauce (e.g. Adderall XR, Ritalin LA)
- Vyvanse capsules can be mixed in water, OJ, or yogurt
Chewable tab (e.g. Vyvanse)
ODT
Patch (e.g. Dayrana)
Suspension
Examples of first-line stimulants used for ADHD
Taken in AM
Methylphenidate (e.g. Concerta, Daytrana, Ritalin)
Lisdexamfetamine (Vyvanse)
Dextroamphetamine/Amphetamine (Adderall, Adderall XR)
Examples of meds used to help sleep at night in ADHD pts
clonidine IR (Catapres)
Diphenhydramine (OTC, 25-50mg)
Melatonin (OTC, 2-5mg)
All stimulants are ___ scheduled meds and must be dispensed with MedGuide
C-II
Do not use stimulants within ___ of MAOi d/t risk of ____ when used together
14 days
hypertensive crisis
Warnings with stimulant use
Increase HR and BP (d/t increased levels of DA and NE), can cause serious CV events in children and adults
Other vascular problems (e.g. ppriapism, Raynaud’s disease)
New-onset psychosis or mania, or an exacerbation of preexisting psychosis (e.g. mixed/manic episode in bipolar disorder)
Lower seizure threshold
Loss of appetite - can decrease child’s growth trajectory
Serotonin syndrome risk
