ADHD Flashcards
Describe the symptoms of ADHD
Hyperactivity, impulsivity and inattention → can lead to functional impairment such as psychological, social, educational and occupational difficulties
When do symptoms typically appear? and what gender most common in?
3-7 year olds, may not be recognised after 7 if hyperactivity not present. Men
What is the treatment pathway for ADHD
Methylphenidate or Lisdexamfetamine (switch if no improvement in 6 weeks)
Dexamfetamine can be tried if pt having beneficial response to lisdexamfetamine but cannot tolerate longer DoA
What kind of preparations are preferred in ADHD?
Pharmacokinetic profile, convenience, improved adherence, reduced risk of drug diversion and lack of need to be taken to work. IR can be used in flexible dosing regimens, initial dose titration. Both can also be used together
What is second line in treatment of ADHD
Atomoxetine (non-stimulant, if others CI or ineffective)
Specialist advice - guanfacine or atypical antipsychotic (if aggression/irritability)
When would you review guanfacine
Postural hypotension or fainting, reduce dose and alternate
Describe the mechanism of action of methylphenidate
Potent CNS stimulant, increased dopamine and NA levels in brain
List the side effects of methylphenidate
Reduced appetite, insomnia, weight lost
Increased HR, BP
Tic’s and Tourette’s syndrome
Growth restriction in children - Monitor height + weight. Allow catchup (drug-free) period to grow
What are the monitoring parameters for methylphenidate?
Pulse, BP, appetite, weight and heigh on initiation, following each dose increment and 6 months thereafter
Psychiatric disorders
What are the C.I’s for methyphenidate?
CVD - hyperthyroidism, severe hypertension, uncontrolled bipolar, severe depression
Prescribing of MR methyphenidate
Must be prescribed by the brand
Relationship between dexamfetamine and lisdexamfetamine
lisdexamfetamine is pro-drug of dexamfetamine - has a longer half life
Side effects of ampfetamines
Appetite loss, anorexia, increased HR/BP, Tic’s and Tourette’s syndrome, Growth restriction in children (monitor weight and height), allow catchup (drug-free) period to grow
What are the overdose symptoms of amfetamines
Wakefullness, hyperactivity, paranoia, hallucinations, HTN, followed by exhaustion, convulsions, hyperthermia, coma
What are the monitoring parameters for amfetamines?
Pulse, BP, appetite, weight, height on initiation, following each dose increment and 6 months thereafter
Aggression during initial period
Growth in children
