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Exam 6 > ADHD > Flashcards

ADHD Flashcards

1
Q

ADHD affects ____ of children and ___ US adutls

A

5-8%

4%

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2
Q

What are some of the psychosocial outcomes of ADHD

A

education and occupational underachievement, substance use problems, mood disorders, suicidal behaviors, earlier sexual activity, criminal convictions, more divorces

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3
Q

ADHD (is/is not) heritable

A

is-> 0.88

for example, eye color is 0.8

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4
Q

There are many comorbidities with ADHD such as

A

anxiety, depression, SUD, personality issues

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5
Q

Many patient’s parents also had ADHD which may have made them more likely to

A

have kids at young age, be unemployed, not take ids to doctor, substance abuse, put kids up for adoption

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6
Q 
Name the psychiatric syndrome:
five or more inattentive symptoms and/or five or more hyperactive impulsive symptoms
at least 6 months
inappropriate for developmental level
impairment present in 2 or more settings
may have impairment before age 12
A

ADHD

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7
Q

What are some inattentive symptoms in ADHD?

A

Does not give close attention to details/careless mistakes, trouble keep attention on tasks, does not listen when spoken to, does not follow through on directions, trouble organizing, doesn’t like thinks with sustained mental effort, loses things, easily distracted, forgetful in daily activities

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8
Q

What are some hyperactive symptoms in ADHD?

A

Fidgets or squirms in seat, gets up from seat inappropriately, excessive running or climbs when not appropriate, trouble doing things quietly, on the go/driven by a motor, talks excessively

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9
Q

What are some impulsive symptoms in ADHD?

A

blurts out answers before others finish, trouble waiting one’s turn, interrupt + intrudes (butt into conversation)

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10
Q

How to assess if an individual has ADHD?

A

standardized self report + observer rating scapes from multiple settings.
do not count on MSE, beware rater bias, testing has limited external validity (assess the environment that’s a problem)

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11
Q

What are behavioral treatments for ADHD in children?

A

positive reinforcement, parent training, school accommodations, organizational skills training

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12
Q

Behavioral treatment for ADHD in adults?

A

CBT, working memory training, medication, workplace accommodation

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13
Q

What are some advantages of stimulants as treatment of ADHD?

A

They work, different formulations + delivery + doses, doesn’t matter to miss a day, can be given on work or school days only

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14
Q

First and second line treatment for ADHD are ______. The two categories are?

A

CNS stimulants
methylphenidate (ritalin, metadata, daytrana)
Amphetamine based (adrenal, dexedrine, Vyvanse)

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15
Q

Does tolerance or dependency develop to CNS stimulants for ADHD?

A

No (usually don’t need to take for rest of life, just situation dependent)

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16
Q

What are potential adverse effects from CNS stimulants for ADHD?

A

CV problems, abuse potential, tics, appetite loss, irritability, anxiety, insomnia, zombie effect

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17
Q

Examples of antihypertensives that could be used to treat ADHD?

A

clonidine, Kapvay, Tenex, Intuniv

18
Q

______ is selective norepinephrine reuptake inhibitor used to treat ADHD, but clinically not as good as stimulants

A

atomoxetine. often underused.

increases HR, BP, risk of SI

19
Q

Are antidepressants used to treat ADHD?

A

not really
tricyclic: rarely bc safety + tolerability
Bupropion- not FDA approved but some benefit maybe, could be helpful for comorbid depression

20
Q

The two neurotransmitters that are deficient in ADHD

A

Dopamine and norepinephrine
These pathways affect attention and executive functioning
Dysregulation tuning leads to hyper activity inattention +impulsivity. noise>salient signal

21
Q

Medications for ADHD restore tuning. MOA for stimulants, atomoxetine, and α2 agonists

A
  • increase [ ] of DA and NE
  • norepi reuptake inhibitor
  • post synaptic alpha2 agonist
22
Q

Methylphenidate MOAs (treatment for ADHD)

A

block reuptake of DA and NE in synapse. inhibit monoamine oxidase, block breakdown of DA and NE.

23
Q

Amphetamine based meds for ADHD MOAs

A

block reuptake of DA and NE by inhibiting reuptake transporter
inhibit MAO (block breakdown DA and NE)
substrate for transporter-> VMAT2-> displace DA and NE from synaptic vesicles->increase DA and NE release

24
Q

CNS stimulants improve core symptoms such as _____, _____, ____

A

inattention, impulsivity, hyperactivity

25
Q

The goal for CNS stimulants for ADHD is __ hours of coverage. (Do/do not) give with food

A

12 hours

do not

26
Q

for ADHD, if CNS stimulant doesn’t work, what is the next step

A

switch to another stimulant. you want two trials of stimulants

27
Q

Onset, duration, and doses/day for immediate release, intermediate release, extended release ADHD meds

A

immediate: 30 min, 4 hours, 2-3/day
intermediate: 60 minutes, 6 hours, 2/day
extended: 30min-2hr, 10hrs, 1/day

28
Q

The most common adverse effects from CNS stimulants as treatment for ADHD

A

decreased appetite (eat lots of food at bfast/bedtime)
stomachache + headache (give with food)
insomnia (early in day)
irritability/jittery->decrease dose

29
Q

What are some psychiatric adverse effects from CNS stimulants as a treatment for ADHD?

A

(rare) psychosis, mood disturbances (irritability, lability, depression), anxiety
- >use nonstimulant

30
Q

Why should there be just a second of cause in using a CNS stimulant for ADHD in a patient with CV disease?

A

increase BP and heart rate. generally no increased risk of CV events though-> get ECGs just to be sure

31
Q

Growth suppression can be seen in CNS stimulants for ADHD because _____

A

alteration in human growth hormone, decreased thyroxine secretion, appetite suppression
medication holiday is good
if a worry-> non stimulant med

32
Q

CNS stimulants are a schedule ___ because there is abuse potential

A

II-> a low risk of stimulant abuse. oral route, slow absorption, slow onset, scheduled dosing, controlled environment. there is thoughts but not documentation that someone could develop SUD

33
Q

__% ADHD patients fail stimulants, so non-stimulants should be used.

A

10%

34
Q

First line treatment for ADHD is NOT stimulants if:

A

comorbid med condition so don’t use stimulants.
comorbid with tic disorder (contraindicated)
active SUD

35
Q

Are non stimulants for ADHD controlled substances? Why would you switch to one?

A

not controlled substances.

no abuse potential, lower risk of growth effect + sleep disturbances

36
Q

Atomoxetine MOA? Time of onset of effect?

A

inhibit reuptake of NE.
less effective than stimulants
2-4 weeks to onset-> full benefit 6-12 weeks

37
Q

Adverse effects of atomoxetine?

A

increased SI, liver injury, HR BP up

less effect on growth + sleep

38
Q

Clonidine and guanfacine MOA? Why would you use to treat ADHD?

A

-Post synaptic α-2a receptor agonism->direct stem α-2a in PRF-> ^blood in PFC -> ^working memory + executive function

39
Q

Why would you use Clonidine and guanfacine to treat ADHD?

A

Adjust to stimulants with severe ADHD->partially managed or aggressive/disruptive
Use when comorbid with tic
Useful for insomnia (clonidine is sedating α2b)

40
Q

Clonidine and guanfacine adverse effects?

A

sedation (clonidine)

hypotension

41
Q

Best treatment to use with someone with ADHD and a tic disorder?

A

Atomoxetine

42
Q

What medication is best to treat ADHD in someone with SUD?

A

atomoxetine, α1 agonist, buproprion

Exam 6 (14 decks)

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