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exam 4 > ADHD > Flashcards

ADHD Flashcards

1
Q

Demographics of ADHD

A

more common in males, white children and adolescents

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2
Q

ADHD is more common in people who…

A

have a first degree diagnosed relative

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3
Q

ADHD is multifactorial, true or false

A

true

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4
Q

What three factors feed into the diagnosis of ADHD

A

environmental, genetics, and physiological

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5
Q

50% of children with a parent diagnosed with ADHD will also have ADHD

A

true

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6
Q

median age of ADHD diagnosis

A

6 years old

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7
Q

in preschool, ADHD manifests as what

A

hyperactivity

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8
Q

in elementary school, ADHD manifests as what

A

inattentiveness

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9
Q

/ children with ADHD will have the diagnosis in adulthood

A

1/3

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10
Q

what are the comorbid conditions of ADHD

A

bipolar disorder (10%), mild tic (8-11%), AND there’s an increased risk of substance use and antisocial personality disorder

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11
Q

What could happen if ADHD is left untreated

A

substance use and antisocial personality disorder

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12
Q

four impacts of ADHD

A

poor academic performance, low self esteem, poor relationships, and employment difficulties

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13
Q

how many symptoms in each domain must be present in order to diagnose with ADHD

A

at least 6 symptoms in each domain

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14
Q

Adult ADHD diagnosis criteria

A

at least 5 symptoms are required for either of the two domains

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15
Q

True or false, several inattentive or hyperactive symptoms must be present prior to age 18 to be diagnosed with ADHD

A

false, prior to age 12

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16
Q

True or false, in order to be diagnosed with ADHD, several inattentive or hyperactive impulse symptoms are present in 3 or more settings

A

false, 2 or more settings

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17
Q

What cultural populations have less ADHD diagnoses than white children

A

black and latinx children

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18
Q

what are the two diagnostic domains for ADHD

A

hyperactivity and inattention

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19
Q

what are the 9 symptoms in the inattention domain

A

careless mistakes
difficult sustaining attention
doesn’t seem to listen
fails to finish tasks
difficulty organizing tasks
avoids things that require a lot of mental effort
loses things
easily distracted
forgetful in daily activities

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20
Q

9 Hyperactivity symptoms

A

fidgets
leaves seat a lot
runs and climbs
cannot play quietly
on the go
talks excessively
blurts out answers
difficult waiting turn
interrupts

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21
Q

what category of drugs is used for ADHD

A

stimulants usually, some non-stimulants

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22
Q

what kinds of drugs are stimulants

A

amphetamines or methylphenidates

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23
Q

what are 9 non-stimulants used for ADHD

A

atomextine, Viloxazine, Clonidine ER, Guanfacine ER, atypical antipsychotics, Bupropion, Imipramine, Modafinil, and mood stabilizers

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24
Q

What does RAS stand for

A

reticular activating system

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25
Q

Which gender is more likely to be diagnosed with ADHD

A

males`

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26
Q

Are adults or children more likely to be diagnosed with ADHD

A

children, adult rates 3-5%

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27
Q

Current trend of ADHD diagnosis

A

exponentially increasing

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28
Q

What are the top two causes of ADHD on the pie chart in the slides

A

Low body weight and heritable (genetics)

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29
Q

What is the main neurotransmitter implicated in ADHD

A

dopamine transporter

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30
Q

What 6 systems are implicated in ADHD

A

Dopamine transporter, COMT, cholinergic receptors, cholesterol metabolism, CNS development, glutamate receptors

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31
Q

ADHD causes reduced brain volume in certain areas, T/F

A

True

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32
Q

What is a metabolic change that happens in adults with ADHD

A

decreased cerebral glucose metabolism

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33
Q

What is a key clinical presentation of ADHD

A

symptoms must interfere with functioning and development

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34
Q

where is the circuity mechanism in the brain

A

medial prefrontal cortex

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35
Q

what is the name of stimulant compounds that mimic the effect of endogenous agonists of the sympathetic nervous system

A

methylxanthines (indirect-acting sympathomimetics

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36
Q

what is an example of a methyxanthine

A

caffeine

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37
Q

what receptor is antagonized by methylxanthines

A

adenosine receptors

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38
Q

are methylxanthines antagonists or agonists

A

antagonists

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39
Q

what is the result of methylxanthines on cAMP

A

increase cAMP, inhibit phosphodiesterases

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40
Q

what is the result of methylxanthines on ryanodime receptors

A

increase activity which increases intracellular ca2+

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41
Q

is adenosine receptor 1 (a1A) usually inhibitory or stimulatory on neurotransmitters

A

inhibitory linked

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42
Q

what receptor type is usually located in the cerebral cortex, hippocampus, cerebellum, thalamus, brain stem, and spinal cord

A

adenosine receptors

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43
Q

three effects that result from activation of adenosine receptors in the CNS

A

sedation, anxiolysis, anticonvulsant activity

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44
Q

one effect that result from peripheral activation of adenosine receptors

A

decrease heart rate

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45
Q

is A2A receptor usually inhibitory or stimulatory

A

stimulatory

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46
Q

what is A2A receptor responsible for

A

vasodilation

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47
Q

Where are A2B receptors located

A

glial cells

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48
Q

when are A3 receptors (4)

A

during excessive metabolism, seizures, hypoglycemia, stroke

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49
Q

How well do methylxanthines work on A3 receptors

A

not antagonized by methylxanthines

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50
Q

four common results of methylxanthines (7)

A

arousal, increased alertness, decreased fatigue, nervousness, insomnia, vasoconstriction, diuretic

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51
Q

What does VMAT stand for

A

vesicular monoamine transporter

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52
Q

what are the pathways called that are involved in abuse and addiction

A

reward pathways

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53
Q

what three neurotransmitters are examples of monoamine transporters

A

dopamine, norepinephrine, serotonin

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54
Q

what is one use of cocaine

A

local anesthetic

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55
Q

what are two examples of indirect-acting sympathomimetics

A

cocaine and amphetamines

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56
Q

what neurotransmitters does cocaine inhibit (3)

A

dopamine, norepinephrine, 5HT (serotonin)

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57
Q

why are amphetamines abused

A

they are highly rewarding

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58
Q

what are the effects of amphetamines (3)

A

increased ability to concentrate, wakefulness, alertness

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59
Q

are amphetamines selective or non-selective activators of monoamines

A

non-selective

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60
Q

What receptor is MDMA more selective for

A

5-HT (serotonin)

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61
Q

what is psychedelic revival associated with

A

MDMA (ecstasy, molly, love drug)

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62
Q

4 examples of amphetamines

A

dextroamphetamine, lisdexamfetamine, amphetamine, methamphetamine

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63
Q

What is unique about mydayis

A

mixture of amphetamine salts

64
Q

two other uses for amphetamines besides ADHD

A

narcolepsy and weight loss

65
Q

is adderall pure or a mix of salts

A

mix of salts

66
Q

what does atomoxetine do

A

norepinephrine transporter NET reuptake inhibitor

67
Q

is atomoxetine for adults or children

A

adults only

68
Q

whats the brand name of atomoxetine

A

strattera

69
Q

what ADHD drug is also approved for narcolepsy

A

modafinil

70
Q

What two transporters are inhibited by solriamfetol (sunosi)

A

NET and DAT

71
Q

What does TONES stand for and what drug is associated with it

A

Treatment of Obstructive sleep apnea and Narcolepsy Excessive Sleepiness with solriamfetol

72
Q

can stimulants be used for narcolepsy

A

yes

73
Q

can antidepressants be used for narcolepsy

A

yes

74
Q

can anxiolytics be used for narcolepsy

A

no

75
Q

what receptor does pitolisant act on

A

histamine 3 receptor antagonist/inverse agonist

76
Q

do stimulants stimulate the reuptake of neurotransmitters

A

NOOOOOO they inhibit the reuptake of neurotransmitters

77
Q

What two things do stimulants inhibit

A

NET and DAT, which inhibit the reuptake of norepinephrine and dopamine which increases the amount in the synapse

78
Q

do stimulants cause the release of neurotransmitters from the presynaptic terminal

A

YEAH

79
Q

stimulants do what to monoamine oxidase

A

INHIBIT

80
Q

atomoxetine and viloxazine mechanism of action

A

selective inhibition of norepinephrine reuptake

81
Q

guanfacine and clonidine mechanism of action

A

selective a2a agonist

82
Q

how quickly can we see the result of stimulants

A

short period of time, can adjust dose over a short period of time

83
Q

when should dose of stimulant be given

A

morning, avoid giving at night

84
Q

how many times a day are IR doses given (recommended)

A

twice a day at least

85
Q

True or false, pediatric patients should have their stimulant dose calculated based off of weight and height

A

false, not found to be impactful

86
Q

What kind of dose is preferred for patients under 16kg

A

IR because limited low-dose availability of long-acting stimulants

87
Q

you can use two different stimulants

A

false, keep it the same

88
Q

you can use two different dosage forms of stimulants

A

true

89
Q

how should the dose be adjusted if a patient experiences late afternoon symptoms

A

change to ER formulation

90
Q

what age is mydayis 12.5 mg recommended for

A

13-17

91
Q

What is the dose of mydayis for adults

A

25mg/day

92
Q

what is the dosage form of daytrana (methylphenidate)

A

patch

93
Q

what are the directions for daytrana

A

apply patch to outside of hip 2 hours prior to needed effects, remove after 9 hours and alternate hip daily

94
Q

daytrana is beneficial only for…

A

patients who already respond to methylphenidate

95
Q

what is the only patch form of stimulant

A

daytrana

96
Q

what is the brand name of lisdexamfetamine

A

vyvanse

97
Q

what should you know about vyvanse (lisdexamfetamine)

A

its a prodrug that is converted to dextroamphetamine

98
Q

lisdexamphetamine should only be used if the patient responds to

A

dextroamphetamine

99
Q

what is a counseling point of Jornay PM

A

take dose in the evening between 6:30PM and 9:30pm

100
Q

what is the brand name of methylphenidate hydrochloride

A

Jornay PM

101
Q

What are the adverse effects of stimulants (11)

A

appetite lose
abdominal pain
headaches
sleep disturbances
decreased growth
hallucinations
increased BP
Increased HR
sudden cardiac death
priapism
raynauds

102
Q

How to manage reduced appetite and weight loss

A

eat high calorie meals when stimulant effects are low (breakfast or dinner)

103
Q

how to manage stomach ache

A

take on full stomach, lower dose if possible

104
Q

how to manage insomnia

A

dose earlier in the day, lower dose, consider sedating med at bedtime

105
Q

how to manage headache

A

divide dose, give with food, give analgesic

106
Q

how to manage rebound symptoms

A

longer-acting stimulant trial, atomoxetine, antidepressant

107
Q

how to manage irritability and jitteriness

A

assess for co-morbid condition, reduce dose, consider mood stabilizer or atypical antipsychotic

108
Q

what should be done to manage priapism or raynauds

A

discontinue the med

109
Q

what are two uncommon adverse effects

A

hallucination and sudden cardiac death

110
Q

how to manage sudden cardiac death

A

assess risk of cardiac structural abnormality and family history, if concerned do a cardiac ECHO

111
Q

how to manage hallucinations

A

discontinue stimulant, reassess diagnosis, use mood stabilizer or antipsychotic

112
Q

7 things to monitor on stimulants

A

appetite, behavior, blood pressure, heart rate, sleep, growth rate, ECG (sudden cardiac death)

113
Q

what two drugs are alpha 2 agonists

A

guanfacine ER and Clonidine ER

114
Q

three counseling points of guanfacine ER

A

onset of action is about a month, should be taken once a day, and is a cyp3a4 substrate

115
Q

what is the generic name of intuniv

A

guanfacine ER

116
Q

what is the generic name of kapvay

A

Clonidine ER

117
Q

What should be done when discontinuing Clonidine and Guanfacine… why

A

must taper dose down, prevent rebound hypertension

118
Q

what is the generic name for strattera

A

atomoxetine

119
Q

how do you dose atomoxetine (strattera)

A

weight based dosing

120
Q

what is the target of atomoxetine

A

NET inhibitor

121
Q

what is the target of Viloxazine

A

NET inhibitor

122
Q

what is the generic name of Qelbree

A

Viloxazine

123
Q

what is the age for atomoxetine

A

6 years and older

124
Q

what substrate is atomoxetine

A

2D6

125
Q

What is a counseling tip for Viloxazine

A

its a capsule, swallow whole or put in applesauce

126
Q

what substrate is violoxazine

A

2D6/UGT stubstrate

127
Q

what does Viloxazine inhibit besides NET

A

1A2 inhibitor

128
Q

side effects of atomoxetine and viloxazine (3)

A

increased HR
increased BP
Increased suicidal thinking

129
Q

what is the boxed warning for viloxazine and atomoxetine

A

increase in suicidal thinking

130
Q

what are the side effects of guanfacine and clonidine (5)

A

decreased HR
Decreased BP (orthostasis)
somnolence
dizziness
rebound hypertension if abrupt dc

131
Q

what are the monitory parameters of non-stimulants

A

appetite, behavior, blood pressure, heart rate, growth rate, LFTs, sleep

132
Q

what should be monitored if they take atomoxetine

A

LFTs

133
Q

is bupropion approved for ADHD

A

not FDA approved

134
Q

when should bupropion be used for ADHD

A

when concerned about misuse or side effects of stimulants

135
Q

what does bupropion inhibit

A

2d6 inhibitor

136
Q

what is a contraindication of bupropion

A

seizures and eating disorders

137
Q

what is an adverse effect of modafinil (provigil)

A

SJS/TEN

138
Q

compare the efficacy of tricyclic antidepressants and methylphenidate

A

methylphenidate is more effective than tricyclic antidepressants for ADHD

139
Q

what is a concern of tricyclic antidepressants

A

sudden cardiac death in children, lethal in overdose

140
Q

can mood stabilizers or atypical antipsychotics be used for ADHD

A

may be used if there is comorbid bipolar disorder, conduct disorder, or intermittent explosive disorder

141
Q

what atypical antipsychotic is often seen in ADHD

A

valproate

142
Q

can antipsychotics be used as monotherapy for ADHD

A

NOOOOOO

143
Q

what is the first line treatment for ADHD in preschool children

A

parent training in behavior management (PTBM)

144
Q

what is the second line treatment for ADHD in preschool children

A

PTBM and FDA approved med

145
Q

what is the first line treatment for elementary and middle school children

A

PTBM and FDA approved med

146
Q

what is the first line treatment for adolescents with ADHD

A

FDA approved med and maybe PTBM

147
Q

what is the first line med for preschool

A

methylphenidate

148
Q

what drugs class should not be used in preschool children for ADHD

A

non-stimulant

149
Q

what is first line med for ADHD elementary age and adolescents

A

stimulants

150
Q

what is second line drug for children above preschool

A

atomoxetine, guanfacine, clonidine

151
Q

what can be used as adjunctive treatment

A

guanfacine and clonidine in addition to stimulants

152
Q

is methylphenidate long acting or short acting

A

both

153
Q

when could lisdexamphetamine potentially be trialed

A

after at least 6 weeks on methylphenidate

154
Q

what is the first line med for adults with ADHD

A

methylphenidate or lisdexamphetamine or dextroamphetamine or atomoxetine if unable to tolerate above meds

155
Q

third line ADHD drugs

A

bupropion, clonidine, imipramine, modafinil, atypical antipsychotics

156
Q

is guanfacine ER recommended in adults

A

noooooo

exam 4 (7 decks)

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