ADHD Flashcards

1
Q

Overview of ADHD

A

higher rate if diagnosed in a first degree relative
etiology is multifactorial (environment, genetics, physiological)

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2
Q

Clinical course

A

One third of children with ADHD will have the diagnosis in adulthood

increased risk of substance use and antisocial personality disorder if ADHD is left untreated

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3
Q

ADHD diagnosis criteria

A

For each domain must have 6 symptoms

for older adolescents and adults (17 years and older), at least 5 symptoms are required for either of the two specifiers
several inattentive or hyperactive symptoms must be present prior to age 12 years

inattentive and hyperactive symptoms must be present in two or more settings

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4
Q

Inattention symptoms
must have 6 present

A

fail to have close attention to detail
doesn’t seem to listen
difficulty sustaining attention in tasks
doesn’t follow instructions
difficulty organizing tasks
loses things necessary for activities
easily distracted
forgetful in daily activity

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5
Q

Hyperactive and impulsivity symptoms
must have 6 present

A

fidgets
leaves seat
runs about
unable to engage in activity quietly
talks excessively
blurts out an answer
difficulty waiting their turn
interrupts or intrudes on others

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6
Q

Stimulant dosing

A

Dose response effects seen in a short period of time
IR formula is prefered in patients weighing more than 16kg
avoid giving dose too late in the day
Dont use two different stimulants, instead use two different dosage forms of the same stimulant

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7
Q

Mydayis (mixed amphetamine salts)

A

max dose is 25mg or 12.5mg (13-17yo) if CrCl is less than 30-15ml/min

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8
Q

Daytrana (methylphenidate)

A

Patch form
do not give the patch if patient has tried oral methylphenidate and failed that therapy

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9
Q

Vyvanse (lisdexamfetamine)

A

Prodrug converted to dextroamphetamine

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10
Q

Jornay PM

A

Take dose in the evening between 6:30pm and 9:30pm

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11
Q

Stimulant side effets

A

Appetite loss
sleep disturbances
Priapism (prolonged erection)
hallucinations
headaches

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12
Q

Stimulants common adverse effects and management

A

reduced appetitie - get high calorie meals when stimulant effects are low

stomach ache - take on full stomach

insomnia - take dose earlier in the day

headache - divide dose

rebound symptoms - longer acting formula

irritability, jitteriness - reduce dose and assess for another mental health disorder

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13
Q

Stimulants UNCOMMON adverse effects

A

Hallucinations - d/c stimulant reassess diagnosis

Risk for sudden cardiac death - assess patients risk of cardiac abnormalities

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14
Q

Stimulant monitoring

A

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

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15
Q

Alpha 2 agonists

A

Guanfacine ER - 3A4 substrate

Clonidine ER - dosed twice daily

Must taper to d/c to avoid rebound hypertension

SE: decreased HR and BP, orthostasis, somnolence, dizziness, rebound hypertension if abrupt stop

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16
Q

Norepinephrine reuptake inhibitors and SE

A

Atomoxetine - 2D6 substrate, weight base dosing >70kg give 40mg once daily, max 100mg

Viloxazine - capsules - swallow whole or put in applesauce, 2D6/UGT substrate; strong 1A2 Inhibitor

SE: increased HR and BP, increased suicidal thinking

17
Q

Bupropion

A

Not FDA approved for ADHD
2D6 inhibitor
contraindicated in seizure disorders and eating disorders

18
Q

AAP guidelines for preschool age

A

First line is parent training in behavior management
second line is training and FDA approved medication
First line is methylphenidate

19
Q

AAP guidelines for elementary and middle school age

A

First line is FDA approved medication and parent training in behavior management
First line - stimulants
Second line: atomoxetine, guanfacine ER, clonidine ER

20
Q

AAP guidelines for adolescents (age 12-18)

A

First line is FDA approved medication and may consider parent training therapy
Only guanfacine ER and clonidine ER have evidence as adjuncts to stimulants

21
Q

ADHD guidelines for adults

A

Methylphenidate or lisdexamfetamine

  • dextroamphetamine (if unable to tolerate lisdexamfetamine long half life)

Atomoxetine (if no symptoms response to above agents)