ADHD

Question 1

ADHD is a behavioural disorder that is characterised by these 3 symptoms

Answer 1

hyperactivity
impulsivity
inattention

Question 2

symptoms of ADHD typically occur in children in this age range, but may not be recognised until after 7 esp if hyperactivity not present

Answer 2

3-7 yrs

Question 3

ADHD more common in F or M?

Answer 3

Males

Question 4

Some children will continue to have symptoms throughout adolescence and into adulthood. The following symptom tends to persist, whilst the following tend to recede over time

Answer 4

inattentive symptoms tend to persist, and hyperactive or impulsive symptoms tend to recede over time

Question 5

Also associated with increased risk of disorders e.g. ODD, conduct disorder, mood disorders, substance misuse - T or F?

Answer 5

True

Question 6

management of pt who have benefitted from drug treatment but symptoms are still causing significant important in at least one area of function (e.g. interpersonal rships, education and occupational attainment, risk assessment)

Answer 6

Consider combination of non drug (e.g. psychological interventions) and drug treatment

Question 7

drug treatment is initiated by …

Answer 7

specialist trained in diagnosis and management of ADHD

Question 8

which patients with ADHD should you start treatment in

Answer 8

symptoms are still causing significant impairment in at least one area of function, despite environmental modifications

Question 9

1st line for ADHD drug treatment adult (2)

Answer 9

lisdexamfetamine or methylphenidate

Question 10

How long should you trial a drug (lisdexamfetamine/methylphenidate 1st line) before considering switching to the other?

Answer 10

If symptoms have not improved after 6 week trial of either drug, consider switching to the other

Question 11

A patient is having a beneficial response to lisdexamfetamine, but cannot tolerate its longer duration of effect. What is the alternative

Answer 11

Dexamfetamine unlicensed can be tried

Question 12

In patients intolerant to both 1st line options of methylphenidate and lisdexamfetamine, or who have not responded to separate six week trials of both drugs, consider treatment with …

Answer 12

atomoxetine (non stimulant drug)

Question 13

Pt is unresponsive to one or more stimulant drugs (lisdex, methylphenidate), and atomoxetine. What do you do

Answer 13

Seek advice or refer to tertiary specialist in ADHD

Question 14

Guanfacine is initiated by specialist and indicated for ADHD in children for whom stimulate are not suitable, not tolerated, or ineffective. If the following two side effects occur with guanfacine, reduce dose or offer alternative treatment

Answer 14

sustained orthostatic hypotension (Excessive fall in BP when standing)
fainting episodes

Question 15

These 3 drugs + 1 drug class have been used in management of ADHD but use is not recommended without specialist advice due to limited evidence

Answer 15

bupropion
modafinil
TCAs
venlafaxine

all unlicensed

Question 16

Sexual dysfunction is associated with this drug that is used for ADHD

Answer 16

atomoxetine

Question 17

If a pt has new, or worsening existing seizures, what do you do

Answer 17

review treatment
stop any drug that might be contributing to seizures
treatment can be cautiously reintroduced is unlikely to be the cause

Question 18

Monitor patients for the development of this side effect associated with stimulant use. If it is stimulant related, consider dose reduction; stopping treatment; changing to non stimulant drug e.g. atomoxetine

Answer 18

tics

Question 19

A patient who has ADHD and has recently commenced stimulant drug (e.g. methylphenidate or lisdexamfetamine) has developed tics. What do you do

Answer 19

if stimulant related, consider dose reduction, stopping treatment or changing to non stimulant drug e.g. atomoxetine

Question 20

how often does ADHD treatment need to be reviewed and who by

Answer 20

at least once a year by specialist

Question 21

Treatment should be reviewed by specialists at least once a year and trials of ………, or ………. should be considered where appropriate

Answer 21

trials of treatment free periods, or dose reductions

Question 22

prescribing pathway for child aged 5 and over

Answer 22

1. methylphenidate
2. lisdexamfetamine if 6 week trial of above at max tolerated dose does not improve symptoms
3. dexamfetamine instead above if prolonged duration of action of lisdexamfetamine not tolerated
4. intolerant of both methylphenidate + lisdexamfetamine - give atomoxetine or guanfacine

Question 23

prescribing pathway for adults

Answer 23

1. methylphenidate or lisdexamfetamine
2. dexamfetamine if pt cannot tolerate long duration of action of lisdexamfetamine
3. atomoxetine