ADHD Flashcards
ADHD is a behavioural disorder that is characterised by these 3 symptoms
hyperactivity
impulsivity
inattention
symptoms of ADHD typically occur in children in this age range, but may not be recognised until after 7 esp if hyperactivity not present
3-7 yrs
ADHD more common in F or M?
Males
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
inattentive symptoms tend to persist, and hyperactive or impulsive symptoms tend to recede over time
Also associated with increased risk of disorders e.g. ODD, conduct disorder, mood disorders, substance misuse - T or F?
True
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)
Consider combination of non drug (e.g. psychological interventions) and drug treatment
drug treatment is initiated by …
specialist trained in diagnosis and management of ADHD
which patients with ADHD should you start treatment in
symptoms are still causing significant impairment in at least one area of function, despite environmental modifications
1st line for ADHD drug treatment adult (2)
lisdexamfetamine or methylphenidate
How long should you trial a drug (lisdexamfetamine/methylphenidate 1st line) before considering switching to the other?
If symptoms have not improved after 6 week trial of either drug, consider switching to the other
A patient is having a beneficial response to lisdexamfetamine, but cannot tolerate its longer duration of effect. What is the alternative
Dexamfetamine unlicensed can be tried
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 …
atomoxetine (non stimulant drug)
Pt is unresponsive to one or more stimulant drugs (lisdex, methylphenidate), and atomoxetine. What do you do
Seek advice or refer to tertiary specialist in ADHD
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
sustained orthostatic hypotension (Excessive fall in BP when standing)
fainting episodes
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
bupropion
modafinil
TCAs
venlafaxine
all unlicensed
Sexual dysfunction is associated with this drug that is used for ADHD
atomoxetine
If a pt has new, or worsening existing seizures, what do you do
review treatment
stop any drug that might be contributing to seizures
treatment can be cautiously reintroduced is unlikely to be the cause
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
tics
A patient who has ADHD and has recently commenced stimulant drug (e.g. methylphenidate or lisdexamfetamine) has developed tics. What do you do
if stimulant related, consider dose reduction, stopping treatment or changing to non stimulant drug e.g. atomoxetine
how often does ADHD treatment need to be reviewed and who by
at least once a year by specialist
Treatment should be reviewed by specialists at least once a year and trials of ………, or ………. should be considered where appropriate
trials of treatment free periods, or dose reductions
prescribing pathway for child aged 5 and over
- methylphenidate
- lisdexamfetamine if 6 week trial of above at max tolerated dose does not improve symptoms
- dexamfetamine instead above if prolonged duration of action of lisdexamfetamine not tolerated
- intolerant of both methylphenidate + lisdexamfetamine - give atomoxetine or guanfacine
prescribing pathway for adults
- methylphenidate or lisdexamfetamine
- dexamfetamine if pt cannot tolerate long duration of action of lisdexamfetamine
- atomoxetine
