ADHD Flashcards
What are Diagnostic and Statistical Manual of Mental Disorders (DSM) for ADHD
Symptoms develop before age of 12, and present for six months
- Symptoms present in two or more settings
- Symptoms interfere with with school/work/social life
Three presentations (types) of ADHD:
- predominantly inattentive
- predominantly hyperactive-impulsive
- combined presentation
what are the Potential etiology of ADHD
multifactorial and likely involves gene-environment interplay
- some candidate genes involve dopamine receptors,
dopamine transporter, serotonin receptors, serotonin transporter,
glutamate receptors
- norepinephrine likely also involved - levels found to be increased
what is the Pathophysiology of ADHD
MRI (volume)
- reduced total brain and grey matter
- reduced cortical volume in prefrontal, occipital, and parietal lobes
- white matter results are inconsistent
Functional MRI (reduced function)
- motor inhibition tasks: basal ganglia, cortical areas
- working memory tasks: frontoparietal cortex and insula
- attention tasks: prefrontal cortex, thalamus, basal ganglia
Norepinephrine: more important for executive functions (working memory,
impulse inhibition, planning ahead)
Dopamine: more important for maintaining attention specifically
what are the Psychostimulants
amphetamine and methylphenidate products
what are the adverse events of the Psychostimulants
- decreased appetite
- stomach pain
- sleep disturbances
- headaches
- cardiovascular risk
Potential for dependence
how does Amphetamine work
Blocks the re-uptake of DA and NE
**Also induces the release of DA
give me a medication that is mix of the mixed salts (dextro and levo enantiomers
adderall
give me a medication that is dextroamphetamine
dexedrine
give a medication that is lisdexamfetamine
vyvanse
how does lisdexamfetamine work
lysine attached to dextroamphetamine
- metabolised in blood to release
both components
- thus, dextroamphetamine delivery
to the brain is slow and steady
what is Atomoxetine
- Non-stimulant
- Norepinephrine, dopamine, and serotonin reuptake inhibitor
- Affinity for norepinephrine > serotonin > dopamine
- Potential therapeutic for those who don’t respond to stimulants, or who
cannot tolerate adverse effects - Effects restricted to the prefrontal cortex (low potential for abuse)
what is the brand name of the atomoxetine
strattera
how does Guanfacine work
Non-stimulant
- Adrenergic alpha2 agonist (selective for alpha2A receptor)
- Previously used to lower blood pressure, and off-label for ADHD
- Available in once-per-day extended-release tablets
- The dose is titrated up to build tolerance to cardiovascular effects
what is the brand name of the Guanfacine
Intuniv
