ADHD Flashcards
What is the general criteria for ADHD?
> 6 sx of inattention for >6 months
6 sx of hyperactivity for >6 months
At what age MUST there be some symptoms by?
12
IS it enough to just have symptoms at school OR at home?
No needs to be in more than 1 setting
Why are boys more commonly diagnosed?
because girls missed cause pinnation goes unnoticed
What neurotransmitters are involved in ADHD?
DA and NE
How does neurotransmitters work in ADHD?
low DA causes inability to concentrate on dull task
NE dysfunction aids in inattention, mood and arousal
What assessment score used? Which one does teacher use?
- SNAP-IV 26
- CADDRA- teacher
When doe symptoms of ADHD start?
preschool
When does diagnosis usually occur for ADHD?
School age
When does inattentive become dominant?
adulthood
What is the most effective treatment (general)?
behaviour AND drug
What non pharm for ADHD?
CBT
behaviour parent training, classroom training, peer training
Issue with study comparing atomoxetine and concrete?
did not include people that saw no improvement of both drugs or intolerable
MOA of atomoxetine?
Norepinephrine reuptake inhibitor
Is atomoxetine or concrete more effective?
CONCERTA
If a family wanted a non stimulant for ADHD what do we suggest?
atomoxetine
What is drugs better for in ADHD?
core ADHD symptoms
What is CBT better for in ADHD?
social, behaviours, anxiety
Methylphenidate MOA?
inhibits reuptake of DA and NE
AMphetamine MOA?
increase release of DA and NE
perhaps also 5HT
inhibits reuptake
Pros of methylphenidate
less peripheral activity BUT still some increased heart rate and BP
Does DA or NE have a bigger role in ADHD?
DA
MOA of guanfacine and clonidine
alpha 2 adrenergic agonist
Why is guanfacine better than clonidine?
more selective for 2A receptor= better improvement in behaviour and memory function
Side effects of guanfacine and clonidine?
low BP and heart rate
Why are long acting stimulant used?
can’t be diverted
How much do stimulants help and when to see effect?
30-40% sx reduction in 70% of people
see response in 1 week
What is an adequate trial of stimulants?
3-4 weeks
Which is more efficacious, Methylphenidate or amphetamines?
equal
If you fail methylphenidate what next?
amphetamines
How beneficial is non stimulants?
25-30% reduction in 60% of people
When is adequate trial for non stims?
6-8 weeks
What is role of short acting stimulants?
adjuvant to long acting
What are third line options for ADHD? Why do they suck?
bupropion, clonidine, imipramine, modafinil
suck= not effective s/e bad
FIrst line amphetamine EDS option?
vyvanse
First line covered option?
Concerta
First line methylphenidate EDS option?
biphentin
What SR drug IS TERRIBLE?
ritalin SR- 8 hour Half life
Duration of first line agents?
> 12 hours
What is special about Vyvanse?
prodrug= can’t absue
Can you switch to generic if patient is on brand name stimulant?
NOOOOOO
How much can stimulant decrease height?
1-2 cm
Contraindications of psychostimulants?
severe hypertension, symptomatic cardiovascular disease
mania or psychosis
Contraindications of atomoxetine?
same as stimulants BUT no for advanced atherosclerosis
When is atomoxetine preferred
substance abuse, severe anxiety or tic disorders
Contraindications of alpha 2?
can’t be adherent due to rebound hypertension
Why are AP interacting with stims?
because they BLOCK dopamine
What interactions is there for antihypertensive and stims?
may decrease hypotensive effect
What interactions is there for SSRI/SNRI and stims?
increase toxic effect of AD and risk of serotonin syndrome
What is optimal dose of stimulants?
Where no increase of drug elicits a further response
What drug does not increase BP and HR?
Alpha 2
Which class has low rate of appetite suppression?
Alpha 2
What drugs have anticholinergic s/e?
ALL
Which class doesn’t cause anxiety?
alpha 2
Which class does not cause dizzy?
atomoxetine
alpha 2 -dose related
Which class causes irritability?
Stims and atomoxetine
What ones cause headache?
all
Which drug doesn’t cause insomnia?
Alpha 2
Which once does not cause drowsy?
Stims
Which are good for tics?
atomoxetine and alpha 2
Which class doesn’t not get skin reactions?
Alpha 2
Which class has rebound affect of neuro sx?
Stims
Which class causes decrease in weight?
stims and atomoxetine
Which class does not cause sex dysfunction?
Stims and alpha 2(best)
