ADHD

Question 1

ADHD is considered to be a ________ diagnosis.

Answer 1

clinical

No biological markers or imaging abnormalities that enable us to diagnose it

Question 2

Uninformed takeup of a new job & excessive interruption of others’ conversations are examples of what types of behaviors?

Answer 2

Impulsive

Question 3

A child who fidgets excessively & runs around in the middle of class is demonstrating what types of behaviors?

Answer 3

Hyperactive

Question 4

What are the essential features of ADHD?

Answer 4

Persistent patterns of inattention

&/or

Hyperactivity / impulsivity that interferes with function or development

Question 5

What is the youngest age we can diagnose someone with ADHD?

Answer 5

12yrs

Question 6

Can ADHD be diagnosed in a child that only shows inattentive / hyperactive-impulsive symptoms at school?

Answer 6

No… Must be present in >/= two different settings.

Question 7

Why is it likely that ADHD prevalence in girls is underdiagnosed?

Answer 7

More often present with inattentiveness (as opposed to hyperaroused presentation more commonly seen with boys).

Question 8

If a parent has ADHD, what is the fractional likelihood they will have a child with ADHD?

Answer 8

1/3

Question 9

What two primary NTs show dysregulated levels in those with ADHD?

Answer 9

DA & NE

Question 10

What are some prenatal risk factors that increase one’s likelihood of developing ADHD?

Answer 10

-Low birth wt
-Premature birth
-Perinatal stress
-FAS
-Severe O2 deprivation
-Smoke exposure (both in-utero & post-birth)

Question 11

Given the high prevalence of EEG abnormalities (~90%) in those with ADHD, can it be used as a diagnostic tool?

Answer 11

Nope

Question 12

At the preschool age (most common AOO), what symptom clusters dominate?

Answer 12

Hyperactive / Impulsive

Question 13

A high percentage of kids diagnosed with ADHD also have what comorbid conditions?

Answer 13

1) Oppositional Defiant Disorder (ODD) [Austen’s Nephew Cain lol]

2) Conduct Disorder (CD)

Question 14

What were the findings of the Newcorn et al. (2008) landmark ADHD trial?

Answer 14

-Concerta > Atomoxetine at 6wks for ADHD response.

-Completion of treatment regimens were similar between both groups.

-Rates of adverse effects also similar between two groups.

Question 15

Explain Concerta’s MOA.

Answer 15

Inhibits presynaptic reuptake of DA & NE via transport protein blockade.

Question 16

How does Amphetamine’s MOA differ from Concerta’s (& thus makes it much more potent of a drug)?

Answer 16

Increases release of DA & NE from presynaptic nerves, as well as stimulates release of 5HT / acts as 5HT agonist at high doses.

Question 17

Describe Atomoxetine’s MOA.

Answer 17

Inhibits presynaptic NE reuptake

Question 18

Describe Guanfacine & Clonidine’s MOA.

Answer 18

Alpha 2 Receptor Agonist within the Prefrontal Cortex; improves delay-related PFC neuron firing & underlying working memory / behaviors.

Question 19

Which one has more Alpha 2 selectivity; Guanfacine or Clonidine?

Answer 19

Guanfacine

Question 20

Core ADHD symptoms are reduced by ___ - ___ % when long-acting stimulants are used.

Answer 20

30 - 40% (in 70% of treated patients)

Question 21

What is considered to be an adequate trial of a long-acting stimulant?

Answer 21

3 - 4wks

Question 22

T or F: Stimulant drug usage improves overall exam scores & material retention.

Answer 22

False!

Question 23

Why are longer acting stimulants preferred over immediate release formulations?

Answer 23

Reduce rebound effects & better tolerated

Question 24

The OOA of non-stimulant drugs for ADHD management is ___ wks, with max effects being demonstrated at ___ - ___ wks.

Answer 24

OOA: 2wks
Peak: 6 - 8wks

Question 25

In cases of ADHD + comorbid substance use, what class of medications is considered 1st line?

Answer 25

Non-Stimulants

Question 26

In cases of ADHD + severe anxiety / tic disorders, what class of medications is considered 1st line?

Answer 26

Non-Stimulants

Question 27

Dextroamphetamine Spansules are an example of what medication class?

Answer 27

Short / Immediate-Acting Psychostimulant

Question 28

What class of medication (especially at low doses) can be used to treat comorbid aggression in ADHD patients?

Answer 28

Atypical Antipsychotics

Question 29

In cases of drug shortages, what must be considered for those being treated for ADHD?

Answer 29

Bioequivalence of various dosage forms (not just simply a matter of swapping things out)… Drastically different responses!

Question 30

Outright C/Is to using psychostimulant drugs?

Answer 30

1) MAOI use / 14d after MAOI d/c

2) Narrow Angle Glaucoma

3) Untreated Hyperthyroidism

4) Mod to Sev HTN

5) Pheochromocytoma

6) CVD

7) Hx Mania / Psychosis

Question 31

What must we monitor for when initiating somebody on a psychostimulant?

Answer 31

-HR / BP incr.
-Priapism (Prolonged Erections)
-Growth Retardation
-Peripheral Vasculopathy

Question 32

Outright C/I to using Guanfacine?

Answer 32

Inability to take scheduled doses (can lead to dangerous Rebound HTN).

Question 33

If an ADHD patient with no other comorbidities is worried about sexual dysfunction, which drug(s) should be avoided?

Answer 33

Atomoxetine (psychostimulants & A2 Agonists are not known to demonstrate)

Question 34

If an ADHD patient is particularly worried about losing weight &/or appetite suppression, what is the preferred medication to use?

Answer 34

A2 Agonist (ie. Guanfacine / Clonidine)… Wt Loss & eating suppression shown with psychostimulants & Atomoxetine.