ADHD Flashcards
ADHD is considered to be a ________ diagnosis.
clinical
No biological markers or imaging abnormalities that enable us to diagnose it
Uninformed takeup of a new job & excessive interruption of others’ conversations are examples of what types of behaviors?
Impulsive
A child who fidgets excessively & runs around in the middle of class is demonstrating what types of behaviors?
Hyperactive
What are the essential features of ADHD?
Persistent patterns of inattention
&/or
Hyperactivity / impulsivity that interferes with function or development
What is the youngest age we can diagnose someone with ADHD?
12yrs
Can ADHD be diagnosed in a child that only shows inattentive / hyperactive-impulsive symptoms at school?
No… Must be present in >/= two different settings.
Why is it likely that ADHD prevalence in girls is underdiagnosed?
More often present with inattentiveness (as opposed to hyperaroused presentation more commonly seen with boys).
If a parent has ADHD, what is the fractional likelihood they will have a child with ADHD?
1/3
What two primary NTs show dysregulated levels in those with ADHD?
DA & NE
What are some prenatal risk factors that increase one’s likelihood of developing ADHD?
-Low birth wt
-Premature birth
-Perinatal stress
-FAS
-Severe O2 deprivation
-Smoke exposure (both in-utero & post-birth)
Given the high prevalence of EEG abnormalities (~90%) in those with ADHD, can it be used as a diagnostic tool?
Nope
At the preschool age (most common AOO), what symptom clusters dominate?
Hyperactive / Impulsive
A high percentage of kids diagnosed with ADHD also have what comorbid conditions?
1) Oppositional Defiant Disorder (ODD) [Austen’s Nephew Cain lol]
2) Conduct Disorder (CD)
What were the findings of the Newcorn et al. (2008) landmark ADHD trial?
-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.
Explain Concerta’s MOA.
Inhibits presynaptic reuptake of DA & NE via transport protein blockade.
How does Amphetamine’s MOA differ from Concerta’s (& thus makes it much more potent of a drug)?
Increases release of DA & NE from presynaptic nerves, as well as stimulates release of 5HT / acts as 5HT agonist at high doses.
Describe Atomoxetine’s MOA.
Inhibits presynaptic NE reuptake
Describe Guanfacine & Clonidine’s MOA.
Alpha 2 Receptor Agonist within the Prefrontal Cortex; improves delay-related PFC neuron firing & underlying working memory / behaviors.
Which one has more Alpha 2 selectivity; Guanfacine or Clonidine?
Guanfacine
Core ADHD symptoms are reduced by ___ - ___ % when long-acting stimulants are used.
30 - 40% (in 70% of treated patients)
What is considered to be an adequate trial of a long-acting stimulant?
3 - 4wks
T or F: Stimulant drug usage improves overall exam scores & material retention.
False!
Why are longer acting stimulants preferred over immediate release formulations?
Reduce rebound effects & better tolerated
The OOA of non-stimulant drugs for ADHD management is ___ wks, with max effects being demonstrated at ___ - ___ wks.
OOA: 2wks
Peak: 6 - 8wks
In cases of ADHD + comorbid substance use, what class of medications is considered 1st line?
Non-Stimulants
In cases of ADHD + severe anxiety / tic disorders, what class of medications is considered 1st line?
Non-Stimulants
Dextroamphetamine Spansules are an example of what medication class?
Short / Immediate-Acting Psychostimulant
What class of medication (especially at low doses) can be used to treat comorbid aggression in ADHD patients?
Atypical Antipsychotics
In cases of drug shortages, what must be considered for those being treated for ADHD?
Bioequivalence of various dosage forms (not just simply a matter of swapping things out)… Drastically different responses!
Outright C/Is to using psychostimulant drugs?
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
What must we monitor for when initiating somebody on a psychostimulant?
-HR / BP incr.
-Priapism (Prolonged Erections)
-Growth Retardation
-Peripheral Vasculopathy
Outright C/I to using Guanfacine?
Inability to take scheduled doses (can lead to dangerous Rebound HTN).
If an ADHD patient with no other comorbidities is worried about sexual dysfunction, which drug(s) should be avoided?
Atomoxetine (psychostimulants & A2 Agonists are not known to demonstrate)
If an ADHD patient is particularly worried about losing weight &/or appetite suppression, what is the preferred medication to use?
A2 Agonist (ie. Guanfacine / Clonidine)… Wt Loss & eating suppression shown with psychostimulants & Atomoxetine.
