Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Therapeutics > ADHD > Flashcards

ADHD Flashcards

1
Q

What are risk/prognostic factors of ADHD?

A
  • males&raquo_space; females
  • whites&raquo_space; blacks > hispanics
  • 1st degree relative w/ ADHD
  • minor physical anomalies (hypertelorism, highly arched palate, low set ears)
    -motor delays/neurological soft signs
  • very low birthweight
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are some patho features of ADHD?

A
  1. decreased total brain volume
  2. decreased activity
  3. lack of connectivity
  4. default mode = network overactivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the main ADHD symptoms?

A
  1. inattention
  2. hyperactivity
  3. impulsivity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the general requirements to diagnosis ADHD?

A
  1. symptom onset BEFORE 12 yo
  2. significant impairment in 2 or more settings with documented symptoms
  3. symptoms interfere with or dec quality of social, academic or occupational functioning
  4. 6 or more symptoms for at least 6 months (if 17 or older only need 5 symptoms)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the general treatment algorithm for a patient with predominant ADHD?

A
  1. stimulant —– MPH or AMP
    (try both before 2nd line)
  2. atomoxetine, viloxazine, guanfacine ER, clonidine ER, bupropion
    (1st line if pt has active SUD)
  3. combo therapy or TCA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What is the general treatment algorithm for ADHD in a patient with predominant Tourette’s?

A
  1. dopamine antagonist or alpha agonist
    - haloperidol, risperidone, aripiprazole
    - clonidine or guanfacine

if some response….
- ADD stimulant, atomoxetine or alpha agonist

if still inadequate….
- try alternative dopamine antagonist or alpha agonist

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What is the general treatment algorithm for ADHD in a patient with predominant bipolar/severe aggression?

A
  1. atypical antipsychotic, lithium, or anticonvulsants
    (mood stabilizers)

If some response…
- ADD stimulant

if still inadequate…
- try alternative or additional mood stabilizer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What is the general treatment algorithm for ADHD in a patient with predominant anxiety/depression?

A
  1. antidepressant

If some response…
- ADD stimulant

if still inadequate…
- try alternative antidepressant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What adjustment should be made when moving from AMP to MPH?

A

increase dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What adjustment should be made when moving from MPH to AMP?

A

decrease dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which is more potent? AMP or MPH?

A

AMP!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What needs to be monitored at baseline and then every 3 months on stimulant therapy?

A

height, weight appetite and sleeping patterns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What ADR are common for stimulants?

A
  • psychiatric
  • cardiac (inc BP & HR)
  • growth inhibition
  • reduced appetite/weight loss
  • insomnia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How are psychiatric ADR of stimulants managed?

A

decrease dose or D/C

+ supportive therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

T or F: A contraindication to stimulant use is cardiac issues.

A

FALSE, cardiac issues are NOT CI for stimulant use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

How is the growth inhibition ADR of stimulants managed?

A

yearly drug free trials (i.e. no stimulants over school breaks)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is the reduced appetite/weight loss ADR of stimulants managed?

A

eating high fat meals when stimulant effect is low (fat will delay abs, keep consistent)

ADD cyprohepatdine QHS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How is the insomnia ADR of stimulants managed?

A

give dose earlier

lower last dose of day/give it earlier

ADD sedating medication QHS
(guanfacine, clonidine, melatonin, cyproheptadine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What agents increase MPH absorption and decrease the delayed effect of ER formulations?

A

antacids, PPIs, H2RAs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What agent decreases the excretion of AMP?

A

antacids

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What agent increases the absorption of AMP?

A

PPIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What agent decreases the absorption of AMP?

A

acidic agents

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What stimulant has a DDI with CYP2D6 inhibitors (i.e. some psych agents)/what happens?

Which stimulant is preferred in patients on concurrent psych agents?

A

increases exposure of mixed AMP salts

MPH is preferred

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q
A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the issue with alcohol when using stimulants?

A

alcohol can cause stimulant dumping

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What does adjustment is needed when going from Dex-MPH to MPH?

What about MPH to Dex-MPH?

Which is more potent?

A

double the dose

half the dose

Dex-MPH is 2x more potent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What stimulant is preferred & first line in children?

A

MPH!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What stimulant is FDA approved in children?

A

AMP!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Which MPH products are 30% IR/70% ER?

A
  1. MPH ER (Metadate ER, Quillivant XR)
  2. MPH ER chew (Quillichew)
  3. MPH CD (Metadate CD)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Which MPH products are 50% IR/50% ER?

A
  1. MPH LA (Ritalin LA)
  2. Dex-MPH ER (Focalin XR)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Which MPH extended release product is preferred in patients with severe AM symptoms?

A

50% IR/50% ER —– MPH LA (Ritalin LA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Which MPH extended release products are beads and the capsules can be opened to put in apple sauce?

A
  1. MPH CD (Metadate CD)
  2. MPH LA (Ritalin LA)
33
Q

Which MPH product needs to be shaked vigorously prior to administration?

A

MPH XR suspension (Quillivant XR)

34
Q

What is an important counseling point for the MPH OROS (Concerta, Relexxii)?

A

shell of the tablet will appear in stool

35
Q

Which MPH extended release products require complete restarting of dose titration when switching to them?

A
  1. MPH MLR (Aptensio XR)
  2. MPH MLR-02 (Adhansia XR)
  3. Dex-MPH/Ser-Dex-MPH (Aztarys)
36
Q

Which stimulant product MUST be administered between 6:30-9:30 pm?

A

MPH PM (Jornay PM)

37
Q

What is Ser-Dex-MPH?

A

prodrug pf Dex-MPH

38
Q

What is an important counseling point for Dex-MPH/Ser-Dex-MPH (Aztarys)?

A

risk of suicidal ideation

39
Q

What is the protocol when you miss a dose of MPH PM (Jornay PM)?

A

skip it and take the following dose at usual PM/HS time

40
Q

Which stimulant products are available as ODT?

A
  1. MPH XR-ODT (Cotempla XR-ODT)
  2. AMP sulfate IR-ODT (Evekeo ODT)
  3. AMP sulfate XR-ODT (Adzenys XR-ODT)
41
Q

What are the available MPH immediate release products?

A
  1. MPH IR (Ritalin, Methylin)
  2. Dex-MPH IR (Focalin)
42
Q

Which transdermal stimulant product has a BBW for permanent skin reactions?

A

MPH transdermal patch (Daytrana)

43
Q

Which stimulant agent is preferred in patients with a history of cardiovascular disease?

A

MPH

44
Q

Which AMP products are 50% IR/50% ER?

A

Mixed AMP-XR salts (Adderall XR)

45
Q

What stimulant agents are FDA approved for 3 and up?

A

IR AMPs!!!

  1. Mixed AMP-IR salts (Adderall)
  2. AMP sulfate IR (Evekeo)
  3. dextroAMP IR (Dexedrine, Zenzedi)
46
Q

Which AMP product is beads and the caps can be opened up to sprinkle on applesauce?

A

Mixed AMP-XR salts (Adderall XR)

47
Q

What AMP liquid formulations are available?

A
  1. AMP sulfate XR solution (Dyanavel XR)
  2. AMP sulfate ER suspension (Adzenys ER)
  3. dextroAMP IR liquid (ProCentra)
48
Q

Which AMP extended release product does not cause peaks/troughs?

Why???

A

AMP sulfate XR (Mydayis)

it has triple time release beads that decrease med wearing off effect

49
Q

What AMP product was designed for less abuse potential?

A

Lisdexamfetamine (Vyvanse)

50
Q

How long do transdermal stimulant products need to be applied before effect is needed?

How early should they be removed before bedtime?

A

2 hours prior to needed effect

3 hours or more before bedtime

51
Q

Which transdermal stimulant product is approved for 6 & up?

A

dextroAMP transdermal patch (Xelstrym)

52
Q

Which transdermal stimulant product is approved for 6-17 yo as it has not been studied in adults?

A

MPH transdermal patch (Daytrana)

53
Q

Which transdermal stimulant product needs to be disposed of safely because 50% of drug remains in the patch after use?

A

MPH transdermal patch (Daytrana)

54
Q

Which transdermal stimulant product can only be applied to the hip?

A

MPH transdermal patch (Daytrana)

55
Q

What are the 4 generalities of ADHD therapy in patients under 6 years old?

A
  1. NO ER formulations
  2. NO non-stimulants
  3. NO patches
  4. try non-pharm first
56
Q

When can effectiveness of norepinephrine reuptake inhibitors for ADHD be assessed?

A

need 6-8 weeks at max tolerated dose

57
Q

What are the class ADR of norepinephrine reuptake inhibitors used in ADHD?

A

risk of inducing mania

QT prolongation

58
Q

What are the norepinephrine reuptake inhibitors used in ADHD?

A

atomoxetine (Strattera)

viloxazine ER (Qelbree)

59
Q

What is the BBW for norepinephrine reuptake inhibitors used in ADHD?

A

suicidality

60
Q

What is an important counseling point for atomoxetine (Strattera)?

A

it may worsen behavior initially

61
Q

How is atomoxetine (Strattera) dosed?

MDD?

A

BID

40 mg

62
Q

How is viloxazine ER (Qelbree) dosed?

MDD?

A

QAM

< 17 yo —– 400 mg
adults —– 600 mg

63
Q

What effect does viloxazine ER (Qelbree) have on CYP metabolism?

A

Its a strong CYP1A2 inhibitors and interacts with many psych & pain meds

64
Q

Which norepinephrine reuptake inhibitors used in ADHD is associated with liver toxicity w/ long term use?

A

atomoxetine (Strattera)

65
Q

Which norepinephrine reuptake inhibitors used in ADHD needs renal dose adjustments?

A

viloxazine ER (Qelbree)

66
Q

What is the effect of concurrent paroxetine or fluoxetine on atomoxetine (Strattera) use?

A

increases the concentration of atomoxetine (Strattera)

67
Q

What are the alpha adrenergic agonists FDA approved for ADHD?

A

clonidine ER (Kapvay)

guanfacine ER (Intuniv)

**can also use IR versions but not FDA approved

68
Q

What are the class ADR of alpha adrenergic agonists used in ADHD?

A

sedation, dizziness, hypotension, constipation & heart block

69
Q

What is an important counseling point for the extended release formulations of alpha adrenergic agonists used in ADHD?

A

do not take with high fat meal

70
Q

When can effectiveness of alpha adrenergic agonists for ADHD be assessed?

A

1-2 months

71
Q

What are some benefits of using bupropion for ADHD?

A
  • beneficial in patients with comborbid depression
  • has less appetite suppression/weight loss compared to stimulants
72
Q

What is an important dosing consideration for bupropion?

A

prepubertal children have faster metabolism, need to dose BID

73
Q

When can effectiveness of bupropion for ADHD be assessed?

A

after 6 weeks at max tolerated dose

74
Q

What is the use of TCAs in ADHD?

A

VERY LAST LINE!

75
Q

What TCAs are used for ADHD?

A

imipramine, desipramine, nortriptyline

76
Q

What are lithium/AEDs (i.e. valproate & carbamazepine) effective for in ADHD therapy?

A

aggression, explosive behavior, impulsivity

77
Q

When are What are lithium/AEDs (i.e. valproate & carbamazepine) typically used in ADHD therapy?

A

childhood onset bipolar OR comorbid ADHD/bipolar

78
Q

What is the use of antipsychotics in ADHD therapy?

A

adjunct for severe aggression, comorbid conduct disorder or bipolar disorder

DO NO TREAT ADHD SYMPTOMS, pt needs ADHD therapy as well

79
Q

What are the preferred antipsychotics for use in ADHD patients?

A

2nd gen: aripiprazole, olanzapine, quetiapine, risperidone, ziprasidone

(avoided b/c EPS -> chlorpromazine, haloperidol)

Therapeutics (17 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions