ADHD

Question 1

what is ADHD?

Answer 1

attention deficit hyperactivity disorder

characterised by hyperactivity, impulsivity and inattention

can lead to functional, social, psychological and educational impairment

Question 2

treatment for children aged 5 and over

Answer 2

1) methylphenidate - first line treatment

2) if 6 week trial of methylphenidate at max tolerated dose does not improve symptoms - try LISDEXAMFETAMINE (dexamfetamine if cannot tolerate longer duration of LIS)

if pt can’t tolerate methylphenidate or lisdexamfetamine

3) atomoxetine or guanfacine

Question 3

treatment for adults

Answer 3

1) use methylphenidate or lisdexamfetamine (dexamfetamine if cant tolerate longer duration of lis)

2) atomoxetine (causes QT prolongation, hepatotoxicity, suicidal ideation)

MR preparations of stimulants - preferred due to their PK profile, convenience and improved adherence
- MR should be prescribed by BRAND ONLY

Question 4

methylphenidate imp points

Answer 4

CNS stimulant

high BP, tachycardia, arrhythmias

behaviour/mood change

decreased appetite, growth retardation and weight loss - esp in CHILDREN

monitor pulse, BP, psychiatric symptoms, appetite, weight, height - following dose changes, then 6 monthly

Question 5

lisdexamfetamine and dexamfetamine

Answer 5

similar side effects and monitoring to methylphenidate

overdose:
- excessive anxiety, paranoia, hallucinations, hypertension
- followed by exhaustion, convulsions