ADHD Flashcards
What conditions should CNS stimulants not be used to treat?
Depression, obesity, senility, debility, or fatigue relief.
What are the main indications for methylphenidate?
ADHD and narcolepsy.
How does methylphenidate work?
Blocks dopamine and norepinephrine (NE) transporters, increasing their levels in the brain.
What is atomoxetine and how does it work?
A NE-selective reuptake inhibitor that increases NE levels in the prefrontal cortex to improve ADHD symptoms.
Methylphenidate
Sympathomimetic drug used to treat ADHD and narcolepsy
Atomoxetine
Used to treat ADHD
What lifestyle advice should be given to ADHD patients?
Maintain a balanced diet, good nutrition, and regular exercise.
What are environmental modifications for ADHD?
Adjustments like seating, lighting, noise control, movement breaks, and reinforcing verbal instructions with written ones.
When should environmental modifications be trialled?
Before starting drug treatment.
What are ADHD-focused psychological interventions?
Cognitive behavioural therapy (CBT), which may be used alone or with medication.
When is a combination of drug and non-drug treatment considered?
When drug treatment alone does not fully control symptoms.
Who should initiate ADHD drug treatment?
A specialist trained in ADHD diagnosis and management.
When should ADHD drug treatment be started?
When symptoms cause significant impairment despite environmental modifications.
What are the first-line medications for ADHD?
Lisdexamfetamine mesilate or methylphenidate hydrochloride.
What should be done if the first-line drug is ineffective after 6 weeks?
Switch to the alternative first-line drug.
When is dexamfetamine sulfate considered?
If lisdexamfetamine is beneficial but not tolerated due to its long duration.
Why are modified-release stimulant preparations preferred?
Better adherence, convenience, reduced misuse risk, and no need for midday dosing.
When are immediate-release preparations used?
For flexible dosing or during dose titration.
When should atomoxetine be considered?
If both methylphenidate and lisdexamfetamine are ineffective or not tolerated.
When should a tertiary specialist ADHD service be consulted?
If the patient is unresponsive to multiple stimulant drugs and atomoxetine.
What should be done if a patient develops tics on stimulants?
Reduce dose, stop treatment, or switch to a non-stimulant.
What are the alternative (unlicensed) ADHD treatments?
Bupropion, modafinil, tricyclic antidepressants, and venlafaxine (only under specialist advice).
What should be monitored in ADHD patients on medication?
Effectiveness, side effects, sleep patterns, stimulant misuse, and sexual dysfunction (with atomoxetine).
How often should ADHD treatment be reviewed?
At least once a year by a specialist.
When should treatment-free periods or dose reductions be considered?
During annual specialist reviews when appropriate.
Second line treatment
Atomoxetine
When pt is intolerant to methylphenidate and lisdexamfetamine
Pt has not responded to separate 6 week trials of both first lines
