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ADHD Flashcards

1
Q

DSM 5–> Attention Deficit Hyperactivity Disorder is Now called

A 
Neurodevelopmental Disorder
ADHD combined
ADHD inattentive
ADHD hyperactive/impulsive
Other specified, or unspecified
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2
Q

(ADHD) How different from DSM-IVTR?

A

Starts before age 12, not 8
Symptoms must be in multiple settings
Must cause Social disability

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3
Q

key symptoms of ADHD

A

6 inattention symptoms for 6 months

  1. Poor attention to details –> mistakes
  2. Cannot sustain attention
  3. Does not listen
  4. Does not follow through
  5. Does not organize
  6. Avoids tasks
  7. Loses things
  8. Is distracted
  9. Is forgetful
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4
Q

6 key ADHD hyperactive/impulsive symptoms

A
  1. Fidgets
  2. Leaves seat
  3. Runs/climbs
  4. Not quiet
  5. Talks a lot
  6. Blurts out
  7. Cannot wait turn
  8. interrupts
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5
Q

Course of ADHD

A
  1. Most often apparent at young age where age appropriate norms for paying attention and delaying gratification are not met
  2. Milder and more inattentive cases may not be notices until later in life when demands are greater
  3. Inattentiveness tends to persist greater then hyperactivity/impulsivity
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6
Q

ADHD characteristics

A 
DSM 5
Attention Deficit Hyperactivity Disorder is Now called Neurodevelopmental Disorder
ADHD combined
ADHD inattentive
ADHD hyperactive/impulsive
Other specified, or unspecified
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7
Q

course of ADHD

A
  1. Most often apparent at young age where age appropriate norms for paying attention and delaying gratification are not met
  2. Milder and more inattentive cases may not be notices until later in life when demands are greater
  3. Inattentiveness tends to persist greater then hyperactivity/impulsivity
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8
Q

Inattentiveness tends to persist greater then

A

hyperactivity/impulsivity as you get older

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9
Q

the stimulant class

A

has great efficacy in adults, teens, children –> promote DA and NE increase activity

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10
Q

side effects of stimulant?

A
  1. stunt growth (short)

2. weight loss for stims

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11
Q

The stimulant class has great efficacy in adults, teens, children

A 
Promote DA and NE increase activity
All carry risk of addiction
Paranoia in misuse
Stunt growth, weight loss
?Cardiac issues
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12
Q

The non-stimulants (atomoxetine (NRI)) and (Guanfacine ER and Clonidine ER (alpha-2 NE agonists) have

A

less efficacy
But carry no addiction risk
Interestingly are often sedating…
May lower blood pressure..

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13
Q

Atomoxetine is a NET inhibitor only

A

(norepi reuptake inhibitor)

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14
Q

Guanfacine ER and clonidine ER Agonize or stimulate the

A

alpha-2 norepinephrine receptor
In the brainstem this may dampen NE release and lower blood pressure as an autoreceptor
In the frontal cortex, these receptors are located on glutamate pyramidal neurons (heteroreceptors) and help to improve signal to noise ratio, allowing the neuron to fire appropriately when face with multiple environmental stimuli. This ‘fine tunes’ operation of the frontal cortex which is responsible for prioritizing, response inhibition, and vigilance

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15
Q

for mild ADHD

A 
Behavioral modification and training
Self control therapy
Behavioral Parent Training
Relaxation
Education Support
Distraction Control
Attention Sustaining
Cognitive Restructuring
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16
Q

what are the ADHD pharmacy for preschoolers

A
  1. methylphenidate (approved for older child)
  2. amphetamines (approved for very young child)
  3. behavioral therapy –> this is always the first choice of drug for ADHD
17
Q

slow release amphetamine drug is favored for children

A

b/c it’s less addictive

18
Q

in case of adults ADHD

A

they also get non-addictive drugs such as guafacin and clonidine then you would use slow releasing amphetamines…

19
Q

alpha 2 agonist makes

A

glutamate receptor better (you are not using NE to fix the problem)

20
Q

what is the no.1 occurring illness with ADHD?

A

anxiety?

21
Q

ADHD and nuerotransmitters?

A

decreased tonic of both NE and DA firing in PFC

22
Q

medication management for ADHD?

A 
The stimulant class has great efficacy in adults, teens, children
- Promote DA and NE increase activity
- All carry risk of addiction
- Paranoia in misuse
- Stunt growth, weight loss
?Cardiac issues
23
Q

diagnosis of ADHD is usually the

A

last diagnosis after excluding anxiety, depression, etc

24
Q

drug of choices for ADHD that are not addictive are

A
  1. atomoxetine (NRI)
  2. guanfacine
  3. clonidine (alpha 2 agonist)
25
Q

psychotherapy for ADHD?

A

Behavioral modification and training

  1. Self control therapy
  2. Behavioral Parent Training
  3. Relaxation
  4. Education Support
  5. Distraction Control
  6. Attention Sustaining
  7. Cognitive Restructuring
26
Q

alpha 2 agonists drug (NE drugs) make

A

glutamate neuro transmission better for ADHD

27
Q

Atomoxetine is a

A

NET inhibitor only (norepi reuptake inhibitor)

28
Q

Guanfacine ER and clonidine ER

A

Agonize or stimulate the alpha-2 norepinephrine receptor

29
Q

ADHD summary?

A
  1. Make the diagnosis in a vignette
  2. Understand complexity in adults
  3. Know treatment options
  4. How atomoxetine works
  5. GuanfacineER and Clonidine ER too
  6. Methylphenidate and amphetamine too

BS (15 decks)

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