ADHD Flashcards
Which sex is most affected by inattentive ADHD?
Female
How many symptoms are required to make a diagnosis of ADHD?
6+
Before what age do the symptoms need to be present and how long do they need to be present for?
12
6 months
When is atomoxetine (Strattera) considered the first line therapy for ADHD?
When family history of substance abuse is present
Patient currently has tics
Patient has a comorbid anxiety disorder
What are some second line options for treating ADHD?
Clonidine
Guanfacine
(Alpha-2 agonists)
What are some third line agents?
Bupropion- NE/DA reuptake inhibitor
Imipramine- TCA
What type of psychotherapy is beneficial for these patients once their symptoms are under control?
Behavioral parenting training
What are the key components of ADHD?
Inattention
Hyperactivity
Impulsivity
What is the incidence of ADHD?
3 to 5 percent
Which neurotransmitters are lacking in patients with ADHD? Which part of the brain are they predominatily missing?
DA and NE
Prefrontal cortex
Which aspect of the brain is responsible for selecting what an individual focuses on?
Dorsal anterior cingulate gyrus
Which part of the brain is responsible for sustaining attention on a topic?
Dorsolateral prefrontal cortex
Impairment in what cortex appears to be resbonsible for hyperactivity?
Prefrontal motor cortex
Impairment of which cortex results in impulsivity?
Orbitofrontal cortex
What other conditions must a child with ADHD be evaluated for?
Oppositional defiant disorder
Conduct disorder
What 3 things will medication help with, if the child WANTS to do them?
- Sitting still
- Focusing
- Think before they act
What will medicaiton not help a patient do?
Make good decisions
What would distinguish early onset bipolar-disorder from ADHD? Both have restlessness and distractibility.
Bipolar patients will have an affective component
Blood levels of what mineral should also be checked?
Lead
Which seizure disorder should be evaluated?
Petit mal seizures
Absences seizures
What are some signs it could be a seizure disorder?
Child has staring spells
Child will not be “thinking” of something else
What condition has a very similar presentaiton to a patient with ADHD and ODD?
Bipolar disorder
What is the first line medication for ADHD?
Stimulants
What are the two classes of stimulants used to treat ADHD?
Methyphenidate
Amphetamine
What are the common adverse effects of stimulants?
Decreased appetite Insomnia Irritablity Dysphoria Headacht Tics
What is the benefit of using stimulants?
Rapid onset
Wear off by the end of the day
What is the MOA of atomoxetine?
Selective inhibitor of presynaptic NE transporter
What are the disadvantages of atomoxetine?
Slower onset
24 hr duration of action
Both atomoxetine can decrease a patient’s appetite, what medications can be prescribed with may help increase appetite as well as sleep?
Clonidine
Guanfacine
If imipramine is prescribed what two things must be monitored in the patient?
Blood levels
ECGs- QT prolongation
In what conditions is bupropion contraindicated?
Seizure disorders
May also exacerbate tics
How with the inattentiveness of a patient with anxiety differ from a patient with ADHD?
ADHD - External stimuli - Pleasurable behaviors Anxiety - Internally focused - Ruminative and worried
What are the two types of presentation for ADHD?
- Inattentive presentation
2. Hyperactive/Impulsive presentation
