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Psych 2 > ADHD > Flashcards

ADHD Flashcards

1
Q

ADHD:

  • characteristics
  • which type MC in men? Women?
  • neuropathogenesis
A

-manifests in childhood w/ sx of hyperactivity, impulsivity, and or inattention and present in more than one setting. Sx affect cognitive, academic, behavioral, emotional, and social functioning.

Hyperactive MC in boys, inattentive MC in girls

Neuopathogenesis:
-decreased activation in the basal ganglion and anterior frontal lobe, which are the areas that correlate with impulse control and attention. Increased Dopamine clearance leading to increased NE activity.

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2
Q

Functions of the frontal lobe?

A

-ability to project future consequences resulting from current action, choice between good and bad actions, override and suppression of socially unacceptable responses

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3
Q

DSM V criteria for ADHD

A

Need 6 or more sx of inattention or hyperactivity/impulsivity (5 or more for ages 17 and older)

  • sx inappropriate for the given age
  • negatively impacts social and academic or occupational activites
  • sx develop prior to age 12
  • sx in two or more settings for at least 6 mo
  • sx not better explained byy another psych disorder.
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4
Q

ADHD Inattentive Sx

A
  • failure to give close attention to detail
  • difficulty sustaining attention in task
  • failure to listen when spoken to directly
  • failure to follow instructions
  • difficulty organizing tasks and activities
  • reluctance to engage in tasks that require sustained mental effort
  • loses things necessary for tasks or activities
  • easy distractability
  • forgetfulness in daily activities
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5
Q

ADHD Impulsive-hyperactivity Sx

A
  • fidgetiness with hands andd feet or squirmms in seat
  • difficulty remaining seated in class
  • excessive running/climbing in inappropriate situations
  • difficulty engaging in quite activities
  • is often on-the-go
  • talks excessively
  • blurts out answers
  • difficulty awaiting turns
  • interrupting and intruding on others
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6
Q

ADHD Medical Evaluation

Dx and Tx of ADHD in adults

A
  • parents and teacher fill out Vanderbilt form
  • refere for vision and hearing tests
  • Hx & PE

ADHD IN ADULTS:
-dx should be made by mental health professional

-sx and medications are the same as adolescent ADHD.

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7
Q

ADHD Tx:

  • tx of choice?
  • therapy types?
  • criteria for initiation of medications for ADHD
  • what testing/documentation needs to be done prior to pharm therapy?
A

Tx of choice: stimulants (Ritalin, Adderall, Concerta)

Therapies:
-behavioral therapy (must be used with meds)

Criteria for inititation:

  • confirmed ADHD
  • older than 6YO
  • parental consent
  • school is cooperative
  • normal HR and BP
  • no hx of seizures
  • does not have tourette syndrome, autism spectrum disorder, anxiety disorder, substance abuse among household members.

Document -pretreatment Ht, wt, BP, HR, appetite, sleep pattern, HA, abd pain

  • medical eval + EKG
  • assess for substance use/abuse
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8
Q

What drug classes are used in the tx of ADHD?

A

Stimulants = first line therapy; Methylphenidate, Amphetamines (Dextroamphetamine, Dextroamphetamine-amphetamine)

Atomoxetine

Alpha-2 adrenergic agonists

Antidepressants (Tricyclics and Buproprion)

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9
Q

Methylphenidate:

  • short acting drugs
  • time to onset
  • duration
  • half life
A

Drugs: Ritalin, Methylin

Onset: 20-60minutes

Duration: 3-5hrs

Half life: 2-3hrs

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10
Q

Methylphenidate:

  • long acting drugs
  • time to onset
  • duration
  • formulations
A

Drugs: Metadate ER, Methylin ER, Ritalin SR, Concerta, Daytrana(patch), Focalin XR (dexmethylphenidate)

Time to onset: 20-60minutes

Duration: 8-12hrs

Formulations: single pulse, sustained release, osmotic release, oral suspension, transdermal

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11
Q

Amphetamines:

  • what are the short acting drugs?
  • onset of action
  • duration
A

Drugs:
-Dextroamphetamine: Dexedrine, Dextrostat, Procentra

-Amphetamine-dextroamphetamine: adderall

Onset: 20minutes
Duration: 4-6hrs

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12
Q

Amphetamines:
-what are the long acting drugs?

-what is the first line drug? onset of action? duration?

A

Drugs:

  • Lisdexamfetamine (Vyvanase)
  • Dextroamphetamine SR
  • Amphetamine- Dextroamphetamine (Adderall XR)

Adderall XR is first line; onset is 20min, duration 8-10hrs

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13
Q

What are the non-stimulant medications?

A

2nd line: Atomoxetine (Strattera)

3rd line:

  • alpha-2adrenergic agonists:
  • -clonidine (Catapres)
  • -Guanfacine (Tenex)
  • antidepressants:
  • -Tricyclics: Imipramine (Tofranil andd Desipramine (Norpramin)
  • -Buproprion (Wellbutrin)
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14
Q

Atomoxetine (Strattera)
-whats minimum age required for this med?
-how long until effects are noticed?
-

A

Must be older than 6YO

This may take 1-2wks before effects are noted, with stimulant medication effects are noted right away.

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15
Q

How often do we monitor therapy once starting a new ADHD med?

A

assess weekly during titration stage (may last 1-3mo)

after titration phase pts seen monthly to monitor weight, heart rate, and BP on a stable dose without new SE.

Once on a stable dose f/u should be every 3-6mo

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16
Q

What SE are essential to assess at every follow up visit? If these SE occur how do we manage them?

A

Decreased appetite:

  • eat after/at mealtimes
  • eat nutrient dense food

Poor Growth:
-drug hoidays

Dizziness:

  • monitor BP and pulse
  • ensure adequate fluid intake

Insomnia/nightmares:

  • omit, reduce the last dose of the day
  • consider short acting

Mood Lability: sx that may occur as med wears off can be averted by using a longer acting formulation or increasing from BID to TID if short acting.

Rebound: sx taht occur as med wears off; may improve by stepping dose down at end of day

Tics:
-conduct drug trial at different doses including no meds to be sure that they are related to meds,

Psychosis:
-assess for suicidality, hallucinations, increased aggression; verify dose is appropriate and refer to mental health specialist

Diversion/Misuse:

  • monitor sx and Rx refills for evidence of misuse
  • long acting stimulants have less potential for abuse
  • open discussion
17
Q

Reasons for tx failure?

A
  • lack of adherence to medication regimen
  • are tx goals and expectations realistic?
  • is there another comorbid psychiatric dx?
  • if fail multiple stimulants or intolerable SE then trail of Atomoxetine (Strattera) or an alpha-2 adrenergics
18
Q

What medications cannot have drug holidays?

A
  • atomoxetine or alpha-2-adrenergic agonists

* b/c of extended half life, these take awhile to build up in your system to be effective.

19
Q

Termination of Therapy

A
  • may abruptly discontinue stimulants or atomoxtine(Strattera)
  • alpha-2-adrenergic agonists and tricyclics should be tapered off over several weeks.
20
Q

Ritalin

  • MOA
  • SE
  • how often can you dose this medication?
A

MOA: inhibits reuptake of dopamine and NE

  • SE:
  • -anxiety
  • -wt loss
  • -psychiatric sx: psychosis, aggression, hallucinations
  • -heart problems in at risk people
  • -easy bruising n
  • -high potential for abuse/addiction
  • Schedule II Drug

Can dose short acting (4hrs), intermediate (8hrs), or long acting (12hrs)

21
Q

Adderall

-SE

A

SE:

  • high potential for abuse/addiction
  • anxiety
  • wt loss
  • psychosis, hallucination, aggression
  • heart problems in at risk people (sudden death)
  • Schedule II drug
22
Q

Dextroamphetamine; DEXEDRINE

  • previous uses?
  • SE
A

previously used at OTC diet pill

SE:

  • heart problems in those with heart problems
  • psychiatric problems (Bipolar)
  • increased BP and rate
  • Children/Teenagers:
  • -seeing things or hearing voices
  • -believing things that are not true
  • -new manic sx
23
Q

Lisdexamphetamine (Vyvanase)

-converted to what after oral ingestion?

A

dextroamphetamine.

* less addictive but still a schedule II drug

24
Q

Atomoxetine (Strattera)

  • works on what NT?
  • BBW?
  • SE
A

Works on NE

BBW: increased risk of suicidal behavior less than 25YO (is this only because it was initially used as an anti-depressant?)

SE: dry mouth, insomnia, nausea, decreased appetite, constipation, decreased libido, Erectile dysfunction, urinary hesitancy, dizziness, sweating
-chest pain, SOB, arrhythmias, psychosis, jaundice

25
Q

Guanfacine (Intuniv)

  • what drug class?
  • SE
  • Caution with what other dz?
A

Alpha-2-adrenergic agonists

SE:

  • fast or slow HR
  • palpitations, chest tightness
  • numb/tingling
  • depresssion
  • hypotension

Caution: kidney and liver Dz

Psych 2 (8 decks)

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