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Behavioral Health > ADHD > Flashcards

ADHD Flashcards

1
Q

3 Types of ADHD

A

Hyperactive
Impulsive
Inattention

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2
Q

What do ADHD symptoms affect?

A 
Cognitive functioning
Academic functioning
Behavioral functioning
Emotional functioning
Social functioning
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3
Q

What other psychiatric disorders is ADHD frequently associated with?

A 
Oppositional defiant disorder (ODD)
Conduct disorder (CD)
Depression
Anxiety disorder
Learning disabilities
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4
Q

Major Transmitters in ADHD

A

Dopamine

Norepinephrine

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5
Q

Where are dopamine sensitive neurons?

A

Frontal lobe

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6
Q

What is the dopamine system associated with?

A 
Reward
Attention
Short term memory
Planning 
Motivation
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7
Q

Functions of the Frontal Lobe

A

Ability to project future consequences
Choice between good & bad actions
Override & suppression of socially unacceptable responses
Determination of similarities & differences

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8
Q

Differences in the Brain of a Person with ADHD

A

Decreased activation in the basal ganglion & anterior frontal lobe
Increase in dopamine transporter activity
Dopamine imbalance allows inappropriate increase in norepinephrine activity

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9
Q

Methylphenidate

A

Increases extracellular dopamine in the brain

Changes areas of function in the frontal lobe

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10
Q

DSM V Symptoms of Inattention or Hyperactivity/Impulsivity

A

Symptoms inappropriate for given age
Negatively impacts social & academic or occupational activities
Symptoms prior to age 12
Symptoms present in 2+ settings
Symptoms present for at least 6 months
Symptoms not better explained by other psychiatric

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11
Q

ADHD Inattentive Symptoms

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 & activities
Reluctance to engage in tasks that require sustained mental effort
Loses things necessary for tasks or activities
Easy distractibility
Forgetfulness in daily activities

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12
Q

ADHD Impulsive-Hyperactivity Symptoms

A

Fidgetiness with hands & feet or squirms in seat
Difficulty remaining seated in class
Excessive running or climbing in inappropriate situations
Difficulty in engaging in quiet activities
Is often “on-the-go” or acts as if “driven by a motor”
Often talks excessively
Excessive talking & blurting out answers before questions have been completed
Difficulty awaiting turns
Interrupting & intruding on others

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13
Q

Medical Evaluation of ADHD

A 
Vanderbilt forms
Refer for vision & hearing tests
Complete H&P
Blood lead level (maybe)
TSH (maybe)
Sleep study (maybe)
Neurology consult (seizure/neuro disorder)
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14
Q

Treatment of ADHD

A

Ritalin
Adderall
Concerta
Behavioral therapy

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15
Q

Criteria for Initiation of Pharmacotherapy for ADHD

A

Complete diagnostic assessment that confirms ADHD
>6 years old
Parental consent
School is cooperative
No previous sensitivity to the medication
Normal HR & BP
No Hx of seizure disorder
Doesn’t have Tourettes, autism spectrum disorder, anxiety disorder, substance abuse among household members

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16
Q

Things to Note Prior to Therapy for ADHD

A

Comprehensive medical eval + EKG
Pretreatment height, weight, BP, HR
Pretreatment appetite, sleep patterns, headaches, & abdominal pain
Assess for substance use/abuse

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17
Q

Education for ADHD Pharmacology

A

Meds prescribed to help with self control & ability to focus
Benefits vs. risks
Risks: CV issues, anorexia, insomnia, tics, priapism
Follow up protocol expectations
Patient specific goals

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18
Q

Potential Goals for ADHD Treatment

A

Less interruption in class
Turning in homework on time
Keeping their butt in their seat

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19
Q

Medications for ADHD

A

1st: methylphenidate (Ritalin) or dextroamphetamine (Adderall)
2nd: atomoxetine (Straterra)

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20
Q

Considerations for Medication Choice in ADHD

A 
Duration of coverage
Ability to swallow pills
Time of day when symptoms occur
Desire to avoid administration at school
Coexisting tic disorder
Coexisting emotional or behavioral condition
Potential SE
Hx of substance abuse
Expense
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21
Q

Pros of Pharmacotherapy for ADHD

A

Long record of safety & efficacy
Improves: core symptoms, parent-child interactions, aggressive behavior, academic productivity & accuracy, improved self-esteem

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22
Q

Cons of Pharmacotherapy for ADHD

A

Insufficient data to judge long term academic performance
Symptoms tend to improve over time
Does not significantly affect learning problems, reduced social skills, oppositional behavior, emotional problems

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23
Q

How to choose which stimulant for ADHD?

A

Providers preference & comfort level

Patient & parent preference

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24
Q

Drugs Classes of ADHD Medications

A

Stimulants
Atomoxetine
Alpha-2-adrenergic agonists
Antidepressants

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25
Q

Stimulant Medications for ADHD

A

Methylphenidate
Detroamphetamine
Detroamphetamine-amphetamine

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26
Q

Antidepressant Medications for ADHD

A

TCAs

Bupropion

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27
Q

Short Acting Methylphenidate’s for ADHD

A

Ritalin

Methylin

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28
Q

Time Frames for Ritalin & Methylin

A

Onset: 20-60 minutes
Duration: 3-5 hours
Half-life: 2-3 hours

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29
Q

Extended Release Long Acting Methylphenidate’s for ADHD

A

Metadate ER
Methylin ER
Ritalin SR

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30
Q

Time Frames for Extended Release Long Acting Methylphenidate’s for ADHD

A

Onset: 20-60 minutes
Duration: 8 hours

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31
Q

Sustained Release Long Acting Methylphenidate’s for ADHD

A

dexmethyllphenidate (Focalin XR)
Metadate CD
Ritalin LA

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32
Q

Time Frames for Sustained Release Long Acting Methylphenidate’s for ADHD

A

Onset: 20-60 minutes
Duration: 9 hours; 12 hours (Focalin XR)
BID dosing

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33
Q

Long Acting Osmotic Release Methylphenidate for ADHD

A

Concerta

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34
Q

Times Frame for Concerta

A

Onset: 20-60 minutes
Duration: 12 hours

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35
Q

Long Acting Oral Suspension Methylphenidate for ADHD

A

Quillivan XR

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36
Q

Time Frames for Quillivan XR

A

Onset: 60 minutes
Duration: 12 hours

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37
Q

Long Acting Transdermal Methylphenidate for ADHD

A

Daytrana

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38
Q

Time Frames for Daytrana

A

Onset: 60 minutes
Duration: 12 hours
Last 3 hours after removal of patch

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39
Q

Short Acting Amphetamines for ADHD

A

Dextroamphetamine’s

Amphetamine-destroamphetamine (Adderall)

40
Q

Time Frames for Dextroamphetamines

A

Onset: 20 minutes
Duration: 4-6 hours

41
Q

Time Frames for Adderall

A

Onset: 20 minutes

Duration 4-6 hours

42
Q

Examples of Dextroamphetamine’s

A

Dexedrine
Dextrostate
Procenta (Oral solution)

43
Q

Examples of Long Acting Amphetamines

A

Lisdexamfetamine (Vyvanase)
Dextroamphetamine SR (Dexedrine spansule)
Amphetamine-dextroamphetamine (Adderall XR)

44
Q

Time Frame for Lisdexamfetamine (Vyvanase)

A

Onset: 1 hour
Duration: 10-12 hours

45
Q

Time Frame for Dextroamphetamine SR (Dexedrine spansule)

A

Onset: 20 minutes
Duration: 6-8 hours

46
Q

Time Frame for amphetamine-dextroamphetamine (Adderall XR)

A

Onset: 20 minutes
Duration: 8-10 hours

47
Q

Reasons for a Short Acting Stimulant

A

Initial prescription in children

48
Q

Reasons for a Long Acting Preperation

A

Initially age 6+

Start at lowest dose & titrate up

49
Q

Methylphenidate SR (Ritalin) Dose Titration

A

Increase 20 mg/day q 3-7 days

Weight based

50
Q

Methylphenidate LA (Ritalin LA) Dose Titration

A

Increase 10 mg/dose q 3-7 days

Weight based

51
Q

Methylphenidate ER (Concerta) Dose Titration

A

Increase 9-18 mg/dose q 3-7 days

Age based

52
Q

Dextroamphetamine SR (Dexedrine Spansule) Dose Titration

A

Increase 5 mg every 3-7 days

Weight based

53
Q

Amphetamine-Dextroamphetamine SR (Adderall XR) Dose Titration

A

Increase 5 mg every 3-7 days

Max dose 40 mg

54
Q

Lisdexamphetamine (Vyvanase) Dose TItration

A

Increase 10-20 mg q 3-7 days

Max dose 70 mg

55
Q

Non-stimulant Medications

A

Atomoxetine (Strattera)
Alpha-2-adrenergic agonsists
Antidepressants

56
Q

Alpha-2-adrenergic Agonists for ADHD

A

Clonidine (Catapres)

Guanfacine (Tenex)

57
Q

Antidepressants for ADHD

A

TCAs: imipramine (Tofranil), desipramine (Norpramin)

Bupropion (Wellbutrin)

58
Q

Atomoxetine (Strattera) Dose Titration for

A

Increase 1.2 mg/kg/day after 3 days

Max dose lesser of 1.4 mg/kg or 100 mg/day

59
Q

Atomoxetine (Strattera) Dose Titration for >70 kg

A

Increase to 80 mg after 3 days

After 2-4 weeks may increase to 100 mg

60
Q

Monitoring for SE

A

Assess weekly during titration
Parent/teacher feedback
Monthly after titration for weight, HR & BP until stable with no SE
Optimal dose = favorable outcomes with minimal SE

61
Q

SE of ADHD Pharmacotherapy

A 
Decreased appetite
Poor growth
Dizziness
Insomnia/nightmares
Mood lability
Rebound
Tics
Psychosis
Diversion & misuse
62
Q

Managing Decreased Appetite

A

Give at/after a meal
Nutrient dense foods
Off food child likes for noon meal

63
Q

Managing Poor Growth

A

Drug holidays

64
Q

Managing Dizziness

A

Monitor BP & HR

Adequate fluid intake

65
Q

Managing Insomnia or Nightmares

A

Bedtime routine
Good sleepy hygiene habits
Omit/reduce last dose of day
Consider short acting vs. long acting

66
Q

Managing Mood Lability

A

Convert to long acting formulation or BID to TID

Mood changes at peak concentration

67
Q

Symptoms of Mood Lability

A

Sadness
Irritability
Increased activity

68
Q

Controlling Mood Changes at Peak Concentration

A

Reduce dose

Switch to long acting

69
Q

Managing Rebound

A

Stepping down dose at end of day

70
Q

Managing Tics

A

Drug trial at different doses to see if related to med

71
Q

Managing Psychosis

A

Verify dose is appropriate
Verify medication administered as prescribed
Refer to mental health specialist

72
Q

Symptoms of Psychosis with ADHD Medications

A

Suicidality
Hallucinations
Increased aggression

73
Q

Management of Diversion & Misuse

A

Monitor symptoms & prescription refills
Long acting less potential for abuse
Keep track of prescription dates
Open discussion

74
Q

Reasons for ADHD Treatment Failure

A 
Lack of adherence
Medication diversion
Goals & expectations realistic
Co-morbid psychiatric diagnosis
Fail multiple stimulants or intolerable SE, trial atomoxetine or alpha-2-adrenergic or buproprion
75
Q

When are drug holidays permissible?

A

Weekends
Summers
ONLY FOR STIMULANTS

76
Q

Maintenance of ADHD Therapy

A

Follow up every 3-6 months

Monitor height, weight, BP, HR

77
Q

Termination of ADHD Therapy

A

Stimulants or atomoxetine can be abruptly

Alpha-2-adrenergics & TCAs should be tapered

78
Q

Ritalin (Methylphenidate)

A

Short & Long acting agents

Blocks dopamine & norepinephrine re-uptake

79
Q

Short Acting Ritalin (Methylphenidate)

A

Ritalin

Methylin

80
Q

Long Acting Ritalin (Methylphenidate)

A

Metadate ER
Methylin ER
Ritalin SR

81
Q

Longer Acting Ritalin (Methylphenidate)

A

Focalin XR
Metadate CD
Ritalin LA

82
Q

Longest Acting Ritalin (Methylphenidate)

A

Concerta
Quillivan XR
Daytrana

83
Q

SE of Ritalin (Methylphenidate)

A 
Anxiety
Weight loss
Psychosis
Aggression
Hallucinations
Sudden cardiac death in at risk people
Easy bruising
Schedule II
84
Q

Amphetamine-dextromphetamine (Adderall)

A

Schedule II
Popular
Slightly more effective than Ritalin

85
Q

SE of amphetamine-dextroamphetmine (Adderall)

A 
Anxiety
Weight loss
Psychosis
Hallucinations
Aggression
Sudden cardiac death in at risk people
86
Q

Dextroamphetamine (Dexedrine)

A

Among most effective treatment for ADHD
Schedule II
Sudden cardiac death in at risk people

87
Q

Heart Related Problems with Dextroamphetamine (Dexedrine)

A

Sudden death in people with heart problems or defects
Sudden death, stroke & MI in adults
Increased BP & HR

88
Q

Psychiatric Problems in Dextroamphetamine (Dexedrine)

A

New/worse behavior & thought problems

New/worse bipolar

89
Q

Children/Teenager Problems in Dextroamphetamine (Dexedrine)

A

Seeing things
Hearing voices
Believing things that aren’t true
New manic symptoms

90
Q

Lixdexamphetmaine (Vyvanase)

A

Less addictive but still Schedule II

91
Q

Atomoxetine (Strattera)

A

Works on norepinephrine
Black box warning: increased risk of suicidal behavior
Less effective than stimulants
Expensive

92
Q

SE of Atomoxetine (Straterra)

A 
Dry mouth
Insomnia
Nausea
Decreased appetite
Constipation
Decreased libido
Erectile dysfunction
Urinary hesitancy
Dizziness
Sweating
Chest pain
SOB
Irregular heart beat
Unusual thoughts or behavior
Aggression
Hallucinations
Jaundice
Abdominal pain
93
Q

Alpha-2-adrenergic Agonist

A

ER Guanfacine (Intuniv)

94
Q

SE for ER Guanfacine (Intuniv)

A 
Fast/slow HR
Pounding heartbeat, chest tightness
Numbness/tingling
High rate of fainting
Depression
Hypotension
95
Q

When should you caution use of guanfacine (Intuniv)

A

Kidney or liver disease

96
Q

Alternative Treatment for ADHD

A

Buproprion (Wellbutrin)

97
Q

SE of Bupropion (Wellbutrin)

A

Anxiety

Insomnia

Behavioral Health (25 decks)

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