ADHD Flashcards
some symptoms of inattention an how many for how long do you need
6 or more symptoms for 6 months
not close atention to detail, doesnt listen when spoken to, does not follow through, trouble organuzing, avoids things requiring mental effort, easily distracted, forgetful
how many symptoms of hyperactivity-impulsivity for how long
6 or more symptoms for 6 months to an extent that is disruptive
symptoms of hyperactivity
fidgets gets up from seat often runs or climbs everywhere trouble playing quietly on the go talks excessively
symptoms of impulsivity
blurts out answers before question finished
trouble waiting for turn
interrupts or intrudes
4 criteria for ADHD
some symptoms present before age 12
some impairment is present in 2 or more settings
clinically significant impairment in social, school, work functioning
symptoms dont happen due to other disorder
ADHD diagnosis
symptoms of inattention or hyperactivity and impulsivity present during childhood and cause functional impairment in 2 diff settings for 6 months
clear evidence that symptoms interfere with social, school, work functioning
3 types of adhd
predominantly inattentative
predominately hyperactive-impulsive
combined
do stimulants impact children who dont have adhd
yes
whats a reason for more people with adhd
less strict criteria
ex. increased age to 12, less symptoms in adults
is adhd heritable
yes
common co-morbidities with adhd
anxiety
tic
oppositional defiant disorders
useful baseline info
height weight severity psychiatric and development history medical history esp cardiac eating and sleeping patterns economics potential for abuse
adhd rating scaler
conners
skamp
snap4
cbcl
what did we learn from the big MTA trial
medication management alone or combined with behavior treatment are nearly equally effective and superior to behavior treatmetn alone or community based treatmetn
when would we consider behavioural therapy alone
mild
diagnosis uncertain
patient <6
when is combined behavioural and meds better than meds alone
oppositional behaviour/aggressive symptoms
internalizing symptoms
parent child interaction difficulties
what was noted after an 8 year follow up
no diff between the 4 interventions
3 factors that could influence medicaiton choice
cost
history of drug abuse
comorbid symptoms
methyphenidate short acting
ritalin
disadvantages of short acting
bid or tid dosing symptoms may return between doses lunchtime dose has to be at school stigma compliance
advantage of short acting
cheap
methyphenidate sustained release products
biphentin
concerta
advantages of biphentin
covered part 1
lots of different strengths for easy titration
capsules can be opened and sprinkled
when might you want to use a long acting in the morning and immediate when they get home
long acting to get them through the school day then short later if theyre having difficulty doing homework so that they can still sleep
disadvantages of concerta
cost compared to the generic
weird doses so titration issues
biphentin delivery system
outer layer immediate release
inside coating delayed
concerta delivery system
fluid comes in and pushes out the medcation to a certain point
3 methyphenidate based psychostimulants
ritalin
concerta
biphentin
3 amphetamine based psychostimulants
dexedrine
adderall
vyvanse
if a patient fails on a sitmulant should they be tried on another
yes
short acting amphetamine
dexedrine
disadvantage of adderal
expensive and not covered by pharmacare
adderall delivery system
50% of beads are immediate release the others are delayed
what is the point of the pro drug vyvanse
no therapeutic advantage but less prone to be abused
vyvanse delivery system
enzymes cleave the prodrug progressively releasing the active product
is vyvanse an advanntage
he doesnt think so
non stimulant options
strattera - SSRI
intuniv - alpha2 agonist
which pills can be crushed/ sprinkled
dexedrine adderall vyvanse ritalin biphentin
which pills need to be swallowed whole
concerta
strattera
intuniv
advantage of strattera
comorbid conditions
once daily
no substance abuse
disadvantages of strattera
cost not covered
BA increased in 2D6 poor metabolizers
no long term evaluation
adverse effects of strattera
decrease appetite ab pain somnolence lower growth CV issues suicidal liver failure
how does intiuniv work
increase blood flow to prefrontal cortex
intuniv diff from clonidine
less sedation and diziness
longer half life
med if have phsyical aggression
stimulants
may add amoxetine if persists
med if have anxiety
use slow titration of stimulants
consider SSRI if persists
med if have depression
treat condition causing most impairment first then reasses
med if have insomnia
try stimulant early in theday
consider adjunctive insomnia treatment or switch to atomoxetine
med if have substance abuse disorder
consider atomoxetine
stimulants with lower abuse - concerta
med if have tic disorder
stimulants
alpha 2 agonist if persist
safety concerns for stimulants
black box - sudden cardiac death
affect growth
monitoring for stimulants
evaluation of CV status
baseloine ECG, HR, HP
sitmulant? side effects
insomnia anorexia headache weight loss new onset tics irritable
do adhd drugs increase risk of suicide
no
role of drug holidays
sometimes people stop during summer holdays or spring break
can interfere with social functions and starting and stopping may cause irritability
not the best idea
short term and long term beenfits of medication
helps test scores in the short term no long term data
how long should someone be treated
possible to grow out of adhd
should reasses every few years and see if drug is still needed
