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Clinical 2.0 winter > ADHD > Flashcards

ADHD Flashcards

1
Q

some symptoms of inattention an how many for how long do you need

A

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

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2
Q

how many symptoms of hyperactivity-impulsivity for how long

A

6 or more symptoms for 6 months to an extent that is disruptive

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3
Q

symptoms of hyperactivity

A 
fidgets
gets up from seat often 
runs or climbs everywhere
trouble playing quietly 
on the go 
talks excessively
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4
Q

symptoms of impulsivity

A

blurts out answers before question finished
trouble waiting for turn
interrupts or intrudes

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5
Q

4 criteria for ADHD

A

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

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6
Q

ADHD diagnosis

A

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

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7
Q

3 types of adhd

A

predominantly inattentative
predominately hyperactive-impulsive
combined

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8
Q

do stimulants impact children who dont have adhd

A

yes

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9
Q

whats a reason for more people with adhd

A

less strict criteria

ex. increased age to 12, less symptoms in adults

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10
Q

is adhd heritable

A

yes

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11
Q

common co-morbidities with adhd

A

anxiety
tic
oppositional defiant disorders

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12
Q

useful baseline info

A 
height 
weight
severity 
psychiatric and development history 
medical history esp cardiac
eating and sleeping patterns
economics
potential for abuse
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13
Q

adhd rating scaler

A

conners
skamp
snap4
cbcl

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14
Q

what did we learn from the big MTA trial

A

medication management alone or combined with behavior treatment are nearly equally effective and superior to behavior treatmetn alone or community based treatmetn

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15
Q

when would we consider behavioural therapy alone

A

mild
diagnosis uncertain
patient <6

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16
Q

when is combined behavioural and meds better than meds alone

A

oppositional behaviour/aggressive symptoms
internalizing symptoms
parent child interaction difficulties

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17
Q

what was noted after an 8 year follow up

A

no diff between the 4 interventions

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18
Q

3 factors that could influence medicaiton choice

A

cost
history of drug abuse
comorbid symptoms

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19
Q

methyphenidate short acting

A

ritalin

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20
Q

disadvantages of short acting

A 
bid or tid dosing
symptoms may return between doses
lunchtime dose has to be at school 
stigma
compliance
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21
Q

advantage of short acting

A

cheap

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22
Q

methyphenidate sustained release products

A

biphentin

concerta

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23
Q

advantages of biphentin

A

covered part 1
lots of different strengths for easy titration
capsules can be opened and sprinkled

24
Q

when might you want to use a long acting in the morning and immediate when they get home

A

long acting to get them through the school day then short later if theyre having difficulty doing homework so that they can still sleep

25
Q

disadvantages of concerta

A

cost compared to the generic

weird doses so titration issues

26
Q

biphentin delivery system

A

outer layer immediate release

inside coating delayed

27
Q

concerta delivery system

A

fluid comes in and pushes out the medcation to a certain point

28
Q

3 methyphenidate based psychostimulants

A

ritalin
concerta
biphentin

29
Q

3 amphetamine based psychostimulants

A

dexedrine
adderall
vyvanse

30
Q

if a patient fails on a sitmulant should they be tried on another

A

yes

31
Q

short acting amphetamine

A

dexedrine

32
Q

disadvantage of adderal

A

expensive and not covered by pharmacare

33
Q

adderall delivery system

A

50% of beads are immediate release the others are delayed

34
Q

what is the point of the pro drug vyvanse

A

no therapeutic advantage but less prone to be abused

35
Q

vyvanse delivery system

A

enzymes cleave the prodrug progressively releasing the active product

36
Q

is vyvanse an advanntage

A

he doesnt think so

37
Q

non stimulant options

A

strattera - SSRI

intuniv - alpha2 agonist

38
Q

which pills can be crushed/ sprinkled

A 
dexedrine
adderall
vyvanse
ritalin 
biphentin
39
Q

which pills need to be swallowed whole

A

concerta
strattera
intuniv

40
Q

advantage of strattera

A

comorbid conditions
once daily
no substance abuse

41
Q

disadvantages of strattera

A

cost not covered
BA increased in 2D6 poor metabolizers
no long term evaluation

42
Q

adverse effects of strattera

A 
decrease appetite
ab pain
somnolence
lower growth 
CV issues
suicidal
liver failure
43
Q

how does intiuniv work

A

increase blood flow to prefrontal cortex

44
Q

intuniv diff from clonidine

A

less sedation and diziness

longer half life

45
Q

med if have phsyical aggression

A

stimulants

may add amoxetine if persists

46
Q

med if have anxiety

A

use slow titration of stimulants

consider SSRI if persists

47
Q

med if have depression

A

treat condition causing most impairment first then reasses

48
Q

med if have insomnia

A

try stimulant early in theday

consider adjunctive insomnia treatment or switch to atomoxetine

49
Q

med if have substance abuse disorder

A

consider atomoxetine

stimulants with lower abuse - concerta

50
Q

med if have tic disorder

A

stimulants

alpha 2 agonist if persist

51
Q

safety concerns for stimulants

A

black box - sudden cardiac death

affect growth

52
Q

monitoring for stimulants

A

evaluation of CV status

baseloine ECG, HR, HP

53
Q

sitmulant? side effects

A 
insomnia
anorexia
headache
weight loss 
new onset tics
irritable
54
Q

do adhd drugs increase risk of suicide

A

no

55
Q

role of drug holidays

A

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

56
Q

short term and long term beenfits of medication

A

helps test scores in the short term no long term data

57
Q

how long should someone be treated

A

possible to grow out of adhd

should reasses every few years and see if drug is still needed

Clinical 2.0 winter (28 decks)

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