ADHD

Question 1

The diagnosis of ADHD requires:

Answer 1

Inattention, hyperactivity and impulsivity persisted for at least 6months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities

Question 2

What happens in the brain to cause ADHD?

Answer 2

Deficits in function of the prefrontal cortex manifest as impulsivity, poor problem-solving, and hyperactivity
Dysfunction of dopamine transmission related to genetic defects in the transporter (DAT) and receptors

Question 3

What are 5 examples of stimulants used for treatment of ADHD?

Answer 3

Methylphenidate (Concerta/Ritalin)
Dexmethylphenidate (Focalin)
Amphetamine/dextroamphetamine (Adderall)
Dextroamphetamine (Dextrostat, Dexedrine)
Lisdexamfetamine (Vyvanse)

Question 4

What are 3 examples of non-stimulants used for treatment of ADHD?

Answer 4

Atomoxetine (Strattera)
Guanfacine (Intuniv)
Clonidine (Kapvay)

Question 5

True or False? There is an increased risk of seizures for people that use stimulants

Answer 5

False. There is no increased seizure risk

Question 6

What are adverse effects of stimulants?

Answer 6

Appetite loss
Dysphoria
Headaches
Abdominal pain
Sleep disturbances
Motor tics
Reduction in growth rates
Risk of abuse

Question 7

The Multimodal Treatment study of ADHD (MTA) found that beneficial effects of stimulants are not seen after ___ years of treatment

Answer 7

3

Question 8

True or False? Stimulants have more potential for abuse over non-stimulants

Answer 8

True

Question 9

True or False? Methylphenidate has more potential for abuse over amphetamine

Answer 9

False. Amphetamine has the highest potential for abuse

Question 10

True or False? XR formulations have more potential for abuse over immediate-release formulations

Answer 10

False. Immediate-release formulations have the highest potential for abuse

Question 11

Stimulants have a BBW for:

Answer 11

Sudden cardiac death

Question 12

___ has double the potency of methylphenidate

Answer 12

Dexmethylphenidate

Question 13

True or False? You may open capsule of Focalin XR and sprinkle contents over spoonful of applesauce for immediate use

Answer 13

True

Question 14

True or False? Adderall XR has approval for children 3-5 years old

Answer 14

False. Adderall immediate-release and dextroamphetamine immediate-release have FDA approval for children aged 3-5. Methylphenidate is also used in children aged 3-5 but does not have FDA approval

Question 15

___ is a prodrug of dextroamphetamine and has less abuse potential than other stimulants

Answer 15

Lisdexamphetamine

Question 16

What are adverse effects of strattera?

Answer 16

Somnolence and GI upset

Question 17

What is one positive aspect and one negative aspect of atomoxetine compared to stimulants?

Answer 17

No potential for abuse

Slower onset of action (2-4 weeks vs 1 hour)

Question 18

What is the BBW for atomoxetine?

Answer 18

Increased risk of suicidal ideation in children and adolescents

Question 19

For atomoxetine, besides the BBW, what additional caution must be taken

Answer 19

Perform LFTs. May cause liver injury. Discontinue if jaundice present

Question 20

___ is useful in patients with ADHD as well as aggressive behavior

Answer 20

Clonidine

Question 21

Adverse effects of non-stimulants are:

Answer 21

Somnolence
Bradycardia
Hypotension

Question 22

What medication should be attempted if a patient does not benefit from use of a stimulant?

Answer 22

Attempt another stimulant before switching over to a non-stimulant

Question 23

Which stimulant is considered last line?

Answer 23

Amphetamine/dextroamphetamine

Question 24

Which non-stimulant is considered last line?

Answer 24

Clonidine