ADHD Flashcards
ADHD def’n
‘a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development…. and negatively impacts directly on social and academic/occupational activities’
GIve 3 adverse outocmes associated with ADHD
educational problems (resulting in low rates of high-school graduation and completion of postsecondary education) [6], difficult peer relationships [7] and increased rates of motor vehicle accidents, accidental injuries, and substance misuse
3 RF’s for persistence of ADHD into adulthood
combined inattention/hyperactivity, increased symptom severity, comorbid major depressive or other mood disorder, high comorbidity (>3 additional DSM disorders), parental anxiety, and parental antisocial personality disorder [11].
3 RF’s for ADHD
in utero exposure to alcohol or tobacco [18] and low birth weight (<2,500 g) [19][20]. Hypoxic–anoxic brain injury [21], epilepsy disorders [22], and traumatic brain injury
5 parts of clinical process in diagnosis of ADHD
- Several visits
- Detailed history (prenatal, perinatal, medical, mental health)
- dev/behav hx
- fam medical and mental health hx
- review report cards
- obtain standardized behavioural scales taht eval DSM5
…DON’T Do: lab tests, psych testing
for adhd dx, sx must be present before what age?
12
for adhd dx, sx must be present for how long?
> 6 mos
5 DDX for ADHD
"SLO IT" like SLOW IT DOWN: Sleep disorder Learning D/O ODD Intellectual disability Tic D/O
Learning disorder Sleep disorder Oppositional defiant disorder Anxiety disorder Intellectual disability Language disorder, mood disorder, tic disorder, conduct disorder Autism spectrum disorder Developmental coordination disorder
4 syndromes prevalent in ADHD?
Fragile X
Turner
TS
NF1
also 22q11
5 disorders co-morbid with ADHD?
CO-AD’S
OCD *ODD *CD bipolar disorder tic disorders substance use disorders *DCD= dev coordination d/o *Specific learning d/o *ASD Eating disroder
3 parts to med exam for ADHD
physical, neuro, dysmorpohology assessments
Give 5 non pharm intervention for ADHD
DOC’s Do’s:
- Daily Report Card
- Organizational skills training
- Classroom management
- Social skills training
- Diet
Also: psychoeducation, exercise, PBT
trial a given stimulant for how long before determining not working?
2-4 weeks
two stimulants?
dextroamphetamine
methylphenidate
drug holidays in adhd not good for whom?
those with risk-taking behaviours or struggling with peer interactions or “at risk for poor outcomes”
which type of stimulant is hardest to take recreationally?
extended release
is it ok if adhd patient has appetite suppression at lunch? at dinner?
lunch ok; dinner not ok
2 suitable drugs to start for as first chioce older kids iwth adhd?
vyvanse (amphetamine/dextroamphetamine);concerta= MPH
2 suitable drugs to start as first choice for younger kids iwth adhd?
biphentin (MPH), adderall (dextroamphetamine), vyvanse
Which ADHD meds can be given as beads?
biphentin, adderall
Which ADHD med can be given as powder than can be mixed in liquid or food?
vyvanse
2 short release ADHD meds?
Ritalin SR, Generic MPH ER
2 non-stim ADHD meds?
atomoxetine Hcl= strattera; intuniv= guanfacine
4 side effects of stimulants
decreased appetite "too focused" irritability Increased in HR, BP Raynaud's phenomenon Psychosis Delayed puberty
who should get ECG before starting ADHD meds?
Only children and youth at risk for stimulant-induced cardiovascular AEs (based on family history or a personal history/cardiac examination)
do stimulants affect height?
can cause decrease in growth but for most kids finally adult height only minnimally affected
which non-stim is often used with stims for ADHD?
atomoxetine
which med is helpful when ADHD patient has oppositional sx?
guanfacine
Atomoxetine AEs (3)
irritability,
headache,
appetite loss,
somnolence
Guanfacine AEs:
somnolence, syncope, bradycardia
guanfactine is what type of drug?
Selective alpha 2a-adrenergic receptor agonist
what tyep fo drug is atomoxetine = strattera?
Selective norepinephrine reuptake inhibitor
what type of adhd med requires blood pressure monitorning?
guanfacine, clondine (alpha adrenergic drugs)
2 reasons for longer half life of atomoxetine in some pts?
polymorphism of cytochrome P450; taking other drugs like fluoextine
which adhd drugs must be tapered slowly and why?
alpha adrenergic drugs; to avoid htn, tachyardia, hypertensive encephalopathy
3 syndromes with features of ASD adn ADHD
Fragile X
TS
22q11 deletion
Williams
2 difficulties of treating pts iwth ADHD + ASD
- Less likely to respond to tx
- More likely to have side effects
adhd med helpful in kids iwth ADHD + ASD
guanfacine
5 conditions associated with ID
fragile x klinefelter turner TS neurofibromatosis
pt with adhd and ID: on stimulant. has behavioural sx and doesn’t respond to behavioural interventions. next?
risperidone
CPS reviews what 3 conditions along with ADHD?
ASD, ID, prematurity; these groups have greater impairment
what’s the main nonpharm intervention for pts with ADHD + ASD/ID
exercise
most common comorbidity
learning disorder
first line tx for preschooler
parental behaviour therapy
CADDRA contrindication to meds
Rule out contraindications to medication:
- Glaucoma
- Uncontrolled hypertension
- Any evidence of significant cardiovascular abnormality
