ADHD and Medications

Question 1

How long do ADHD symptoms need to be present for prior to diagnosis?

Answer 1

at least 6 months

Question 2

What are the three types of ADHD?

Answer 2

1. Hyperactive/impulse
2. Inattentive
3. Combined

Question 3

What assessment tool is available for parents/teachers to use to report ADHD symptoms?

What age range is this assessment tool useful for?

Answer 3

Vanderbilt Assessment Scale

for ages 6-12 yo

Question 4

Using the Vanderbilt Assessment Scales, to meet criteria for ADHD what 2 criterion must be met between the symptoms and performance sections?

Answer 4

1. 6+ (+) responses in hyperactive or inattentive symptoms in “Behaviors” section
2. Must have 2 ‘4s’ or 1 ‘5’ in the “Performance” section

Question 5

What are the two major categories of ADHD medications?

Answer 5

Stimulants and Non-Stimulants

Question 6

What are the two classes of Stimulants used to treat ADHD?

Answer 6

1. Methylphenidates
2. Amphetamines

Question 7

What are the 3 most common methylphenidate medications used to treat ADHD?

Answer 7

1. Ritalin
2. Concerta
3. Focalin

Question 8

What are the 2 most common amphetamine medications used to treat ADHD?

Answer 8

1. Adderall
2. Vyvanse

Question 9

What are the 3 most common non-stimulant medications used to treat ADHD?

Answer 9

1. Strattera (atomoxetine)
2. Clonidine
3. Guanfacines

Question 10

What is the generic name for Strattera?

Answer 10

Atomoxitine

Question 11

What is the generic name for Ritalin?

Answer 11

Methylphenidate hydrochloride

Question 12

What is the generic name for Concerta?

Answer 12

Methylphenidate hydrochloride extended release

Question 13

What is the generic name for Focalin?

Answer 13

Dexmethylphenidate

Question 14

Are these stimulants long or short-acting?

Ritalin
Concerta
Focalin

Answer 14

Ritalin - SHORT acting
Concerta - LONG acting
Focalin - SHORT acting

Question 15

What are the three major side effects of methylphenidate medications?

Answer 15

1. decreased appetite
2. sleep disturbances
3. cardiac

Question 16

Are these stimulants long or short-acting?

Adderall
Vyvanse

Answer 16

Adderall - SHORT acting
Adderall XR - LONG acting
Vyvanse - LONGEST 1/2 life

Question 17

Which amphetamine medication is the best for concomitant anxiety symptoms?

Answer 17

Vyvanse

Question 18

What side effect is commonly seen with amphetamine use?

Answer 18

emotional reactivity

Question 19

What are two main side effects of non-stimulant ADHD medications?

Answer 19

drowsiness (3-5 days) and dizziness

• alpha 2 agonists

Question 20

Ritalin (IR) dosing

Children 3-5 yo
Children 6 yo+

Answer 20

3-5: initial 2.5 mg BID, gradually titrate to 7.5 mg BID/TID over 2-4 wks

6+: initial 2.5-5 mg BID, inc. by 5-10 mg/day at weekly intervals
- Max: 2 mg/kg/day

Question 21

Concerta (XR)

Children 6+ who are methylphenidate-naive
Children 6+ who are switching from IR to XR (4)

Answer 21

Naive: 18mg QD

Not naive:

1. 5 mg IR BID/TID –> 18 mg QD
2. 10 mg IR BID/TID –> 36 mg QD
3. 15 mg IR BID/TID –> 54 mg QD
4. 20 mg IR BID/TID –> 72 mg QD

Question 22

Concerta (XR)

How do dose adjustments occur?

What is the max daily dosing? (age 6-12 vs 12+)

Answer 22

Adjust: inc. by 18 mg/day at weekly intervals

Max dosing:
- 6-12: 54 mg/day
- 12+: 72 mg/day

Question 23

Focalin (6yo+)

Methlyphenidate naive dosing (IR and XR) vs switching from methylphenidate

Answer 23

Naive:
- IR: 2.5 mg BID, inc. 2.5-5mg/day weekly (Max: 20mg/day)
- XR: 5 mg QD, inc. 5mg/day weekly (Max: 30mg/kg/day)

Switching:
- initial dose: 1/2 methylphenidate dose

Question 24

Adderall (IR)

3-5 yo dosing vs 6+ yo dosing

Answer 24

3-5: 2.5 mg QD, inc. 2.5mg/day weekly (Max: 40mg/day in 1-2 divided doses)

6+: 5 mg QD/BID, inc. 5 mg/day weekly (Max: 40mg/day)

Question 25

Adderall (XR)

6-12 yo vs 13-17yo dosing

What is the dosing if switching from IR Adderall to XR Adderall?

Answer 25

6-12yo: 5-10mg QD, inc. 5-10mg/day weekly (Max: 30mg/day)

13-17yo: 10mg QD, inc. to 20mg QD after 1 week if not controlled (Max: 20mg/day)

if switching from IR to XR: use same total daily dose of IR taken QD as XR form

Question 26

Vyvanse (6yo+)

Initial dosing

Answer 26

Initial: 20-30mg QD morning

Increase 10mg/day or 20mg/day at 3-7 day intervals

Max: 70mg/day

Question 27

Strattera (6yo+)

<70 kg vs >70 kg dosing

Answer 27

<70kg: 0.5mg/kg/day, inc. to 1.2mg/kg/day after 3 days
- given QD or BID
- Max: 1.4 mg/kg/day or 100mg/day

> 70kg: 40mg QD, inc. to 80mg after 3 days
- given QD or BID
- Max: 100mg/day

Question 28

Clonidine (IR, 6+ yo)

27-40kg dosing
40.5-45kg dosing
>45kg dosing

Answer 28

27-40: 0.05mg at bed, inc. 0.05mg/day every 2-3 days given BID/TID
- Max: 0.2mg/day

40.5-45: 0.05mg at bed, inc. 0.05mg/day every 2-3 days given BID/TID/QID
- Max: 0.3mg/day

> 45kg: 0.1mg at bed, inc. 0.1mg/day every 2-3 days
- Max: 0.4 mg/day

Question 29

Clonidine (XR, 6+ yo)

Dosing, increasing dose, max dose

How long is clonidine tapered over?

Answer 29

Initial: 0.1mg/day at bedtime
- inc. 0.1mg/day every 7 days BID
- Max: 0.4mg/day

Tape over 1-2 weeks

Question 30

Guanfacine (IR, 6+ yo)

<45kg dosing vs >45kg dosing

Answer 30

<45kg: 0.5mg QD at bed, inc. 0.5mg/day BID/TID/QID every 3-4 days
- Max: 0.2mg/day (27-40.5kg) or 0.3mg/day (40.5-45kg)

> 45kg: 1mg QD at bed, inc. 1mg/day BID/TID/QID every 3-4 days
- Max: 4mg/day

Question 31

What is the best initial treatment option for preschool aged children (4-5 yo) who present with ADHD symptoms?

Answer 31

Behavioral Management +/- methylphenidates if behaviors not well controlled

methylphenidate&raquo_space;> amphetamines or non-stimulants

Question 32

How often should patients on ADHD medications be seen in follow-up? (Initial vs maintenance)

Answer 32

Initial: every 1-2 weeks or per titration standards

Maintenance: every 3-6 months depending on other issues

Question 33

At therapeutic dosing, how quickly should the effects of stimulant medications be noticed?

Answer 33

within 30-40 minutes of administration