ADHD (Barash)

Question 1

Genetic imbalance in what NTs for ADHD?

Answer 1

DA and Noradrenergic systems

Question 2

Increased risk of ADHD with prenatal __

Answer 2

smoking exposure

Question 3

which subtype of ADHD most common?

Answer 3

Combined type

Question 4

According to DSM 5, some symptoms for ADHD must be present by what age?

Answer 4

12 y/o

Question 5

In dx children with ADHD, how many symptoms of inattention and/or hyperactivity/impulsivity? What about adolescents and adults?

Answer 5

Kids-6/9

Adolescents and adults=5/9

Question 6

Triad of psychiatry?

Answer 6

ADHD
Tourette’s
OCD

Question 7

AAP Guidelines for tx 6-11 y/o w/ADHD?

Answer 7

• Tx w/FDA-approved med (strong evidence for stimulants) and/or
• Parent and/or teacher behavior management or preferably both

Question 8

AAP Guidelines for tx 12-17 y/o with ADHD?

Answer 8

• Tx w/FDA-approved med

- May Rx behavior tx

Question 9

Do you outgrow ADHD?

Answer 9

Usually NO

-ADHD is a chronic disorder –> 65% of children w/ADHD will have symptoms as adolescents

Question 10

Medical mgmt of ADHD?

Answer 10

-Stimulants are 1st line tx and most effective –> 70-80% will respond to a stimulant

Question 11

Primary MOA of stimulants?

Answer 11

Block reuptake pump
Increase DA and NE levels
Amphetamines cause presynaptic release into synapse

Question 12

Common stimulant SEs?

Answer 12

• Decreased appetite –> give w/or after meals
• Difficulty falling asleep
• Tics
• Stomach ache –> give w/food
• HA’s

Question 13

Big warning with use of stimulants?

Answer 13

Cardiac:

• FDA recommends not using if heart disease, arrhythmia, or FH of arrhythmia
• concern about pts w/undiagnosed heart disease and long-term effects

Question 14

What is a 504 plan? How does it relate to ADHD?

Answer 14

Section 504 of Rehabilitation Act
-Schools receiving fed funds and employers cannot discriminate against people w/disabilities (including ADHD) and must make reasonable accomodations

Question 15

Name Methylphenidate ER drugs

Answer 15

Concerta –> longest lasting, must swallow whole
Ritalin LA –> Can open capsule
Metadate CD –> can open capsule

Question 16

Name D-Methylphenidate drug(s)

Answer 16

Focalin

Focalin XR

Question 17

Duration of action for these amphetamines:

• Dexedrine, Dextrostat=__
• Adderall XR=__
• Adderall, Dexedrine spansules=__

Answer 17

Short acting (4-6 hr)

Extended release (10-12 hr)

Intm acting (5-8 hr)

Question 18

alternative meds for ADHD?

Answer 18

Atomoxetine (straterra) –> selective NE reuptake inhibitor, no abue potential, not controlled, ~3-4 wks to take effect

Clonidine and Guanfacine –> a2-agoniosts, ~2 wks to see effect

Question 19

Meds for the following co-morbidities:

• ADHD and anxiety=__
• ADHD and tics=__
• ADHD and aggression=__

Answer 19

+ anxiety=Stimulants, may need to add SSRI, another option is Atomoxitine

+ tics=Stimulants and Clonidine or other meds for tics, Atomoxetine

+ aggression=Stimulant and Clonidine/Guanfacine