ADHD (Barash) Flashcards
Genetic imbalance in what NTs for ADHD?
DA and Noradrenergic systems
Increased risk of ADHD with prenatal __
smoking exposure
which subtype of ADHD most common?
Combined type
According to DSM 5, some symptoms for ADHD must be present by what age?
12 y/o
In dx children with ADHD, how many symptoms of inattention and/or hyperactivity/impulsivity? What about adolescents and adults?
Kids-6/9
Adolescents and adults=5/9
Triad of psychiatry?
ADHD
Tourette’s
OCD
AAP Guidelines for tx 6-11 y/o w/ADHD?
- Tx w/FDA-approved med (strong evidence for stimulants) and/or
- Parent and/or teacher behavior management or preferably both
AAP Guidelines for tx 12-17 y/o with ADHD?
- Tx w/FDA-approved med
- May Rx behavior tx
Do you outgrow ADHD?
Usually NO
-ADHD is a chronic disorder –> 65% of children w/ADHD will have symptoms as adolescents
Medical mgmt of ADHD?
-Stimulants are 1st line tx and most effective –> 70-80% will respond to a stimulant
Primary MOA of stimulants?
Block reuptake pump
Increase DA and NE levels
Amphetamines cause presynaptic release into synapse
Common stimulant SEs?
- Decreased appetite –> give w/or after meals
- Difficulty falling asleep
- Tics
- Stomach ache –> give w/food
- HA’s
Big warning with use of stimulants?
Cardiac:
- FDA recommends not using if heart disease, arrhythmia, or FH of arrhythmia
- concern about pts w/undiagnosed heart disease and long-term effects
What is a 504 plan? How does it relate to ADHD?
Section 504 of Rehabilitation Act
-Schools receiving fed funds and employers cannot discriminate against people w/disabilities (including ADHD) and must make reasonable accomodations
Name Methylphenidate ER drugs
Concerta –> longest lasting, must swallow whole
Ritalin LA –> Can open capsule
Metadate CD –> can open capsule
Name D-Methylphenidate drug(s)
Focalin
Focalin XR
Duration of action for these amphetamines:
- Dexedrine, Dextrostat=__
- Adderall XR=__
- Adderall, Dexedrine spansules=__
Short acting (4-6 hr)
Extended release (10-12 hr)
Intm acting (5-8 hr)
alternative meds for ADHD?
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
Meds for the following co-morbidities:
- ADHD and anxiety=__
- ADHD and tics=__
- ADHD and aggression=__
+ 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
