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Therapeutics III > ADHD - Block 3 > Flashcards

ADHD - Block 3 Flashcards

1
Q

What is the most common neurobehavioral disorders of childhood?

A

ADHD

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2
Q

What are the characteristcs of ADHD?

A

An ongoing pattern of inattention and/or hyperactivity impulsitivity that interferes with functioning
* typically from a lack of D and NE

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3
Q

What are the neurotransmitters that contribute to alertness, focus, though, and effort?

A

Dopamine and NE

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4
Q

Diagnosis of ADHD are made by using ___?

A

DSM5

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5
Q

Who qualifies for ADHD evaluation?

A

Ages 4-18 who present with academic or behavioral problems and sx of inattention, hyperactivity, or impulsivity

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6
Q

What is the criteria for an ADHD diagnosis?

A
  • Sx/behaviors that have persisted ≥6 months in 2 or more settings
  • <17 years require 6 or more sx
  • > 17 years require 5 or more symptoms
  • Sx must be present prior to 12
  • Sx must interfere with functioning and not caused by another disorder
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7
Q

What are inattentive sx?

A
  1. Misplace items
  2. Sidetracking by unimportant stimuli
  3. Forgets daily activities
  4. Lacks ability to complete schoolwork or follow instructions
  5. Inability to do tasks that requires concentration
  6. Poor listening skills
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8
Q

What are hyperactive sx?

A
  1. Squirms or fidgets
  2. APpears to be driven by a motor
  3. Incapable of staying seated
  4. Overly talkative
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9
Q

What are impulsive sx?

A
  1. Difficulty waiting their turn
  2. Interrupts other conversations
  3. Blurts out answers
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10
Q

How are other cormorbities that display similarities to ADHD?

A

Emotion/behavioral: Az, depression, sustance use disorder
Developmental: dyslexia

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11
Q

What are the ADHD classifications?

A
  • Inattentive premonimant with no hyperactive/impulse past 6 months
  • Hyperactive/impulse predomninat with no inattentive criteria for past 6 months
  • Combo: both inattentive and hyperactive/impulse
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12
Q

What is the tx for ages 4-5 YO?

A

1st line: parent training in behavioral management (PTBM) for 6 months
* Methyphenidate

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13
Q

Tx for 6YO and older?

A

Any FDA approved ADHD med + behavioral interventions

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14
Q

Nonpharm for preschool?

A

PTBM
CLassroom management

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15
Q

Non pharm for adolescents?

A
  1. Break up tasks
  2. Structured scheduled
  3. Planners
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16
Q

What aspects are parents trained in for behavior therapy?

A
  1. Positive communication
  2. Psitive reinforcement
  3. Structure and discipline
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17
Q

Pharm for children ≥6YO?

A

First-line: stimulants (methylphenidate, amphetamine)
2nd line: (atomoxetine, viloxazine, guanfacine, clonidine ER)
Alt: Bupropion

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18
Q

Stimulants

MOA, BBW, CI, Warning

A

MOA: Block reuptake of NE and D and inhibit MOA
BBW: High potential for abuse and dependene
CI: Don’t use within 14 days of MOAIs -> hypertensive risk
Warning: Increase HR and BP -> CV events
* Loss in appetite -> decrease child’s growth
* Serotonin syndrome risk
* Exacerbate preexisitng psychosis
* Increase seizure risk
* Priapism

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19
Q

What is the difference betwen IR and ER/XR/LA stimulants?

A

IR: B-TID, higher risk of diversion and abuse
Long: QD, preferred in children to avoid dosing at school, less diversion and abuse

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20
Q

What Methylphenidate brand is given as an OROS?

A

Concerta

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21
Q

Administration info for Daytrana?

A

Apply 2 hr before desired effect, remove after 9 hr

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22
Q

Admin info for Jornay PM?

A

outer coating delays initial drug release 10 hr to allow for evening dosing

23
Q

What drug is the active isomer of methylphenidate?

24
Q

How are the ADRs of methylphenidate?

A
  1. Insomnia
  2. Decreased appetite/weight loss
  3. HA
  4. Irritability
25
Q

How should methylphenidate be monitored?

A
  1. ECG prior to starting
  2. HR
  3. BP
  4. Heigh and weight in children
26
Q

What are the methylphenidate derivatives?

A

Methylphenidate
Dexmethylphenidate
Azstarys

27
Q

What are the amphetamine derivatives?

A

Adderrall
Amphetamine
Dextroamphetamine
Lisdexamfetamine
Methamphetamine

28
Q

What drug is a prodrug of dextroamphetamine with low abuse potential?

29
Q

Administration info for Xelstrym?

A

Apply 2 hrs before desired effect, remove after 9 hrs

30
Q

What are good formulations for those who can’t swallow?

A

Vyvanze (chewable)
Cotempla (ODT)
Daytrana (patch)
Xelstrym (p[atch)
Quillivant XR (suspension)

31
Q

What are types of capsules that can be opened and spinkled on small amounts of food?

A

Adderall XR and Ritalin LA: sprinkled on applesauce
Vyvanse: mixed in water, orange juice, or yogurt

32
Q

How do you manage reduced appetitie and weight loss ADR?

A

Give high calorie meal when stimulant effects are low or consider cyproheptadine at bedtime

33
Q

How do you manage stomachache ADR?

A

Administer on a full stomach, lower dose if possible

34
Q

How do you manage insomnia ADR?

A

Give dose earlier in the day, consider a sedating medication at HS (guanfacine, clonidine, melatonin, cyproheptadine)

35
Q

How do you manage HA ADR?

A

Give with analgesic (APAP or IBU)

36
Q

What do you manage rebound ADRs?

A

COnsider long-acting stimulant trial, atomoxetine, or antidepressant

37
Q

How do you manage irritability/jitteriness ADR?

A

Reduce dosage

38
Q

What are the steps for stimulant follow up?

A
  1. Start with low doses and titrate up every 7 days
  2. Monitor child’s height, weight, and sleep
  3. Don’t need to be tapered off when used as directerd
39
Q

When would non-stimulants be cosidered first line for ADhD?

A

If prescriber is worried about abuse potential

40
Q

What are the non stimulants?

A

SNRI: atomoxetine (straterra), Viloxazine (Qelbree)
Central alpha-2A adrenergic receptor agonist: Clonidine ER (Kapvay), Guanfacine ER (Intuniv)

41
Q

BBW for SNRI? CI?

A

BBW: Suicidal ideation
CI: MOAI use within past 14 days

42
Q

Can central alpha-2A adrenergic receptor agonist ER be substituted for IR?

A

No, because IR is indicated for HTN

43
Q

ADR of Straterra?

A

Dry mouth, HTN, tachycardia, hepatotoxicity

44
Q

Indications for Viloxazine?

45
Q

Viloxazine ADR?

A

Teratogenicity, increased BP and FR, HA, insomnia

46
Q

ADR of Clonidine and Guanfacine? Warnings?

A

ADR: Decreased HR, hypotension
Warnings: CV effects, requires slow tapering to avoid rebound hypertension

47
Q

Bupropion

Indication, ADR

A

Indication: comorbid mood disorders or pateints with substance use disorders
MOA: weak DA/NE reuptake inhibitor
ADR: Increases seizure risk

48
Q

All CNS stimulants are ____?

A

CII: high abuse potential with severe physical dependence

49
Q

What is diversion?

A

Situation in which a medication prescribed for one person ends up in the hands of another

50
Q

How do you avoid diversion?

A
  1. Illegal
  2. Don’t share
  3. A gift is a sale
51
Q

Who can prescribe controls?

A

MP, NP, OD, PA

52
Q

How do you verify DEA number?

53
Q

How does adult-onset ADHD differ from childhood?

A
  1. Can be present during childhood
  2. Chronically late
  3. Risky driving
  4. Outbursts

Therapeutics III (40 decks)

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