ADHD - Block 3 Flashcards
What is the most common neurobehavioral disorders of childhood?
ADHD
What are the characteristcs of ADHD?
An ongoing pattern of inattention and/or hyperactivity impulsitivity that interferes with functioning
* typically from a lack of D and NE
What are the neurotransmitters that contribute to alertness, focus, though, and effort?
Dopamine and NE
Diagnosis of ADHD are made by using ___?
DSM5
Who qualifies for ADHD evaluation?
Ages 4-18 who present with academic or behavioral problems and sx of inattention, hyperactivity, or impulsivity
What is the criteria for an ADHD diagnosis?
- 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
What are inattentive sx?
- Misplace items
- Sidetracking by unimportant stimuli
- Forgets daily activities
- Lacks ability to complete schoolwork or follow instructions
- Inability to do tasks that requires concentration
- Poor listening skills
What are hyperactive sx?
- Squirms or fidgets
- APpears to be driven by a motor
- Incapable of staying seated
- Overly talkative
What are impulsive sx?
- Difficulty waiting their turn
- Interrupts other conversations
- Blurts out answers
How are other cormorbities that display similarities to ADHD?
Emotion/behavioral: Az, depression, sustance use disorder
Developmental: dyslexia
What are the ADHD classifications?
- 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
What is the tx for ages 4-5 YO?
1st line: parent training in behavioral management (PTBM) for 6 months
* Methyphenidate
Tx for 6YO and older?
Any FDA approved ADHD med + behavioral interventions
Nonpharm for preschool?
PTBM
CLassroom management
Non pharm for adolescents?
- Break up tasks
- Structured scheduled
- Planners
What aspects are parents trained in for behavior therapy?
- Positive communication
- Psitive reinforcement
- Structure and discipline
Pharm for children ≥6YO?
First-line: stimulants (methylphenidate, amphetamine)
2nd line: (atomoxetine, viloxazine, guanfacine, clonidine ER)
Alt: Bupropion
Stimulants
MOA, BBW, CI, Warning
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
What is the difference betwen IR and ER/XR/LA stimulants?
IR: B-TID, higher risk of diversion and abuse
Long: QD, preferred in children to avoid dosing at school, less diversion and abuse
What Methylphenidate brand is given as an OROS?
Concerta
Administration info for Daytrana?
Apply 2 hr before desired effect, remove after 9 hr
Admin info for Jornay PM?
outer coating delays initial drug release 10 hr to allow for evening dosing
What drug is the active isomer of methylphenidate?
Focalin
How are the ADRs of methylphenidate?
- Insomnia
- Decreased appetite/weight loss
- HA
- Irritability