ADHD & Neuropathic Pain Flashcards
diagnosis of ADHD is made with onset of symptoms before age __ with how many symptoms for children vs older adolescents/adults
before age 12
children- 6 or more symptoms
older adolescents/adults- 5 symptoms
symptoms of adhd with wandering off task, lacking persistence, having difficulty remaining focused, and being disorganized
inattention
symptom of adhd with excessive motor activity, fidgeting, tapping, talkativeness, extreme restlessness, and wearing others out
hyperactivity
adhd symptoms with desire for immediate rewards, social intrusiveness, making decisions without considering long term
impulsivity
if predominant ADHD diagnosis, which agents are first line? if poor response to one of these?
MPH, d-MPH, or AMP/mixed AMP
poor response- switch to another
if poor response to 1st line ADHD agents, what is next step?
and if that fails?
atomoxetine, viloxazine, guanfacine, clonidine, bupropion
fails –> combo treatment or TCA
what is used 1st line for ADHD if sub abuse disorder
atomoxetine, viloxazine, guanfacine, clonidine, bupropion
what is 1st line for ADHD diagnosis with predominant TOURETTES? if that fails?
- DA antagonist or a2 agonist
- add stim, atomoxetine, a2 agonist
- alternatives of 1
what is 1st line for ADHD diagnosis with predominant BPD/AGGRESSION? if that fails?
- atypical APS, lithium, anticonv
- add stim
- alt or add mood stabilizer
what is 1st line for ADHD diagnosis with predominant ANZIETY/DEPRESSION? if that fails?
- antidepressant
- add stim
- alt antidepressant
which is more potent? MPH or AMP?
AMP more potent (smaller dose needed if switch from MPH)
benefits of IR stimulants
low cost, less insomnia, less growth AEs
psychiatric AEs of stimulants include
psychosis, aggression, severe anxiety
cardiac AEs of stimulants
which agent may be preferred
inc HR & BP
caution with CV conditions- MPH may be preferred
growth AEs of stimulants include
slow height inc, weight deficit
appetite suppression
how to manage reduced appetite/weight loss with stimulants
high cal meal when stim effect low
cyproheptadine at bedtime
how to manage stomachache with stimulants
take on full stomach, lower dose
how to manage insomnia with stimulants
dose earlier, lower last dose, add sedating QHS med (guan, clon, melatonin, cyprohep)
how to manage HA with stimulants
divide dose, give with food, analgesic
how to manage irritability with stimulants
assess comorbidities, reduce dose, add mood stabilizer/APS
how to manage euphoria, zombie-like, tics, HTN with stimulants
reduce dose, change med
how to manage hallucinations with stimulants
d/c stim, reassess diagnosis, mood stabilizer/APS
some DDI of MPH include
TCAs, antacids, PPI, H2RA
some DDI of AMP include
antacids, PPI, acidic agents, cyp2D6
DDI for both AMP and MPH
MAOI, psychostimulants, alcohol
MPH is only FDA APPROVED for those how old? can it be used in younger anyways?
6 and up
ok to use in 3 and up anyways
which stimulant is preferred in children
MPH
which stimulant has less DDIs
MPH
do males or females have increased bioavailability of MPH
males
which MPH products are 30IR/70ER (3)?
ER, ER chewable, CD
(Metadate ER, Quillichew, Metadate CD)
which MPH products are 50IR/50ER (2)?
Long acting (LA), dex-MPH XR
(Ritalin LA, Focalin XR)
which MPH product is best for severe AM symptoms
MPH LA (Ritalin LA)
MPH XR suspension (quillivant XR) requires
vigorous shaking, reconstitution
MPH product with less symptom rebound and is hard to abuse
OROS (Concerta, Relexxii)
which MPH product is best for rebound afternoon symptoms
ER multilayer bead (MLR)
(Aptensio XR)
MPH ER capsule (Jornay PM) must be administered
between 6:30 and 9:30 pm
which MPH have no easy 1:1 dosing conversion
XR ODT (Contempla)
ER capsule (Jornay PM)
MPH patch (Daytrana) can be applied where? how long?
hip only for 9 hours
MPH and d-AMP patches should be removed at least __ hrs before bed
3
which stimulant patch retains >50% drug after removal, which should be kept in mind for disposal
MPH (daytrana)