ADHD Ott

Question 1

what fraction of children will have the diagnosis in adulthood

Answer 1

1/3

Question 2

if ADHD untreated, what is increased risk?

Answer 2

substance use and antisocial personality disorder

Question 3

ADHD diagnosis

Answer 3

6 symptoms on each domain
2 or more locations
present before age 12
5 sx for 17 years +

Question 4

two domains for ADHD

Answer 4

inattention
hyperactivity/impulsivity

Question 5

how long to see dose response in stimulants

Answer 5

quick

Question 6

mg/kg dosing

Answer 6

dont use it

Question 7

when to do IR dosing

Answer 7

<16 kg

Question 8

what dosing if we have late afternoon sx?

Answer 8

long acting formulation

Question 9

can we use two different stimulants?

Answer 9

no but can use two dosage forms of the same

Question 10

which stimulant comes in patch

Answer 10

Daytrana (methylphenidate)

Question 11

vyvanse is a ____

Answer 11

prodrug converted to dextroamphetamine

Question 12

what time to take Jornay PM dose

Answer 12

6:30-9:30 pm

Question 13

stimulant adverse effects

Answer 13

appetitle loss
sleep problems
abdominal pain
decreased growth
hallucinations
jitters

Question 14

stimulant risks

Answer 14

increase BP
increase HR
sudden cardiac death
pripism
Raynauds

Question 15

what to do if hallucinations on stimulant

Answer 15

discontinue, reassess the diagnosis

Question 16

screen for sudden cardiac death risk?

Answer 16

check family history and risk structure abnormality
if concerned - ECHO

Question 17

stimulant monitoring

Answer 17

appetite
behavior
BP / HR
growth rate
sleep
ECG if cardiac risk

Question 18

alpha 2 agonist drugs

Answer 18

clonidine ER
guanfacine ER

Question 19

guanfacine substrate

Answer 19

3A4

Question 20

what must be tapered before discontinuing and why

Answer 20

clonidine and guanfacine
rebound HTN

Question 21

norepinephrine reuptake inhihhitor drugs

Answer 21

atomoxetine
viloxazine

Question 22

atomoxetine substrate

Answer 22

2D6

Question 23

viloxazine sunstrate

Answer 23

2D6/UGT
1A2 strong inhibitor

Question 24

which med has weight based dosing and when

Answer 24

atomoxetine
< 70 kgs

Question 25

atomoxetine/viloxazine adverse effects

Answer 25

increased HR/BP
sucidal thinking

Question 26

clonidine/guanfacine adverse effects

Answer 26

decreased BP/HR
somnolence
dizziness
rebound HTN if stopped abruptly

Question 27

monitoring for non stimulants

Answer 27

appetite
behavior
BP/HR
growth rate
sleep
LFTs (atomoxetine)

Question 28

is bupropion FDA approved for ADHD

Answer 28

no

Question 29

bupropion substrate

Answer 29

2D6 inhibitor

Question 30

when is bupropion contraindicated

Answer 30

seizure and eating disorder

Question 31

tricyclic antidepressants effectivness

Answer 31

less effective than methylphendiate

Question 32

concerns with tricyclic antidepressants

Answer 32

cardiac concerns - sudden cardiac death in kids
lethal in OD

Question 33

can we use atypical antipsychotics

Answer 33

only if bipolar, conduct, explosive disorder
not for monotherapy

Question 34

treatment guidelines for preschool age

Answer 34

parent training in behavior management
then methylphenidate

Question 35

treatment guideline for elementary/middle school age

Answer 35

parent training in behavior management and stimulants
second line: atomoxetine, guanfacine, clonidine

Question 36

treatment guideline for adolescents

Answer 36

first: stimulants
second: atomoxetine, guanfacine, clonidine

Question 37

adjunctive treatment?

Answer 37

clonidine and guanfacine could be adjunct to stimulants

Question 38

adult NICE guidelines step therapy

Answer 38

methylphenidate/Vyvanse
(switch if no effectiveness)
second: dextroamphetamine if cant tolerate Vyvanse
third: atomoxetine