ADHD Ott Flashcards
what fraction of children will have the diagnosis in adulthood
1/3
if ADHD untreated, what is increased risk?
substance use and antisocial personality disorder
ADHD diagnosis
6 symptoms on each domain
2 or more locations
present before age 12
5 sx for 17 years +
two domains for ADHD
inattention
hyperactivity/impulsivity
how long to see dose response in stimulants
quick
mg/kg dosing
dont use it
when to do IR dosing
<16 kg
what dosing if we have late afternoon sx?
long acting formulation
can we use two different stimulants?
no but can use two dosage forms of the same
which stimulant comes in patch
Daytrana (methylphenidate)
vyvanse is a ____
prodrug converted to dextroamphetamine
what time to take Jornay PM dose
6:30-9:30 pm
stimulant adverse effects
appetitle loss
sleep problems
abdominal pain
decreased growth
hallucinations
jitters
stimulant risks
increase BP
increase HR
sudden cardiac death
pripism
Raynauds
what to do if hallucinations on stimulant
discontinue, reassess the diagnosis
screen for sudden cardiac death risk?
check family history and risk structure abnormality
if concerned - ECHO
stimulant monitoring
appetite
behavior
BP / HR
growth rate
sleep
ECG if cardiac risk
alpha 2 agonist drugs
clonidine ER
guanfacine ER
guanfacine substrate
3A4
what must be tapered before discontinuing and why
clonidine and guanfacine
rebound HTN
norepinephrine reuptake inhihhitor drugs
atomoxetine
viloxazine
atomoxetine substrate
2D6
viloxazine sunstrate
2D6/UGT
1A2 strong inhibitor
which med has weight based dosing and when
atomoxetine
< 70 kgs
atomoxetine/viloxazine adverse effects
increased HR/BP
sucidal thinking
clonidine/guanfacine adverse effects
decreased BP/HR
somnolence
dizziness
rebound HTN if stopped abruptly
monitoring for non stimulants
appetite
behavior
BP/HR
growth rate
sleep
LFTs (atomoxetine)
is bupropion FDA approved for ADHD
no
bupropion substrate
2D6 inhibitor
when is bupropion contraindicated
seizure and eating disorder
tricyclic antidepressants effectivness
less effective than methylphendiate
concerns with tricyclic antidepressants
cardiac concerns - sudden cardiac death in kids
lethal in OD
can we use atypical antipsychotics
only if bipolar, conduct, explosive disorder
not for monotherapy
treatment guidelines for preschool age
parent training in behavior management
then methylphenidate
treatment guideline for elementary/middle school age
parent training in behavior management and stimulants
second line: atomoxetine, guanfacine, clonidine
treatment guideline for adolescents
first: stimulants
second: atomoxetine, guanfacine, clonidine
adjunctive treatment?
clonidine and guanfacine could be adjunct to stimulants
adult NICE guidelines step therapy
methylphenidate/Vyvanse
(switch if no effectiveness)
second: dextroamphetamine if cant tolerate Vyvanse
third: atomoxetine
