ADHD/Peds Psych Flashcards
what disorder has BOTH multiple motor and 1+ vocal tics present at some time (not always concurrently)
tourettes!
what disorder has single or multiple motor or vocal tics present, but not both
persistent/chronic motor or vocal tic disorder…
what tic disorders have to be present for more than 1 year
tourettes
and
persistent/chronic motor or vocal tic disorder.
what tic disorder is present for less than 1 year
provisional tic disorder
onset of tic disorders happen usually before age _____
18
Treating Tic Disorders: what drug class should be used?
antipsychotics
Treating Tic Disorders:
_____ blockade — efficacious 70 - 90%
DA
what antipsychotics are used for treating Tic Disorders?
haloperidol
aripiprazole
risperidone/paliperidone (highest DA block)
Orap - pimozide (orphan drug0
why is pimozide of concern? (comparing to haloperidol)
QT prolongation
why is haloperidol of concern? (comparing to pimozide)
more EPS ADEs
common co=morbidity of tourettes
ADHD
______ can exacerbate motor/vocal tic symptoms
amphetamine based stimulants
what is ODD stand for
oppositional defiant disorder
main criteria groups for ODD
angry/irrititable mood
argumenative/defiant behavior
vindictiveness
diagnosis for ODD has to last at least ____
6 mos
main criteria groups for CD
aggression to ppl/animals
destruction of property
deceitfulness or theft
serious violations of rules
how to treat ODD and CD
psycosocial tx = 1st line
drugs 1st choice: stimulants or clonidine/guanfacine!!!
1st line is NOT atypical antipsychotics
for ODD and CD: if atypical antipsychotics tx failure happens at _____ weeks — consider ______ or _____
2 weeks
typical antipsychotic or mood stabilizer
1st line option for Separation anxiety disorder
combo tx: med monotherapy + psychotherapy
1st line drug option = SSRIs
________ is first line tx for Austism Spectrum Disorder
behavioral interventions
what drugs can be used for Autism Spectrum disorder
typical antipsychotics: haloperidol
atypical antipsychotics: Aripiprazole and Risperidone
what is CD
conduct disorder
for Autism spectrum disorder:
typical or atypical antipsychotics are FDA approved for irritability/aggression
atypical (Aripiprazole and Risperidone)
for Autism spectrum disorder:
typical or atypical antipsychotics are used to reduce social isolation/improve anger related behaviors, hyperactivity
typical (haloperidol)
if a child has issues with repetitive behaviors — what drugs can be used
Antipsychotics: haloperidol, risperidone, aripiprazole
divalproex
(SSRIs done commonly but like like no consistent evidence)
what is DMDD
disruptive mood dysregulation disorder
atomoxetine has little effect on _______
inattention
clonidine and guanfacine has modest effect on ________ and ______
irritability
and
explosive behavior
what are first line tx for DMDD
SSRIs and stimulants
first line for pediatric depression
non pharm:
CBT!!
need group support
what antidepressant should be avoided in kids
paroxetine
what antidepressant can be used down to kids of 8 yo
fluoxetine
what antidepressant can be used for kids starting at age 12
escitalopram
for Peds. Bipolar Disorder:
if Bipolar I w/OUT psychosis
Li+ = Drug of choice
valproate, CBZ, olanzapine, risperidone, quetiapine too
Add 2nd agent after 4 weeks if needed
for Peds. Bipolar Disorder:
if Bipolar I w/ psychosis
Li+, Valproate, CBZ WITH any atypical
may consider d/c atypical if remission for 12 - 24 mos
for Peds. Bipolar Disorder:
if Bipolar I Depressed
1st line Li+
adjunct w/ Li+ do SSRI or bupropion
Atypical Antipsychotics and FDA approvals for Peds.:
Aripiprazole
bipolar
irritability w/ autism
schizophrenia
tourettes
Atypical Antipsychotics and FDA approvals for Peds.:
Asenapine
bipolar
Atypical Antipsychotics and FDA approvals for Peds.:
lurasidone
schizophrenia
bipolar
Atypical Antipsychotics and FDA approvals for Peds.:
Olanzapine
bipolar
schizo
Atypical Antipsychotics and FDA approvals for Peds.:
Paliperidone
schizo
Atypical Antipsychotics and FDA approvals for Peds.:
quetiapine
bipolar
schizo
Atypical Antipsychotics and FDA approvals for Peds.:
which one is ONLY schizophrenia
paliperidone
Atypical Antipsychotics and FDA approvals for Peds.:
which one is ONLY biploar
asenapine
Atypical Antipsychotics and FDA approvals for Peds.:
which one is for tourettes
aripiprazole
Atypical Antipsychotics and FDA approvals for Peds.:
which ones are for irritability for autism
aripiprazole
risperidone
Atypical Antipsychotics and FDA approvals for Peds.:
what is the only drug NOT for schizophrenia
asenapine
Atypical Antipsychotics and FDA approvals for Peds.:
what is the only drug NOT for bipolar
paliperidone
which SSRI is hella hella selective for SERT (like a 7000 fold)
escitalopram
AAP Treatment Guidelines for ADHD:
what do you if pt is 4 - 5 years…?
behavioral tx is 1st line!!
can use methylphenidate if behavioral intervention
AAP Treatment Guidelines for ADHD:
what do you if pt is 6 - 11 years…?
FDA approved sitmulants/atomoxetine/guanfacine/clonidine and or behavioral therapy
(prefer both)
AAP Treatment Guidelines for ADHD:
what do you if pt is 12 - 18 years…?
FDA approved sitmulants/atomoxetine/guanfacine/clonidine and or behavioral therapy
(prefer both)
if getting HA from stimulants — what do you do
divide dose
take with food
give analgesic
if getting stomach ache from stimulants — what do you do
take with food
lower dose if possible
if getting irritability/jitteriness from stimulants — what do you do
asses for co-morbid condition
reduce dose
consider mood stabilizer or atypical antipsychotics
which ADHD drug has a rare ADR of priaprism
methylphenidate
what ADHD drugs (stimulants or non stimulants) can cause peripheral vasculopathy
stimulants!
what drug is a part of daytrana patch
methylphenidate
Daytrana Patch:
patch applied to out side ____
apply ____ hours prior to needed effects
remove after ____ hours
side hip
2 hours
9 hours
if pt cant tolerate _____ dont use daytrana
methylphenidate
bc methylphenidate is daytrana
atomoxetine has warning for ______ toxicity
liver
clonidine or guanfacine is a 3A4 substrate
guanfacine!!
T or F: Lithium is v effective in ADHD
false!!!
good for bipolar
ADHD and Bipolar are co-morbid:
_______ has most evidence in helping
________ is commonly used but not as well studied
CBZ
valproic acid
ADHD and Bipolar are co-morbid:
T or F: atypicals can be used as monotherapy
false!!
not ok for ADHD monotherapy
Atypical Antipsychotics and FDA approvals for Peds.:
Risperidone
bipolar
irritability w/ autism
schizophrenia
