ADHD Treatment Flashcards
is treatment of ADHD unique?
YES! needs to be multimodal and tailored to the specific difficulties of the particular individual
non-pharm treatment for ADHD?
psych education with family or individual psychotherapy
symptomatic improvement rate among medications in ADHD
75-80%
most commonly used drug class for ADHD?
stimulants
methylphenidate
ritalin
dextroamphetamine
dexedrine
mixed amphetamine
adderall
pemoline
cylert
dexmethylphenidate
foculin
lisdexamfetamine dismesylate
vyvanse
types of stimulants
short and long acting
unsupported fears with stimulants
increased risk of drug addiction, growth failure, tourette’s, or serious emotional disturbance
relative contraindications to stimulants
psychosis, seizure d/o, tics, pervasive developmental disorder, CV condition, other meds that may interact with stimulants or substance abuse in the child or family member
MOA of stimulants
- increases both dopamine and norepi
- increases activity in many areas of the brain & increases inhibition in the neocortex or frontal lobes
- inhibits unwanted stimuli or responses
- creating an alert, focused attention
duration of action of stimulants
- rapidly absorbed by the brain
- peak blood levels and effect in 1-3 hours
dosing of ritalin
morning and mid-day (shorter acting)
dosing of dexedrine
morning and mid-day (shorter acting)
dosing of adderall
morning and mid-day (shorter acting)
dosing of cyclert
morning (longer acting)
significance of foculin
- d-enatiomer of methylphenidate
- aims at maximizing target effects and minimizing side effects
significance of vyvanse
- first and only stimulant prodrug
- therapeutically inactive until metabolized by the body
- schedule II
common side effects of stimulants
- rebound hyperactivity & moodiness (treated by modifying dose or adding another dose)
- stomach aches, poor appetite
- headaches
- tachycardia, increased BP
- inhibition of growth and weight gain (normalize after d/c med)
- insomnia
- less commonly: depression, tics or hallucinations
adverse effect of treatment with stimulants
abuse potential
are severe toxic effects common with stimulants?
RARE
what is there a risk of if taking cyclert?
risk of liver complications (monitor LFTs at the start of treatment and throughout its course)
should you give a child with a congenital heart defect a stimulant?
NO! may be susceptible to a rare episode of heartbeat irregularities that can cause sudden cardiac arrest
atomoxetine
strattera
MOA of strattera
- norepinephrine reuptake inhibitor
- NO effect on dopamine
- inhibits 2D6 enzyme
- may decrease metabolism of SSRI
use of strattera
nonstimulant med for ADHD
buproprion
wellbutrin
when should wellbutrin be used to treat ADHD?
concomitant depression
what is there a risk of with wellbutrin?
seizures
venlafaxine
effexor
when should effexor be used to treat ADHD?
with concomitant depression
when can TCAs and SSRIs be used for ADHD
- patient is harder to manage
- patient has not had success with stimulants
- patient has significant coexisting depression, anxiety or tics
can TCAs or SSRI be used with stimulants?
YES! in low doses of stimulants
caution with TCAs and SSRIs
more serious side effects`
what symptoms do TCAs and SSRIs control in ADHD?
overactivity and moodiness, NOT distractability
clonidine
catapress
when should catapress be used?
- concomitant tic disorders
- may help with sleep problems (take at night)
- may help overactvity, NOT distractability
guanfacine
tenex
MOA of tenex and catapress
alpha agonists
can tegretol or depakote be used for ADHD?
yes, but 3rd or 4th line
can haldol or risperdal be used for ADHD
yes, when children have a high degree of aggression or tics
a newly diagnosed child with ADHD should have what before initiation of treatment?
cardiac workup
- pt and family history, with special attention to palpitations, fainting or recent difficulties during exercise
- physical exam with BP and check for heart abnormalities
- EKG
- if necessary, pediatric cardiology consult to discuss important findings
