Attention Deficit Hyperactivity Disorder Flashcards
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ADHD is characterized by symptoms of:
- inattention
- hyperactivity
- impulsivity
” patients often have difficulty focusing, are easily distracted, have trouble staying still and are frequently unable to control impulsive behavior.
dopamine is metabolized to _______ and __________.
epinephrine and norepinephrine
Cognitive behavioral therapy (using psychotherapy to identify and alter thoughts and feelings, which can lead to a change in behavior), is _______ in managing ADHD.
first-line
ADHD medications are considered first line in patients ___________
> or = to 6 years old
The DSM-5 Criteria for ADHD are based on an assessment of the primary symptoms,
Inattention:
1)
2)
and/or
Hyperactivity & Impulsivity:
1)
2)
Inattention:
1) > or = 6 symptoms (of inattention) for children up to age 16 OR
> or = 5 symptoms for ages 17 years and older
2)* - Symptoms must have been present for at least 6 months and are inappropriate for the developmental level*
Hyperactivity & Impulsivity:
1) > or = 6 symptoms (of hyper/impul) for children up to age 16 OR
> or = 5 symptoms for ages 17 years and older
2)* - Symptoms must have been present for at least 6 months and are inappropriate for the developmental level*
Symptoms of Inatention:
- fails to pay attention
- has trouble holding attention
- does not pay attention when someone is talking
- does not follow through on instructions
- fails to finish schoolwork
- has difficulty organizing tasks
- avoids or dislikes tasks which require mental effort
Symptoms of Hyperactivity & Impulsivity:
- often fidgets or squirms
- leaves seat unexpectantly
- runs about when not appropriate
- unable to play quietly
- talks excessively
- blurts out answers
- has trouble waiting his/her turn
The Following Conditions Must be Met: ADHD DSM-5 Criteria
1)
2)
3)
1) Several inattentive or hyperactive-impulsive symptoms were present before age 12 years
2) Symptoms must have been present in 2 or more settings (home, school, work, with friends, or relatives, babysitters);
3) Symptoms interfere with functioning and are not caused by another disorder.
Natural products for ADHD:
Fish Oils Polyunsaturated Fatty Acids (PUFAs)
- supplements were given for 4-16 weeks
- little evidence that PUFA supplementation provides benefit
- some limited data of improvement with combined omega 3 and omega 6 supplementation.
_____________ is used to help with sleep onset in individuals taking stimulants.
melatonin
___________ formulations are preferred for children.
Long-acting
To help maintain more steady symptom control and avoid the need for a dose during the day at school.
Patient-Friendly Formulations For Stimulants:
For young children (and others) who cannot swallow capsules or tablets, what short and long-acting formulations can they use which come in a more convenient dosage form or allow the capsule contents to be place on food?
amphetamine:
amphetamine/dextroamphetamine:
dextroamphetamine:
lisdexamfetamine:
dexmethylphenidate:
methylphenidate:
serdexmethylphenidate:
amphetamine:
(Evekeo) - IR ODT
(Dyanavel XR) - ER oral suspension
(Adzenys XR-ODT) - ER ODT
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amphetamine/dextroamphetamine:
(Adderall XR) - capsule, contents can be opened and sprinkled on
applesauce.
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dextroamphetamine: * products not recommended in children 5 yo and younger.
lisdexamfetamine:
(Vyvanse) - contents can be opened and mixed with water, orange juice or yogurt.
(Vyvanse) - also comes as a long acting chewable tablet.
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dexmethylphenidate:
methylphenidate:
(Ritalin LA) - ER capsule, contents can be opened and sprinkled on applesauce.
(Methylin) - IR oral solution
- IR Chewable tablet
(Quillivant XR) - ER oral suspension
(QuilliChew ER) - ER chewable tablet
(Cotempla XR-ODT) - ER ODT
(Daytrana) - transdermal patch
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serdexmethylphenidate:
Ritalin
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methylphenidate
Class: stimulant
Indications: ADHD first line
MOA: drug works by blocking the reuptake of norepinephrine and dopamine.
Dosage forms: IR tablet, chewable tablet
Dosing: Start 5mg BID, 30min before breakfast and lunch
Max dose: 60mg/day
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chewable tablets: contain phenylalanine (avoid in PKU)
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Methylin
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methylphenidate
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Dosage forms: IR oral solution
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Concerta
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methylphenidate
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Dosage forms: OROS delivery
Dosing: start 18-36mg daily in the morning
Max dose: Max: 72mg/day
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* OROS delivery: the outer coating dissolves fast to provide an immediate relief action, and the rest is slowly released; can see a ghost tablet in stool, harder to crush, which decreases abuse potential.
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Ritalin LA
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methylphenidate
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Dosage forms: ER capsule
Dosing: start 10-20mg daily in the morning
Max dose: Max 60mg/day
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Adhansia XR
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methylphenidate
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Dosage forms: ER capsule
Dosing: start 25mg daily in the morning
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Jornay PM
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methylphenidate
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Dosage forms: ER capsule
Dosing: start 20mg daily at bedtime**
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outer coating delays initial drug release 10 hours to allow for evening dose; inner coating controls the slow release of the drug during the day
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Aptensio XR
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methylphenidate
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Quillivant XR
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methylphenidate
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QuilliChew ER
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methylphenidate
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Cotempla XR-ODT
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methylphenidate
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Daytrana
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methylphenidate
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- loss of pigmentation at application site and areas distant from the application site (can resemble vitiligo), allergic contact sensitization with local reactions (e.g. edema, papules)
Side Effects:
- nausea, insomnia, headache, irritability, blurry vision, dry mouth
Monitoring:
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Apply 2 hours before desired effect (or as soon as child awakens so it starts to deliver prior to school) and remove after 9 hours; alternate hips daily.
Drug-Drug/Food interactions:
Focalin
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dexmethylphenidate
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Azstarys
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serdexmethylphenidate/dexmethylphenidate (Prodrug)
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Adderall
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dextroamphetamine/amphetamine
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Adderall XR
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dextroamphetamine/amphetamine
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Mydayis
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dextroamphetamine/amphetamine
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Adzenys XR-ODT
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- with amphetamines. Avoid use of acidic foods (juice or Vitamin C) as these can decrease amphetamine levels.
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amphetamine
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Dyanavel XR
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amphetamine
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Evekeo ODT
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amphetamine
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Dexedrine
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dextroamphetamine
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ProCentra
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dextroamphetamine
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Zenzedi
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dextroamphetamine
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Vyvanse
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lisdexamfetamine
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Desoxyn
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methamphetamine
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Strattera
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atomoxetine
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Kapvay
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clonidine ER
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Intuniv
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guanfacine ER
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