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Pediatric Pharm Exam 3 > Bipolar and ADHD > Flashcards

Bipolar and ADHD Flashcards

1
Q

Manic Depressive Disorder Definition

A

Serious mental illness in which common emotions become intensely and unpredictably magnified with quick swings from one emotion to another’

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2
Q

Mania Portion of Bipolar Disorder - Mood

A

Long period of ‘high’ with extremely irritable, agitated moods

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3
Q

Mania portion of Bipolar Disorder - Behavior (5)

A
  1. Talking fast, flight of ideas, racing thoughts
  2. Increases in goal-directed activities
  3. Little sleeping
  4. Unrealistic beliefs in one’s own abilities
  5. Risky behavior
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4
Q

Depression portion of Bipolar Disorder

A

Long period of ‘downs’ with loss of interest in activities they once enjoyed

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5
Q

Depression portion of Bipolar Disorder - Behavior (4)

A
  1. Problems concentrating, remembering and making decisions
  2. Changes in eating habits and sleeping habits
  3. Suicidal ideation
  4. Attempting suicide
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6
Q

Non-pharmacological bipolar treatments (2)

A
  1. Cognitive Behavioral Therapy (CBT)

2. Electroconvulsive Therapy (ECT)

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7
Q

Pharmacological bipolar treatments (3)

A
  1. Mood Stabilizers
    - Lithium
    - Valproic Acid
  2. Antipsychotics
  3. Antidepressants (SSRIs/SNRIs, bupropion)
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8
Q

Lithium mechanism of action (4)

A

MOOD STABILIZER

  1. Alters transport across cell membrane
  2. Prevents reuptake of serotonin and norepinephrine
  3. Inhibits postsynaptic D2 receptor
  4. Pretty much only used for mood disorders
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9
Q

Valproic Acid MOA (2)

A

MOOD STABILIZER

  1. Increases availability of GABA
  2. Enhances effect and mimics effect of GABA at postsynaptic receptor sites
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10
Q

Lithium ADEs (6)

A
  1. Bradycardia
  2. Hypo/hyperthyroidism
  3. Nystagmus
  4. Metallic taste
  5. Weight gain
  6. Leukocytosis
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11
Q

Valproate ADEs (6)

A
  1. Thrombocytopenia
  2. Pancreatitis
  3. Anorexia
  4. Somnolence
  5. Abdominal distress
  6. Tremors
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12
Q

Lithium C/I (3)

A
  1. Severe heart dysfunction
  2. renal dysfunction
  3. On an ACE-inhibitor
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13
Q

Valproate C/I

A

Hepatic dysfunction

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14
Q

Lithium pearls (4)

A
  1. FDA approved in children >12 for acute mania or maintenance therapy with bipolar disorder
  2. 100% renal elimination
  3. Half life is 18-36 hours
  4. Good oral bioavailability
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15
Q

Lithium monitoring and therapeutic/toxic levels

A

Requires therapeutic drug monitoring (true trough)

Therapeutic: 0.6-1.2

Toxic >1.5 mEq/mL

*4-6 weeks to reach therapeutic levels

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16
Q

lithium toxicity signs (3)

A
  1. GI distress/tremor
  2. Confusion/somnolence
  3. Seizure/death >2.5mEq/mL
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17
Q

Antipsychotics mechanism of action (2)

A
  1. Prevents binding of serotonin, dopamine, and histamine to receptors
    * Affecting neuronal transmission
  2. Stabilizes mood
18
Q

Typical antipsychotic agents (2)

A
  1. Haloperidol (Haldol) - PO, IM, IV

2. Chlorpromazine (Thorazine)- PO, IM, IV

19
Q

Haloperidol ADEs (5)

A
  1. Sedation +
  2. EPS +++
  3. Ach +
  4. Decreased BP +
  5. QTc +++
20
Q

Chlorpromazine ADEs (5)

A
  1. Sedation +++
  2. EPS ++
  3. ACH ++
  4. Decreased BP +++
  5. QTc +
21
Q

Haloperidol receptor sensitivity

A

Binds to dopamine with greater affinity

22
Q

Chlorpromazine receptor sensitivity

A

binds to dopamine with greater affinity

23
Q

Atypical antipsychotic agents (4)

A

Designed to prevent some of the side effects seen with typical antipsychotics, particularly because they affect dopamine

  1. Aripiprazole (Abilify)
  2. Olanzapine (Zyprexa)
  3. Quetiapine (Seroquel) -PO only
  4. Risperidone (Risperdal)
24
Q

Aripiprazole ADEs (3)

A
  1. Sedation +
  2. EPS +
  3. QTc +
25
Q

Olanzapine ADEs (5)

A
  1. Sedation ++
  2. EPS +
  3. ACH ++
  4. Decreased BP ++
  5. Weight gain +
26
Q

Quetiapine ADEs (4)

A
  1. Sedation ++
  2. ACH ++
  3. Decreased BP ++
  4. Weight gain ++
27
Q

Risperidone ADEs (5)

A
  1. Sedation +
  2. EPS +
  3. Decreased BP ++
  4. Weight gain +
  5. QTc +
28
Q

General info about antipsychotics (4)

A
  1. Antipsychotics generally used after mood stabilizers have failed
  2. Good for acute treatment (IM/IV)
  3. Typicals associated with more adverse effects
  4. Great treatment for ‘ICU delirium’
29
Q

ADD/ADHD Signs and Symptoms (5)

A
  1. Disorganized
  2. Inability to stay focused (easily distracted)
  3. Acting before thinking
  4. Fidgety
  5. Defiant and/or aggressive
30
Q

DSM-V Criteria for ADD/ADHD “Inattention” (9)

A

Must fulfill 6 or more

  1. Careless mistakes
  2. Difficulty sustaining attention
  3. Lack of interest
  4. No follow-through
  5. Difficulty organizing
  6. Avoids tasks that require sustained effort
  7. Loses things necessary for tasks
  8. Easily distracted
  9. Forgetful
31
Q

DSM-V Criteria for ADD/ADHD “Hyperactivity and Impulsivity” (9)

A

Must fulfill 6 or more

Hyperactivity:

  1. Fidgets
  2. Moves when expected to remain still
  3. Runs or climbs things excessively
  4. Difficulty staying quiet
  5. Often ‘on the go’
  6. Excessively talks

Impulsivity

  1. Blurts out answers
  2. Difficulty awaiting turn
  3. Often interrupts
32
Q

Total DSM-V Criteria for ADHD (5)

A
  1. Must fulfill 6 or more from inattention OR 6 or more from hyperactivity/impulsivity

AND:
2. Some impairment present before 12 years

  1. Some impairment present in 2 or more settings
  2. Clear evidence of significant impairment
  3. Symptoms not the result of another disorder
33
Q

ADD/ADHD Treatments (3)

A
  1. Stimulants
  2. Selective Norepinephrine Reuptake Inhibitor
  3. Antihypertensives
34
Q

Stimulants mechanism of action

A

Blocks the reuptake of dopamine and norepinephrine

35
Q

Stimulant agents

A
  1. Dexmethylphenidate (Focalin and Focalin XR)
  2. Mixed amphetamines (Adderrall and Adderall XR)
  3. Methylphenidate (Concerta, Ritalin, Ritalin SR)
36
Q

Stimulant ADEs (5)

A
  1. Insomnia
  2. Tachycardia
  3. Hypertension
  4. Weight loss / anorexia
    * Monitor and make sure child is growing appropriately
  5. Unmask OCD and tics
37
Q

Stimulant Pearls (5)

A
  1. First line agents for ADD/ADHD
  2. All agents are CII medications
  3. Prolonged use increases risk of tolerance
  4. Long-acting agents preferred if insomnia an issue but having troubles concentrating in evenings
  5. Short-acting generally requires 2-3 times/day dosing
38
Q

Atomoxetine (6)

A
  1. Brand name: Strattera
  2. Classification: SNRI
  3. MOA: selectively reuptake of NE
  4. Not a controlled medication
  5. Favorable adverse event profile
  6. May not be as effective as stimulants
39
Q

Antihypertensive MOA (2)

A
  1. Alpha-2 receptor AGONISTS
  2. Exact mechanism for ADD/ADHD unknown
    * Regulates prefrontal cortex of brain
40
Q

Antihypertensive agents (2)

A
  1. Clonidine (Catapres) - tablets and patches

2. Guanfacine (Intuniv)

41
Q

Antihypertensive agents for ADHD ADEs (3)

A
  1. Hypotension
  2. Sedation
  3. Thrombocytopenia
    * Monitor blood cell count

Pediatric Pharm Exam 3 (11 decks)

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