CAM & ADHD

Question 1

What is CAM?

Answer 1

natural products, traditional chinese medicine, homeopathic meds, mind/body practice

Question 2

what % of patients using CAM don’t tell their PCP and why?

Answer 2

1/3 due to fear of judgment, it’s natural, and thinks it doesn’t matter

Question 3

what is the DSHEA?

Answer 3

dietary supplement health and education act 1994

allows FDA oversight for suppements, but FDA has burden of proving unsafe after marketing (recalls)

Question 4

rules for advertising supplements/CAMs?

Answer 4

can’t claim any effects that are a feature of drugs
must be supported by objective scientific evidence
nonspecific claims (promotes digestive health etc) are allowed

Question 5

what are the two databases we can use for CAM

Answer 5

american botanical counsel and databases
natural medicines database

Question 6

is there a genetic link to ADHD

Answer 6

yes

Question 7

risk factors for ADHD?

Answer 7

fam. history
FAS
lead poisoning
maternal smoking
meningitis
poor parent-child relationships

Question 8

how long must ADHD symptoms be present for diagnosis

Answer 8

6 months

Question 9

diagnosis requirements for ADHD?

Answer 9

have symptoms before age 7
+
have ≥ 6 inattention/hyperactivity symptoms
+
symptoms present in more than 1 setting
+
symptoms persist for at least 6 months

Question 10

symptoms of inattention for ADHD?

Answer 10

makes careless mistakes and lacks attention to detail
aversion to activities that require prolonged attention
easily distracted
forgetful
fails to finish projects

Question 11

symptoms of hyperactivity for ADHD?

Answer 11

fidgets/squirms in seat
leaves seat inappropriately
challenge with playing quietly
interrupts others

Question 12

ADHD and addictive behavior?

Answer 12

increased risk for substance use disorder (SUD) by 2x, associated with:
nicotine, alcohol, cocaine

Question 13

treatment guidelines for kiddos with ADHD?

Answer 13

behavioral therapy first, then medication

Question 14

what are the first line of medications for ADHD?

Answer 14

stimulants
risk of diversion

Question 15

first line of meds for kiddos with ADHD aged 4-5?

Answer 15

methylphenidate **only if behavioral therapy doesn’t work

Question 16

first line of meds for kiddos with ADHD aged 6-11?

Answer 16

FIRST LINE: stimulants
Second line: atomoxetine, ER guanfacine, ER clonidine

Question 17

first line of meds for kiddos with ADHD aged 12-18?

Answer 17

ADHD meds (unspecific in slide)

Question 18

contraindications for ADHD stimulant meds?

Answer 18

tourette’s (either fam diagnosis or personal diagnosis)
tics
glaucoma
severe anxiety
MAOI use

Question 19

ER vs IR drugs

Answer 19

ER = extended release
- less frequent dosing + longer onset

IR = immediate release
- less expensive, shorter duration of action, decreased risk for growth retardation

Question 20

which adhd drugs have a high misuse potential

Answer 20

methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine

Question 21

which adhd drugs have a med/low misuse potential

Answer 21

long acting/ER methylphenidate

Question 22

which adhd drugs have a medium misuse potential

Answer 22

amphetamine salts (adderall VR)
Dextroamphetamine (Dexedrine Spansule)

Question 23

which adhd drugs have a low misuse potential

Answer 23

Methylphenidate patch (Daytrana)
Lisdexamfetamine (Vyvanse)
Dexmethylphenidate (Focalin XR)

Question 24

how often to titrate ADHD drugs?

Answer 24

every 3-7 days

Question 25

common ADRs for stimulants ADHD?

Answer 25

decreased appetite
wt loss
stomach ache/headache
rebound sx
irritability/nervousness

Question 26

less common ADRs for stimulants ADHD

Answer 26

dysphoria
zombie-like state
tics
HTN
abnormal pulse
hallucinations
growth retardation

Question 27

ADHD med Stimulant Warnings?

Answer 27

Psychiatric - psychosis, mania, aggression, violent behavior.

discontinue use or stop all together. don’t prescribe with a history.

Question 28

PT considerations for ADHD?

Answer 28

break appointment/tasks into smaller segments
structured schedule
remove distractions
***do not apply direct heat over skin patches and check to see if patch came loose at end of session

Question 29

how do ADHD stimulants work? (MOA)

Answer 29

inhibits reuptake of dopamine and norepinephrine

amphetamines only increase dopamine secreation

Question 30

how do ADHD non-stimulants work (MOA)?

Answer 30

selectively inhibits norepinephrine reuptake
2-4 weeks to see effect but 6-8 for max. benefit

Question 31

how do ADHD non-stimulants-a2 agonists work (MOA)

Answer 31

central alpha adrenergic agonist and increases blood flow to prefrontal cortex
2-4 weeks to see effect

Question 32

how do ADHD non-stimulants-anti depressants work (MOA)

Answer 32

Inhibit norepinephrine and dopamine reuptake (bupropion)