CAM & ADHD Flashcards
What is CAM?
natural products, traditional chinese medicine, homeopathic meds, mind/body practice
what % of patients using CAM don’t tell their PCP and why?
1/3 due to fear of judgment, it’s natural, and thinks it doesn’t matter
what is the DSHEA?
dietary supplement health and education act 1994
allows FDA oversight for suppements, but FDA has burden of proving unsafe after marketing (recalls)
rules for advertising supplements/CAMs?
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
what are the two databases we can use for CAM
american botanical counsel and databases
natural medicines database
is there a genetic link to ADHD
yes
risk factors for ADHD?
fam. history
FAS
lead poisoning
maternal smoking
meningitis
poor parent-child relationships
how long must ADHD symptoms be present for diagnosis
6 months
diagnosis requirements for ADHD?
have symptoms before age 7
+
have ≥ 6 inattention/hyperactivity symptoms
+
symptoms present in more than 1 setting
+
symptoms persist for at least 6 months
symptoms of inattention for ADHD?
makes careless mistakes and lacks attention to detail
aversion to activities that require prolonged attention
easily distracted
forgetful
fails to finish projects
symptoms of hyperactivity for ADHD?
fidgets/squirms in seat
leaves seat inappropriately
challenge with playing quietly
interrupts others
ADHD and addictive behavior?
increased risk for substance use disorder (SUD) by 2x, associated with:
nicotine, alcohol, cocaine
treatment guidelines for kiddos with ADHD?
behavioral therapy first, then medication
what are the first line of medications for ADHD?
stimulants
risk of diversion
first line of meds for kiddos with ADHD aged 4-5?
methylphenidate **only if behavioral therapy doesn’t work
first line of meds for kiddos with ADHD aged 6-11?
FIRST LINE: stimulants
Second line: atomoxetine, ER guanfacine, ER clonidine
first line of meds for kiddos with ADHD aged 12-18?
ADHD meds (unspecific in slide)
contraindications for ADHD stimulant meds?
tourette’s (either fam diagnosis or personal diagnosis)
tics
glaucoma
severe anxiety
MAOI use
ER vs IR drugs
ER = extended release
- less frequent dosing + longer onset
IR = immediate release
- less expensive, shorter duration of action, decreased risk for growth retardation
which adhd drugs have a high misuse potential
methylphenidate, dexmethylphenidate, amphetamine salts, dextroamphetamine
which adhd drugs have a med/low misuse potential
long acting/ER methylphenidate
which adhd drugs have a medium misuse potential
amphetamine salts (adderall VR)
Dextroamphetamine (Dexedrine Spansule)
which adhd drugs have a low misuse potential
Methylphenidate patch (Daytrana)
Lisdexamfetamine (Vyvanse)
Dexmethylphenidate (Focalin XR)
how often to titrate ADHD drugs?
every 3-7 days
common ADRs for stimulants ADHD?
decreased appetite
wt loss
stomach ache/headache
rebound sx
irritability/nervousness
less common ADRs for stimulants ADHD
dysphoria
zombie-like state
tics
HTN
abnormal pulse
hallucinations
growth retardation
ADHD med Stimulant Warnings?
Psychiatric - psychosis, mania, aggression, violent behavior.
discontinue use or stop all together. don’t prescribe with a history.
PT considerations for ADHD?
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
how do ADHD stimulants work? (MOA)
inhibits reuptake of dopamine and norepinephrine
amphetamines only increase dopamine secreation
how do ADHD non-stimulants work (MOA)?
selectively inhibits norepinephrine reuptake
2-4 weeks to see effect but 6-8 for max. benefit
how do ADHD non-stimulants-a2 agonists work (MOA)
central alpha adrenergic agonist and increases blood flow to prefrontal cortex
2-4 weeks to see effect
how do ADHD non-stimulants-anti depressants work (MOA)
Inhibit norepinephrine and dopamine reuptake (bupropion)
