Chapter 66: ADHD Flashcards
The primary treatment for ADHD is stimulant medications because they raise ____ and ____ levels
Dopamine and NE
First-line treatment for pre-school aged children (age 4-5 years)
Parent training in behavior management and/or behavioral classroom intervention
ADHD medications are considered first-line in patients ≥ __ years old
6
DSM-5 diagnostic criteria for inattention
≥6 symptoms of inattention for children up to age 16, OR 5+ symptoms for ages 17 and older. Symptoms must have been present for at least 6 months
Fails to pay attention, 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, loses things, is easily distracted, is forgetful
DSM-5 diagnostic criteria for hyperactivity and impulsivity
6+ symptoms of hyperactivity-impulsivity for children up to age 16, OR 5+ symptoms for ages 17 and older. Symptoms must have been present for at least 6 months
Often fidgets or squirms, leaves seat unexpectedly, runs about when not appropriate, unable to play quietly, is “on the go” as if “driven by a motor,” talks excessively, blurts out answers, has trouble waiting his/her turn and interrupts or intrudes on others
Which conditions must be met in order to be diagnosed with ADHD
- several inattentive or hyperactive-impulsive symptoms were present before the age of 12
- symptoms must have been present in 2 or more settings (e.g., at home, school, work, with friends or relatives, babysitters)
- symptoms interfere with functioning, and are not caused by another disorder
Which natural product is used for a variety of psych conditions and have shown to modestly improve cognitive function and behavior in children with ADHD
Fish oils
What natural product can be taken to help with sleep onset in individuals taking stimulants
Melatonin
What formulation of stimulants are preferred for children who would otherwise need a dose during the day at school
Long-acting
A child or person who cannot swallow capsules or tablets can use these long-acting stimulant formuations:
Capsules - to sprinkle Chewable tablet ODT Patch Suspension
Which stimulant capsules can be opened and sprinkled on a small amount of applesauce
Adderall XR, Ritalin LA
Which stimulant medication can be opened and mixed in water, orange juice or yogurt
Vyvanse capsule
T/F: you can warm the food when sprinkling capsule contents, but you must take it right away
False - do NOT warm the food
Which medication can be used first line when prescribers are concerned about the possibility of abuse by the patient or family
Atomoxetine (Strattera)
Which non-stimulant medication can be tried when stimulants do not work well enough after a trial of 2-3 medications
Atomoxetine (Strattera)
Which medications can be taken to help sleep while taking stimulants
Clonidine IR (Catapres), diphenhydramine (OTC, 25-50 mg), melatonin (OTC, 2-5 mg)
non-stimulants that can be used alone or added onto stimulants
guanfacine ER (intuniv), clonidine ER (Kapvay)
Which symptoms of abuse should be assessed prior to and monitored during stimulant use
dilated pupils, increased HR and BP, sweating, tremor, anxiety
CI: Do not use stimulants within ___ days of ____
14 days of MAOi
What causes the increased HR and BP in patients taking stimulants
Increased levels of DA and NE. Assess for cardiac disease at baseline
What other vascular problems can occur when taking stimulants
Priapism and Raynaud’s disease
T/F: stimulants do not typically lower seizure threshold
False - they can lower the seizure threshold which increases the risk of seizures
T/F: stimulants can cause serotonin syndrome when used with other serotonergic drugs
True
