CHILDREN AND ADOLESCENTS - CNS Flashcards
Neurodevelopmental disorders
multifaced conditions characterised by impairments in cognition, communication, behaviour and/or motor skills resulting from ‘abnormal’ brain development
emotional and behavioural disorders
characterised as either internalizing or externalizing ‘problems’ - tend to occur as a consequence of ‘stressful’ environments/situations
examples of neurodevelopmental disorders
- intellectual disability
- communication disorders
- ASD
- ADHD
examples of emotional and behavioural disorders
- depression
- anxiety disorders inc. OCD/phobias/tics
- eating disorders
- conduct disorders
- challenging behaviours
unlicensed medicines definition
a drug that does not have marketing authority in the UK
off label use of a drug
a licensed drug is being used for an unlicensed indication (different doses, form etc.)
what are antipsychotics used for (first and second generation)
typical (1st gen.) and atypical (2nd gen.) used for
- psychosis
- bipolar disorder
- ASD associated stereotypes
- compulsions
- aggression and self-injurious behaviour
what symptoms do antipsychotics address?
- delusions
- paranoia
- disordered thinking
- aggression/irritability
which antipsychotic is used in treatment-resistant schizophrenia
CLOZAPINE
difference between 1st and 2nd generation antipsychotics
- SGAs less likely to cause extrapyramidal side effects and other symptoms as a consequence of blocked dopamine receptors
- SGA more cardiac toxic, cause weight gain/hypoglycaemia leading to ‘metabolic syndrome’ - a chronic endocrine disorder
AP monitoring requirements
- weight/BMI: initially and every 3 months
- U and Es: baseline and yearly
- blood glucose and lipids: initially and every 3 months
- prolactin: if symptoms or hyperprolactinaemia present
- ECG: initially if pt a ‘cardiac-risk’
- LFTs: baseline and yearly
ADHD - ICD-10 classification meaning
hyperkinetic disorder
narrower restrictive term requiring more pervasive and impairing symptoms
ADHD pathophysiology
ADHD has a ‘defective inhibitory’ response, the ‘compromised’ pre-frontal cortex cannot filter incoming stimuli
drug treatment enhances noradrenaline and dopamine transmission
dexamfetamine moa on synaptic release
facilities release of dopamine from presynaptic cytoplasmic storage vesicles (increase in synapse) and blocks dopamine transporter protein (inhibits reuptake)
methylphenidate moa on synaptic release
acts primarily on the dopamine receptor and has little effect on synaptic release
if synaptic concentration is increased…
there is greater stimulation of post-synaptic neurons through receptors
ADHD first, second and third line meds
1st line > stimulants (methylphenidate first then dexamfetamine)
2nd line > atomoxetine OR guanfacine (only SR)
3rd line > clonidine (initiated by specialist)
methylphenidate formulations and duration of actions
MPH IR > effective for 3-4 hours
MPH SR > Equasym XL 8-10 hours
Medikinet XL > 8 hours
Concerta XL > 12 hours
Elvanse formulation for dexamfetamine
elvanse is lisdexamfetamine dimesylate SR - which is a prodrug of dexamfetamine, less susceptible to abuse
atomoxetine moa
- norepinephrine inhibitor (noradrenaline)
- reduced chance of misuse compared to stimulants
- dose according to body weight
- metabolised by CYP 2D6 (consider hepatic interactions)
non-stimulant drugs > guanfacine in ADHD
- sustained release formulation
- long time to get therapeutic effect (around 2 - 3 weeks)
- has calming effect (may be useful in aggressive/challenging behaviour and in reducing tics)
non-stimulant drugs > clonidine in ADHD
- unlicensed for ADHD
- 2-3 times a day dosing
- longest time to reach therapeutic dose (around 150-300mcg/day)
- drop in BP major side effect
which class of drug do guanfacine and clonidine belong to
HYPERTENSIVE MEDICATION
guanfacine and clonidine side effects due to anti-hypertensive effect
- sleepiness (sedation)
- headache
- fatigue
- abdominal pain
- nasopharyngitis
- weight gain
- drop in BP
monitoring for stimulants
- baseline HR and BP: repeat every dose adjustment and every 6 months
- pre-treatment height and weight on growth chart every 6 months
- complete medical history
treatment of eating disorders
primarily psychological therapies, medication is used to address the poor nutritional status and physical health needs
for delusion aspect SGAs or SSRIs
prescribing issues in CAMHS
- greater metabolic capacity > rapid elimination of drugs that use hepatic pathways
- greater efficient renal elimination
- greater body water and less adipose tissue
- drug formulation/delivery route
- some children unable to swallow the drug/can’t tolerate bitter or unpleasant taste
