Exam 4: ADHD

Question 1

Which type ADHD: ≥6 symptoms for >6 months. Different than others at that development stage and associated with negative consequences?

Answer 1

Inattention

Question 2

Which type ADHD: ≥6 symptoms for >6 months. Inconsistent with developmental level and negatively impairs social and academic/occupational activities

Answer 2

Hyperactivity and Impulsivity

Question 3

What age must several ADHD symptoms be present?

Answer 3

12

Question 4

Impairment from symptoms in at least how many settings?

Answer 4

Two

Question 5

Clear evidence of what?

Answer 5

Interference or quality reduction of developmentally appropriate social, academic, or occupational functining

Question 6

Disturbances not occur when what else?

Answer 6

Other mental disorders

Question 7

ADHD etiology?

Answer 7

Genetic. Multiple DA and NE genes involved.

Question 8

ADHD-like behavior when what was blocked?

Answer 8

NE alpha 2 receptor

Question 9

Who is required to make ADHD dx? (hint: 3)

Answer 9

1. Parent
2. Teacher
3. Physician (ummm…does he know he is lecturing to PA students?)

Question 10

1 tx for ADHD?

Answer 10

Stimulants

Question 11

2 types of stimulants for ADHD tx?

Answer 11

1. Amphetamines

2. Methylphenidate

Question 12

Methylphenidate MOA?

Answer 12

Block DA and NE reuptake

Question 13

Methylphenidate begins working when?

Answer 13

within first day of dosing

Question 14

2 big ADRs of Methylphenidate?

Answer 14

1. Insomnia

2. Decreased appetite

Question 15

Methylphenidate patch has more or less ADRs than PO?

Answer 15

More

Question 16

Amphetamine MOA?

Answer 16

Blocks DA and NE reuptake and enhances release in synapse. Also inhibits MAO and directly stimulated alpha and beta receptors.

Question 17

Amphetamine preferred dosing?

Answer 17

Every day

Question 18

Which Amphetamine has lease abuse risk?

Answer 18

Lis-dexamphetamine

Question 19

Amphetamine DDI with which 2 SSRIs?

Answer 19

1. Paxil

2. Prozac

Question 20

SSRI and Methylphenidate ok together?

Answer 20

Yup

Question 21

Do stimulants increase seizure risk?

Answer 21

Nope

Question 22

Amphetamine and growth?

Answer 22

2cm effect on growth

Question 23

How to manage Amphetamine-caused growth issues?

Answer 23

Weekend vacation or summer vacation if parents can stand it

Question 24

Who most frequently misuses Amphetamines?

Answer 24

College students

Question 25

Which Amphetamine is safer- short acting or long acting?

Answer 25

Long acting

Question 26

Atomoxetine MOA?

Answer 26

Block NE reuptake. Small amount of DA increase.

Question 27

Atomoxetine onset?

Answer 27

Days

Question 28

Atomoxetine max improvement?

Answer 28

Up to 6 weeks

Question 29

Atomoxetine DDI with which SSRI?

Answer 29

Paroxetine. Increases Atomoxetine by 600%!!!

Question 30

When to dose Atomoxetine?

Answer 30

Morning. Sometimes in afternoon.

Question 31

Atomoxetine better if what 2 cormorbid problems?

Answer 31

1. Anxiety | 2. Substance use problem

Question 32

First-line tx for adults with ADHD?

Answer 32

Atomoxetine

Question 33

Which is better- Atomoxetine or stimulants?

Answer 33

Stimulants are slightly better

Question 34

Guanfacine MOA? (hint: it’s a lot of words)

Answer 34

Alpha 2 agonist stimulates alpha-2a post synaptic receptors in prefonral areas causing strenthened connection in attention areas

Question 35

Which is better for ADHD- Guanfacine or stimulants?

Answer 35

Stimulants

Question 36

Stimulants and Guanfacine?

Answer 36

Use Guanfacine as adjunct therapy with stimulants

Question 37

Guanfacine dosed at night helps with what?

Answer 37

Sleep

Question 38

Guanfacine dosed in morning helps with what?

Answer 38

ADHD

Question 39

Is Guanfacine effective for inattention ADHD?

Answer 39

Nope! Stimulants way better.

Question 40

Which 2 disorders is Guanfacine really good for?

Answer 40

1. Oppositional defiant disorder | 2. Conduct disorder

Question 41

Guanfacine full effect in how long?

Answer 41

4 weeks

Question 42

Guanfacine and CV?

Answer 42

Decreased BP and HR

Question 43

Guanfacine and somnolence?

Answer 43

Causes somnolence and sedation

Question 44

Guanfacine ok for tics?

Answer 44

Yup

Question 45

Clonidine compared to Guanfacine

Answer 45

Clonidine is less specific than guanfacine. More sedation and greater decrease in BP.

Question 46

Clonidine’s half-life compared to Guanfacine?

Answer 46

Shorter, causing more frequent dosing.

Question 47

Clonidine + Stimulant good for what?

Answer 47

CV problems

Question 48

Amphetamine and tics?

Answer 48

High dose amphetamine makes tics worse

Question 49

Atomoxetine and tics?

Answer 49

Doesn’t worsen tics but not as good for ADHD as methylphenidate

Question 50

First med to use for ADHD with tics?

Answer 50

Methylphenidate

Question 51

Alpha-2-agonist and tics?

Answer 51

Will reduce tics but not as good for ADHD as Methylphenidate

Question 52

Adult ADHD and intensity of sx?

Answer 52

Reduced compared to kids

Question 53

Is Adult ADHD easy to dx?

Answer 53

Hard!

Question 54

What to treat first in Adult ADHD?

Answer 54

All othe problems first (like pain, anxiety, depression, etc)

Question 55

Which tx to apply first for Adult ADHD?

Answer 55

Non-pharm interventions like Omega-3-fatty acids

Question 56

Short or long acting stimulants preferred in ADHD?

Answer 56

Long-acting

Question 57

If stimulants ineffective then use what? (2 options)

Answer 57

1. Atomoxetine | 2. Alpha-2-agonist

Question 58

Which med is preferred adjunct to stimulants?

Answer 58

Alpha-2-agonist