Exam 4 - Ott ADHD and PEDs

Question 1

When used in ASD, aripiprazole is 1/2 first line agents in ages _____ and used for _____

Answer 1

6-17 & irritability/aggression

Question 2

When used in ASD, risperidone is 1/2 first line agents in ages _____ and used for _____

Answer 2

5-16 & irritability/aggression

Question 3

what antidepressant is FDA approved to treat kids with depression down to 8 years old?

Answer 3

fluoxetine

Question 4

what antidepressant is FDA approved to treat kids with depression 12-17 years old?

Answer 4

escitalopram

Question 5

tx of depression in children step therapy

Answer 5

1. non-pharm: family/caregiver support (necessary for success)
2. cognitive behavioral therapy
3. antidepressant medications
   3.a. fluoxetine, escitalopram, sertraline

Question 6

Peds PTSD tx step therapy

Answer 6

1. Trauma-focused psychotherapy is 1st line tx
2. SSRIs are 1st line drugs

Question 7

aripiprazole - brand name

Answer 7

Abilify

Question 8

asenapine - brand name

Answer 8

Saphris

Question 9

brexpiprazole - brand name

Answer 9

Rexulti

Question 10

lurasidone - brand name

Answer 10

Latuda

Question 11

olanzapine - brand name

Answer 11

Zyprexa

Question 12

olanzapine/fluoxetine - brand name

Answer 12

Symbyax

Question 13

paliperidone - brand name

Answer 13

Invega

Question 14

quetiapine - brand name

Answer 14

Seroquel

Question 15

risperidone - brand name

Answer 15

Risperdal

Question 16

(1) paliperidone - Diagnosis and age range

Answer 16

Schizophrenia - 12+

Question 17

guanfacine ER - Brand name and CYP substrate

Answer 17

Intuniv (alpha-2-agonist)
-remember: 3A4 substrate

Question 18

clonidine ER - Brand name

Answer 18

Kapvay (alpha-2-agonist)

Question 19

what 2 drugs must you taper to avoid rebound HTN in peds ADHD

Answer 19

gaunfacine ER
clonidine ER

Question 20

atomoxetine - Brand name

Answer 20

Strattera (norepi. reuptake inhibitor)

Question 21

viloxazine - brand name

Answer 21

Qelbree (norepi. reuptake inhibitor)

Question 22

atomoxetine - considerations

Answer 22

2D6 substrate
weightbased dosing

Question 23

viloxazine - considerations

Answer 23

2D6/UGT substrate, 1A2 inhibitor
capsules, swallow whole or put in applesauce

Question 24

norepi. reuptake inhibitor AE

Answer 24

increased HR and BP
boxed warning for increased suicidal thinking

Question 25

alpha-2-agonist AE

Answer 25

decreased HR and BP somnolence dizziness rebound HTN if abrupt DC

Question 26

Bupropion - considerations

Answer 26

NOT FDA approved for ADHD but still used after other therapies tried if necessary 2D6 inhibitor CI in seizure disorders and eating disorders

Question 27

Tricyclic antidepressants - considerations

Answer 27

less effective than methylphenidate sudden cardiac death may occur in children

Question 28

atypical antipsychotics in ADHD

Answer 28

may be useful if there is a comorbid bipolar disorder, conduct disorder should not be used as monotherapy

Question 29

ADHD drug therapy considerations by age - preschool

Answer 29

1st line: methylphenidate

Question 30

ADHD drug therapy considerations by age - elementary/middle school

Answer 30

1st line: stimulants 2nd line: atomoxetine, gaunfacine ER, Clonidine ER

Question 31

_____% of children with ADHD will have diagnosis in adulthood

Answer 31

33

Question 32

(increased/decreased) risk of substance use and antisocial personality disorder if ADHD is left untreated

Answer 32

increased

Question 33

diagnostic criteria for ADHD (there are 4)

Answer 33

1. for each Sx domain, must have at least 6 symptoms present 2. for pts 18+, at least 5 Sx are required for either of the two specifiers 3. several inattentive or hyperactive Sx must be present prior to age 12 4. Sx present in 2 or more settings

Question 34

stimulant dosing considerations (4)

Answer 34

1. calculating weight based dosing not helpful 2. IR preferred in pts weighing less than 16kg 3. don't use two different stimulants but can use 2 forms of one drug (long acting and short acting for example) 4. late afternoon Sx may require long-acting formulation

Question 35

Mydayis (mixed amphetamine salts) used in ages _____

Answer 35

13-17

Question 36

Daytrana (methylphenidate) utilizes _____ dosage form

Answer 36

patch

Question 37

Vyvanse (lisdexamphetamine) a _____ and converted to ______ via hepatic first pass metabolism

Answer 37

prodrug, dextroamphetamine

Question 38

Jornay PM (methylphenidate HCl) should be taken what time of day?

Answer 38

take dose in evening between 6:30-9:30pm

Question 39

Stimulant AE (11)

Answer 39

appetite loss (weight loss) ab pain HA sleep distubrances decreased growth hallucinations or other psych Sx Increased BP Increased HR sudden cardiac death priapism peripheral vasculopathy (Raynaud's)

Question 40

how to manage hallucination Sx caused by stimulant

Answer 40

DC stimulant, reassess diagnosis

Question 41

how to manage risk for sudden cardiac death Sx caused by stimulant

Answer 41

assess risk of cardiac structural abnormality and family history -if concern is present, cardiac ECHO can be done

Question 42

age range for atypical antipsychotics in PEDS - schizophrenia

Answer 42

13+

Question 43

age range for atypical antipsychotics in PEDS - Bipolar Disorder

Answer 43

10+