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PHM701 > Final - ADHD > Flashcards

Final - ADHD Flashcards

1
Q

When must onset of symptoms occur for an ADHD diagnosis?

A

before 12 years

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2
Q

At what age do most diagnoses for ADHD occur?

A

6-11 (school age)

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3
Q

What are some non-pharm treatments for ADHD? (5)

A

parent/family education, behavioral classroom management (BCM), behavioral peer interventions (BPI), CBT, metacognitive therapy

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4
Q

What is first-line treatment for ADHD? (2)

A

methylphenidate/dexmethylphenidate or dextroamphetamine/amphetamine salts

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5
Q

What is second-line treatment for ADHD (or if inadequate response)? (5)

A

atomoxetine, viloxazine, guanfacine, clonidine, bupropion

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6
Q

What is first-line treatment for Tourette’s disorder? (2)

A

dopamine antagonist or alpha-2 agonist

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7
Q

What is second-line treatment for Tourette’s disorder? (3)

A

add stimulant, atomoxetine, or alpha-2 agonist

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8
Q

What is third-line for Tourette’s disorder? (2)

A

alternative dopamine antagonist or alpha-2 agonist

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9
Q

What is first-line treatment for bipolar disorder and/or severe aggression? (3)

A

atypical antipsychotic, lithium, anticonvulsants

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10
Q

What is second-line treatment for bipolar disorder and/or severe aggression?

A

add stimulant

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11
Q

What is third-line treatment for bipolar disorder and/or severe aggression? (2)

A

alternative dopamine antagonist or additional mood stabilizer

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12
Q

What is first-line treatment for anxiety or depression (w/ADHD)?

A

antidepressant

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13
Q

What is second-line treatment for anxiety or depression (w/ADHD)?

A

add stimulant

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14
Q

What is third-line treatment for anxiety or depression (w/ADHD)?

A

alternative antidepressant

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15
Q

What is the MOA of methylphenidate and amphetamines? (3)

A

block dopamine and norepinephrine reuptake, increase catecholamine release, inhibit MAO

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15
Q

What are the AEs of stimulants? (3)

A

psychiatric, cardiac (increase HR), stunted growth

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16
Q

What is the management for reduced appetite/weight loss? (2)

A

high calorie meals, cyproheptadine at bedtime

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17
Q

What is the management for insomnia? (3)

A

give dose earlier in day, lower the later dose, add sedating medication at bedtime

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18
Q

What is the management for rebound symptoms? (3)

A

long-acting stimulant trial, atomoxetine or antidepressants

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19
Q

What is the management for irritability/jitteriness? (3)

A

assess for comorbidity, reduce dose, consider mood stabilizer or atypical antipsychotic

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19
Q

What is the management for zombie-like states, tics, and HTN/pulse changes? (2)

A

reduce dose or change medication

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20
Q

Explain the pearls for MPH iR (Ritalin, Methylin)?

A

taken in 2-3 divided doses

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21
Q

Explain the pearl for MPH ER (Metadate ER, Quillivant XR)?

A

30:70 IR:ER

22
Q

Explain the pearls (2) for MPH ER Chew (Quillichew)?

A

30:70 IR:ER and tablets scored

23
Q

Explain the pearls (2) for MPH CD (Metadate CD)?

A

30:70 IR:ER and can sprinkle

24
Q

Explain the pearls (3) for MPH LA (Ritalin LA)?

A

50:50 IR:ER, can sprinkle, best for more severe morning symptoms

25
Q

Explain the pearls (2) for MPH XR suspension?

A

requires shaking and good for 4 months

26
Q

Explain the pearl for MPH OROS?

A

swallow whole/do not crush

27
Q

Explain the pearl for MPH MLR (Aptensio XR)?

A

better for rebound afternoon symptoms

28
Q

Explain the pearl for MPH MLR-02 (Adhansia XR)?

A

none

29
Q

Explain the pearl for MPH XR-ODT (Cotempla XR-ODT)?

A

hard to switch cause of weird dosing (requires new titration)

30
Q

Explain the pearls for MPH transdermal patch (Daytrana)? (2)

A

BBW for skin reactions and tics occur more often

31
Q

Explain the pearls (2) for Dex-MPH IR?

A

no greater benefit over MPH and 1/2 the dose of MPH

32
Q

Explain the pearls (2) for Dex-MPH-XR?

A

50:50 IR:ER, afternoon symptom control not as good as OROS

33
Q

Explain the pearl for Dex-MPH/Ser-Dex-MPH?

A

risk of suicidal ideation

34
Q

Explain the pearls (2) for MPH PM?

A

slow absorption, administer in evening

35
Q

Which methylphenidate-containing products are dosed twice or more a day? (2)

A

MPH IR (Ritalin, Methylin) and Dex-MPH IR

36
Q

Which methylphenidate-containing products have onset of effect greater than an hour? (6)

A

MPH ER, ER Chew, XR-ODT, transdermal patch, Dex-Ser, and PM

37
Q

Which methylphenidate-containing products are dosed in the morning? (6)

A

MPH ER, ER Chew, LA, XR Suspension, OROS, Dex

38
Q

What ages is methylphenidate approved for according to the FDA?

A

6+

39
Q

Which amphetamine-containing products are approved in children 3+? (2)

A

mixed AMP-IR and AMP sulfate-IR

40
Q

Explain the pearl for mixed AMP-XR salts? (2)

A

50:50 IR:ER and can sprinkle

41
Q

Which AMP products require a retritation when switching? (3)

A

AMP ER solution, XR-ODT, and ER suspension

42
Q

What are the AEs for AMP sulfate-XR solution? (3)

A

epistaxis, allergic rhinitis, GI

43
Q

Explain the pearl for lisdexamfetamine?

A

designed for less abuse potential

44
Q

Which amphetamine-containing products can be dosed multiple times a day? (4)

A

mixed AMP-IR, AMP sulfate-IR, AMP sulfate-ODT, and d-AMP IR

45
Q

Explain the pearls for Mydasis? (3)

A

13+, can NOT convert, and formulated to reduce wearing off peaks

46
Q

What is a contraindication for AMP-containing products?

A

cardiovascular diseases

47
Q

Where can Daytrana be applied? Where can Xelstrym?

A

hip only; hip+

48
Q

Which brands of stimulants are approved in ages 3+? (3)

A

Dexedrine, Evekeo, Adderall

49
Q

Compare and contrast atomoxetine to viloxazine? (3)

A

atomoxetine is 1-2 doses, takes longer for max benefit, and duration of effect is half that of viloxazine

50
Q

What are AEs for the norepinephrine reuptake inhibitors? (3)

A

GI, psychiatric, QTc prolongation

51
Q

What are contraindications for norepinephrine reuptake inhibitors? (3)

A

BBW for new-onset suicidality, liver (viLoxetine) and renal problems, CYP inhibitors

52
Q

Compare and contrast clonidine to guanfacine ER? (3)

A

clonidine is more sedating, is 1-2 doses and duration of effect is half that of guanfacine

53
Q

What are other treatments for ADHD? (4)

A

bupropion, TCAs, lithium/anticonvulsants, and antipsychotics

54
Q

When might lithium be a good choice for an ADHD patient? (3)

A

aggression, explosive behavior, impulsivity

55
Q

Which patient groups need higher doses of stimulants?

A

oppositional-defiant/conduct disorder with ADHD

PHM701 (14 decks)

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