Final - ADHD Flashcards
When must onset of symptoms occur for an ADHD diagnosis?
before 12 years
At what age do most diagnoses for ADHD occur?
6-11 (school age)
What are some non-pharm treatments for ADHD? (5)
parent/family education, behavioral classroom management (BCM), behavioral peer interventions (BPI), CBT, metacognitive therapy
What is first-line treatment for ADHD? (2)
methylphenidate/dexmethylphenidate or dextroamphetamine/amphetamine salts
What is second-line treatment for ADHD (or if inadequate response)? (5)
atomoxetine, viloxazine, guanfacine, clonidine, bupropion
What is first-line treatment for Tourette’s disorder? (2)
dopamine antagonist or alpha-2 agonist
What is second-line treatment for Tourette’s disorder? (3)
add stimulant, atomoxetine, or alpha-2 agonist
What is third-line for Tourette’s disorder? (2)
alternative dopamine antagonist or alpha-2 agonist
What is first-line treatment for bipolar disorder and/or severe aggression? (3)
atypical antipsychotic, lithium, anticonvulsants
What is second-line treatment for bipolar disorder and/or severe aggression?
add stimulant
What is third-line treatment for bipolar disorder and/or severe aggression? (2)
alternative dopamine antagonist or additional mood stabilizer
What is first-line treatment for anxiety or depression (w/ADHD)?
antidepressant
What is second-line treatment for anxiety or depression (w/ADHD)?
add stimulant
What is third-line treatment for anxiety or depression (w/ADHD)?
alternative antidepressant
What is the MOA of methylphenidate and amphetamines? (3)
block dopamine and norepinephrine reuptake, increase catecholamine release, inhibit MAO
What are the AEs of stimulants? (3)
psychiatric, cardiac (increase HR), stunted growth
What is the management for reduced appetite/weight loss? (2)
high calorie meals, cyproheptadine at bedtime
What is the management for insomnia? (3)
give dose earlier in day, lower the later dose, add sedating medication at bedtime
What is the management for rebound symptoms? (3)
long-acting stimulant trial, atomoxetine or antidepressants
What is the management for irritability/jitteriness? (3)
assess for comorbidity, reduce dose, consider mood stabilizer or atypical antipsychotic
What is the management for zombie-like states, tics, and HTN/pulse changes? (2)
reduce dose or change medication
Explain the pearls for MPH iR (Ritalin, Methylin)?
taken in 2-3 divided doses
Explain the pearl for MPH ER (Metadate ER, Quillivant XR)?
30:70 IR:ER
Explain the pearls (2) for MPH ER Chew (Quillichew)?
30:70 IR:ER and tablets scored
Explain the pearls (2) for MPH CD (Metadate CD)?
30:70 IR:ER and can sprinkle
Explain the pearls (3) for MPH LA (Ritalin LA)?
50:50 IR:ER, can sprinkle, best for more severe morning symptoms
Explain the pearls (2) for MPH XR suspension?
requires shaking and good for 4 months
Explain the pearl for MPH OROS?
swallow whole/do not crush
Explain the pearl for MPH MLR (Aptensio XR)?
better for rebound afternoon symptoms
Explain the pearl for MPH MLR-02 (Adhansia XR)?
none
Explain the pearl for MPH XR-ODT (Cotempla XR-ODT)?
hard to switch cause of weird dosing (requires new titration)
Explain the pearls for MPH transdermal patch (Daytrana)? (2)
BBW for skin reactions and tics occur more often
Explain the pearls (2) for Dex-MPH IR?
no greater benefit over MPH and 1/2 the dose of MPH
Explain the pearls (2) for Dex-MPH-XR?
50:50 IR:ER, afternoon symptom control not as good as OROS
Explain the pearl for Dex-MPH/Ser-Dex-MPH?
risk of suicidal ideation
Explain the pearls (2) for MPH PM?
slow absorption, administer in evening
Which methylphenidate-containing products are dosed twice or more a day? (2)
MPH IR (Ritalin, Methylin) and Dex-MPH IR
Which methylphenidate-containing products have onset of effect greater than an hour? (6)
MPH ER, ER Chew, XR-ODT, transdermal patch, Dex-Ser, and PM
Which methylphenidate-containing products are dosed in the morning? (6)
MPH ER, ER Chew, LA, XR Suspension, OROS, Dex
What ages is methylphenidate approved for according to the FDA?
6+
Which amphetamine-containing products are approved in children 3+? (2)
mixed AMP-IR and AMP sulfate-IR
Explain the pearl for mixed AMP-XR salts? (2)
50:50 IR:ER and can sprinkle
Which AMP products require a retritation when switching? (3)
AMP ER solution, XR-ODT, and ER suspension
What are the AEs for AMP sulfate-XR solution? (3)
epistaxis, allergic rhinitis, GI
Explain the pearl for lisdexamfetamine?
designed for less abuse potential
Which amphetamine-containing products can be dosed multiple times a day? (4)
mixed AMP-IR, AMP sulfate-IR, AMP sulfate-ODT, and d-AMP IR
Explain the pearls for Mydasis? (3)
13+, can NOT convert, and formulated to reduce wearing off peaks
What is a contraindication for AMP-containing products?
cardiovascular diseases
Where can Daytrana be applied? Where can Xelstrym?
hip only; hip+
Which brands of stimulants are approved in ages 3+? (3)
Dexedrine, Evekeo, Adderall
Compare and contrast atomoxetine to viloxazine? (3)
atomoxetine is 1-2 doses, takes longer for max benefit, and duration of effect is half that of viloxazine
What are AEs for the norepinephrine reuptake inhibitors? (3)
GI, psychiatric, QTc prolongation
What are contraindications for norepinephrine reuptake inhibitors? (3)
BBW for new-onset suicidality, liver (viLoxetine) and renal problems, CYP inhibitors
Compare and contrast clonidine to guanfacine ER? (3)
clonidine is more sedating, is 1-2 doses and duration of effect is half that of guanfacine
What are other treatments for ADHD? (4)
bupropion, TCAs, lithium/anticonvulsants, and antipsychotics
When might lithium be a good choice for an ADHD patient? (3)
aggression, explosive behavior, impulsivity
Which patient groups need higher doses of stimulants?
oppositional-defiant/conduct disorder with ADHD