kid psychopharmacology & neurodevelopment disorders

Question 1

why do kids have an increased volume of distribution?

Answer 1

more water, less fat & plasma albumin

Question 2

why do kids have faster drug elimination?

Answer 2

shorter half lives

Question 3

stimulant medications (4)

Answer 3

methylphenidate, dexmethylphenidate (ritalin, concerta, Focalin)
amphetamine/dextroamphetamine (adderall)
lisdexamphatamine (Vyvanse)

Question 4

stimulant drug MOA

Answer 4

block norepinephrine and dopamine reuptake transporters –> increases levels in synaptic cleft

Question 5

what is special about amphetamines MOA?

Answer 5

also promotes release of dopamine from presynaptic vesicles

Question 6

most common side effects of stimulant medications

Answer 6

decreased appetite, insomnia

Question 7

alpha 2 agonist drugs (2)

Answer 7

clonidine and guanfacine (intuniv)

Question 8

alpha 2 agonists moa & target symptoms

Answer 8

responsible for norepinephrine activity in PFC; regulate inattention, hyperactivity, impulsivity symptoms

Question 9

alpha 2 agonists side effects

Answer 9

fatigue and hypotension – start with bedtime dosing

Question 10

atomoxetine drug

Answer 10

strattera

Question 11

strattera moa

Answer 11

increases dopamine and norepinephrine in PFC, potent selective NET inhibitor, binds SERT and block NMDA receptors

Question 12

viloxazine drug

Answer 12

qelbree

Question 13

qelbree moa

Answer 13

moderate selective NET inhibitor –> increases norepinephrine in amygdala and PFC; acts at specific serotonin receptors

Question 14

difference between Strattera and qelbree in administration?

Answer 14

cannot break Strattera capsules but can open qenbree and mix small beads into kids’ food

Question 15

what are the two types of antidepressants we use for ADHD treatment?

Answer 15

bupropion (wellbutrin) and tricyclics (specifically imipramine)

Question 16

what drug is used occasionally by adults for ADHD? why can’t it be prescribed to kids?

Answer 16

modafinil (provigil)
stevens-johnson syndrome in kids

Question 17

what antipsychotics can be used in ADHD treatment? in what situations do we use them?

Answer 17

haloperidol and chlorpromazine, only for cases with severe aggression and behavioral issues

Question 18

adhd main target symptoms (3)

Answer 18

poor concentration/ inattention, motor hyperactivity, impulsivity

Question 19

what is the gold standard of medication for ADHD treatment?

Answer 19

stimulants

Question 20

contraindications to stimulant use

Answer 20

comorbid medical issues, specifically cardiovascular disease & arrhythmias (get EKG)
growth concerns
guardian preference
substance abuse/ concern for diversion

Question 21

medications to treat ODD

Answer 21

no specific FDA approved, use some to treat comorbid conditions
some evidence for alpha 2 agonists

Question 22

main autism target symptom for drug use

Answer 22

irritability

Question 23

drugs used for severe irritability in ASD?

Answer 23

atypical/ 2nd gen antipsychotics (risperidone & Abilify)

Question 24

3 drug classes used off-label in treatment of ASD?

Answer 24

SSRIs, alpha 2 agonists, anticonvulsants (valproic acid)

Question 25

tics

Answer 25

experienced by 20% of children, but most go unnoticed or are gone within a year

Question 26

persistent tic disorder

Answer 26

either motor or vocal tics, not both

Question 27

tourette's

Answer 27

both verbal and motor tics

Question 28

when do we use medications to decrease tics? what meds?

Answer 28

if tics are frequent, embarrassing, or cause discomfort antipsychotics or alpha 2 agonists

Question 29

enuresis treatment

Answer 29

education, reassurance, medical work up

Question 30

medicine interventions for enuresis

Answer 30

desmopressin, TCAs (neither are great options and really only meant for special occasions)