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Therapeutics III > Ott Pharmacotherapy of Ped Psych > Flashcards

Ott Pharmacotherapy of Ped Psych Flashcards

1
Q

Why must medications be used with caution in pediatric patients?

A

Kids have a higher risk for significant adverse effects compared to adults

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2
Q

Definition of Tourette’s disorder

A

-Tics may wax and wane in frequency, but have been present for over a year
-Onset before age 18

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3
Q

Common comorbidities associated with tic disorders

A

-~75% have ADHD
-~50% have OCD

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4
Q

Tic disorder rule of thirds

A

-1/3 resolve
-1/3 improve
-1/3 stay the same
-~10% have persistent symptoms as adults

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5
Q

First-line treatment for tics

A

Alpha 2 agonists:
-Tics of mild to moderate severity
-~30% reduction

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6
Q

Second-line treatment for tics

A

Atypical antipsychotics (30-60% reduction_

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7
Q

Third-line treatment for tics

A

Typical antipsychotics (~80% reduction)

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8
Q

What are the alpha 2 agonists used to treat tics?

A

-Clonidine
-Guanfacine
-Guanfacine ER

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9
Q

What are the atypical antipsychotics used to treat tics?

A

-Aripiprazole
-Risperidone

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10
Q

What are the typical antipsychotics used to treat tics?

A

-Haloperidol
-Pimozide

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11
Q

What is the age range that aripiprazole is approved for treating?

A

6-17 years old

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12
Q

How do you treat ADHD and Tourette’s at the same time?

A

-Can discontinue amphetamine-based stimulant and give a trial of atomoxetine or a tricyclic antidepressant
-If ADHD symptoms are not well-controlled, can resume amphetamine-based stimulant and adjust dose of antipsychotic to better control Tourette’s symptoms

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13
Q

What must be specified when diagnosing conduct disorder?

A

-Childhood-onset type: less than 10 years old
-Adolescent-onset type: older than 10 years old (no symptoms under 10)
-Unspecified onset: unclear information to determine age at onset

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14
Q

When should pharmacotherapy be considered in patient with ODD or CD?

A

Pharmacotherapy is considered adjunctive, palliative, non-curative and should only be used after baseline symptoms/behaviors have been determined, other interventions have failed and/or aggression has escalated to dangerous levels

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15
Q

How do you treat ODD and CD?

A

Treat underlying conditions (ADHD, depression/anxiety, mania) - ADHD common

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16
Q

Which drugs are considered first choice to treat ODD and CD?

A

Stimulants and clonidine/guanfacine before atypical antipsychotics

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17
Q

When are atypical antipsychotics used for ODD and CD?

A

May be used to treat severe aggression, serious oppositional behaviors, defiance

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18
Q

What medications are often given to ODD and CD patients?

A

Combination stimulant/alpha agonist treatment of ADHD with impulsivity or need for sedation for sleep

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19
Q

What is first-line treatment for separation anxiety disorder?

A

First-line treatment for mild anxiety is psychotherapy with combination therapy for moderate to severe anxiety

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20
Q

What is the first-line drug choice for separation anxiety disorder?

A

SSRIs are the first-line drug therapy choice

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21
Q

What are common co-morbidities associated with separation anxiety disorder

A

-Depression
-ADHD
-Bipolar disorder
Co-morbidities must be treated

22
Q

What is autism spectrum disorder?

A

-Persistent deficits in social communication and social interaction across multiple contexts
-Restricted, repetitive patterns of behavior, interests, activities

23
Q

Behavioral symptoms associated with autism spectrum disorder

A

-Aggression
-Hyperactivity
-Inattention
-Irritability
-Mood instability
-Poor frustration tolerance
-Self-harm
-Severe temper tantrum
-Sleep disturbances
-OCD symptoms
-Hypersensitivity of senses

24
Q

Medical problems associated with autism spectrum disorder

A

-Seizure disorder
-GI disorders

25
Q

What medications are used to treat the core ASD symptoms?

A

No medications have shown efficacy in treating the core ASD symptoms

26
Q

First line treatment for disruptive behaviors in ASD

A

Behavioral interventions

27
Q

What are considered first-line drug agents in the treatment of ASD?

A

Atypical antipsychotics:
-Aripiprazole
-Risperidone

28
Q

Age range to use risperidone

A

5-16 years old

29
Q

Lamotrigine/levetiracetam use in ASD

A

No significant effect on irritability

30
Q

How to treat sleep problems in ASD

A

Melatonin reduced sleep latency and increased time asleep - give 1-6 mg nightly

31
Q

How to treat ADHD in ASD

A

-Stimulants - methylphenidate is preferred
-Clonidine/guanfacine - modest effect on irritability and explosive behavior

32
Q

How to treat repetitive behaviors in ASD

A

Antipsychotics - haloperidol, risperidone, aripiprazole

33
Q

Definition of disruptive mood dysregulation disorder

A

-Severe recurrent temper outbursts manifested verbally that are out of proportion with the intensity/duration of the situation
-Present in at least two of three settings (home, school, with peers) and are severe in at least one of these
-Diagnosis should not be made before age 6 or after age 18

34
Q

First-line treatment for DMDD

A

SSRIs and stimulants

35
Q

How to treat DMDD

A

-More similarity to depression, ADHD, or anxiety than bipolar disorder
-Need to differentiate from bipolar disorder - both for using antidepressants as well as evaluating need for mood stabilizers

36
Q

Symptoms of depression in children

A

-Physical complaints
-Irritability
-Conduct problems
-May have suicidal ideation

37
Q

Symptoms of depression in adolescents

A

-Express feelings of depression
-More suicidal behaviors than younger children

38
Q

Differences in depression for peds patients compared to adult patients

A

-More chronic than episodic
-Instability in mood is common
-May be a marker for bipolar disorder

39
Q

First-line treatment for depression in peds patients

A

-Non-pharmacologic treatment - need motivation of family/caregivers for success
-Cognitive behavioral therapy - remission rates of 70%

40
Q

What antidepressants are used in peds patients?

A

-Fluoxetine
-Escitalopram

41
Q

Which antidepressant must be avoided in peds patients?

A

Paroxetine for suicidal thinking

42
Q

Age range for use of fluoxetine

A

Can be used in anyone as young as 8 years old

43
Q

Age range for use of escitalopram

A

12-17 years old

44
Q

Antidepressant black box warning

A

-Suicidality
-Highest risk in first 3 months of treatment
-Med guide with each prescription
-Antidepressants may lower completed suicide rate

45
Q

Preferred drug options to treat bipolar 1, mixed or manic, without psychosis

A

-Lithium
-Valproate
-Carbamazepine
-Olanzapine
-Risperidone
-Quetiapine
-May augment with second agent if needed after 4 weeks

46
Q

Preferred drug options to treat bipolar 1, mixed or manic, with psychosis

A

-Lithium
-Valproate
-Carbamazepine WITH any atypical antipsychotic
-Consider d/c of atypical if remission for 12-24 months

47
Q

Preferred drug options to treat bipolar, depressed

A

-First line: lithium
-SSRI/bupropion for depression that continues with lithium treatment (adjunct to lithium)

48
Q

First-line treatment for peds PTSD

A

-Trauma-focused psychotherapy
-SSRIs

49
Q

How to diagnose childhood-onset schizophrenia

A

Use adult diagnostic criteria

50
Q

What is childhood-onset schizoprhenia?

A

-Not explained by substance use of PDD/autism
-Visual hallucinations are more common in peds than adults
-Onset of symptoms before age 13
-Rare in children, adolescent prevalence reaches adult prevalence of 0.5-1.0%

Therapeutics III (42 decks)

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