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PHRM 845: Therapeutics III > Otts Sections > Flashcards

Otts Sections Flashcards

1
Q

What is the clinical course for ADHD?

A
  • 1/3 of children with ADHD will have it as a adult
  • There is an INCREASED risk of substance use and antisocial personalty if untreated
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2
Q

What is the potential impact of ADHD?

A
  • Poor Grades, Low self-esteem, Bad relationships, cant work
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3
Q

What is the diagnostic criteria for ADHD?

A
  • 6 symptoms in each domain [work, school, home…]
  • Older patients - 5 symptoms for either two specifiers
  • Inattentive or hyperactive symptoms at 12 yo [present in two or more settings]
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4
Q

What are the ADHD types?

A
  • Combined, Predominatly inattentice presentation, Predominantly hyperactive Presention
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5
Q

What are the Inattentive symptoms [persisting for at least 6 months]?

A
  • Fail to give attention to detail
  • Difficulty sustaining attention
  • Doesnt listen
  • Doesnt follow directinos
  • Difficulty doing tasks
  • Avoids tasks that need work
  • Easily distracted
  • Forgetful
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6
Q

What are the Hyperactive symptoms [persisting for at least 6 months]?

A
  • Fidgets
  • Leaves seat
  • Runs or climbs
  • Unable to play quietly
  • Talks Excessively
  • Can’t wait turns
  • Interrupts
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7
Q

What are some of the Non-Pharmacologic treatment for ADHD?

A
  • Behavioral Therapy, Psychosocial Treatment
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8
Q

What are some of the Pharmacologic Treatments for ADHD?

A
  • Stimulants
  • Non-Stimulants
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9
Q

What is the specific dosing for Stimulants in ADHD?

A
  • Effects in short periods
  • DO NOT NEED to calculate for Kids
  • IR good in kids
  • DO NOT USE 2 DIFFERENT STIMULANTS
  • DO NOT give too late in the day
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10
Q

What are some of the speaical consideration drugs used in ADHD?

A
  • Mydayis [NOT for 12 and under]
  • Daytrana [Patch - ONLY if they respond to methylphendate]
  • Vyvanse [Prodrug - Misuse deterrent]
  • Jornay PM [PM dose so it work in AM]
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11
Q

What are some of the stimulant adverse effects in ADHD?

A
  • Appetite loss, Stomach pain, Headache, Sleep issues, Decreased growth, Increased BP, Increased HR, Sudden Cardiac Death
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12
Q

What are some of the stimulant monitoring in ADHD?

A
  • Appetite, Behavior, Blood Pressure, Growth Rate, Heart Rate, Sleep, ECG
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13
Q

What are the Alpha 2 Agonist in ADHD?

A
  • Intuniv & Kapvay
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14
Q

What is important to know about Guanfacine [Intuniv] in ADHD?

A
  • 3A4 Substrate
  • Once Daily
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15
Q

What is important to know about Clonidine [Kapvay] in ADHD?

A
  • Twice Daily
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16
Q

What are the Norepineephrine Reuptake Inhibitors in ADHD?

A
  • Atomoxetine & Viloxazine
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17
Q

What is important to know about Atomoxetine in ADHD?

A
  • 6 and older
  • 2D6 Substrate
  • Weight Based dosing [<70 kg = 0.5 mg/kg & > 70 kg = 40 mg[]
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18
Q

What are the adverse effects of the non-stimulants in ADHD?

A
  • A2A: Decreased HR and BP, Orthostasis, Sleepy, Dizziness
  • NRI: Increased HR and BP, Increased suicidal thinking [BOXED WARNING]
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19
Q

What are some of the monitoring for the non-stimulants in ADHD?

A
  • Appetite, Behavior, Blood Pressure, Growth Rate, Heart Rate, LFT, Sleep
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20
Q

What is important to know about Burpropion in ADHD?

A
  • NOT FDA approved for ADHD
  • 2D6
  • CONTRAINDICATED: Seizure and eating disorder
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21
Q

What is important to know about Monafinil in ADHD?

A
  • FDA for narcolepsy, OSA, Shift work sleep
  • Headache, Decreased Appetite, SJS/TEN
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22
Q

What is important to know about the TCAs in ADHD?

A
  • Less effective than methylphenidate
  • Cardiac sudden death in childern
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23
Q

What is important to know about the mood stabilizers in ADHD?

A
  • May be useful if there is comordbid bipolar disorderm conduct disorder, intermittent explosive disorder
  • SHOULD NOT use atypical antipsychotics as monotherapy
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24
Q

How does the American Academy of Pediatrics [AAP] use there guidelines for ADHD?

A
  • Pre-school: Parent Training then FDA med
  • Elementary and Middle-school: FDA med + Parent Training
  • Adolescents: FDA Med
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25
Q

What are the AAP remcommendated drugs to use in ADHD?

A
  • Preschool: Methylphenidate [NO non-stim]
  • Elementary/Middle school: Stimulants; Atomoxtine, Guanfacine, Clonidine
  • Addon: Guanfacine and Clonidine are the ONLY ones
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26
Q

What are the NICE: ADHD Guidelines for Adults?

A
  • Methylphenidate OR Lisdexamfetamine
  • Dextroamphetamine [cant use Lisdex]
  • Atomoxtine [last line]
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27
Q

What is important to know about medication use in pediatric psychiatry?

A
  • Kids have higher risks of significant adverse effects from medicaiton than adults
28
Q

How does the DSM-5 describe tic disorders in pediatric psychiatry?

A
  • Tourettes: Both motor and vocal tics for > 1y
  • Persistent motor OR vocal tic disorder: >1y
  • Provisional Tic Disorder: <1y
29
Q

What is important to know about Tic Disorders in pediatric psychiatry?

A
  • ~75% have ADHD, ~50% have OCD
  • 1/3 resolve, 1/3 improve, 1/3 stay the same
30
Q

What is the pharmacologic treatment for Tics in pediatric psychiatry?

A
  • 1st: Alpha 2 Agonist [helps with ADHD too]
  • 2nd: Atypical Antipsychotics [Aripiprazole & Ripseridone; weight gain]
  • 3rd: Typical Antipsychotics [Haloperidol; Pimozide = LAST LINE]
31
Q

What antipsychotics medications are used in Tics in pediatric psychiatry?

A
  • Pimozide [QTc Prolongation, 3A4, EPS]
  • Haloperidol [EPS]
  • Aripiprazole [FDA approved]
  • Risperidone [D2 blockade]
32
Q

What stimulants are used in Tourette’s in pediatric psychiatry?

A
  • ADHD is common with Tourettes
  • Amphetamine = EXACERBATION
  • MUST treat both - Atomoxetine or TCA?
33
Q

How does the DSM-5 describe Oppositional Defiant Disorder in pediatric psychiatry?

A
  • Patterns of angry/irritable mood, argumentative/definat behavior lasting 6 months
34
Q

How does the DSM-5 describe Conduct Disorder in pediatric psychiatry?

A
  • When ODD is properly diagnosed with 3 of the following criteria in the past year:
  • Agression to people, Destruction of property, Theft, Serious violation of Rules [<10y]
35
Q

What is the treatment of ODD & CD in pediatric psychiatry?

A
  • Stimulants and Clonidine/Guanfacine [could help with sleep]
  • Atypical Antipsychotics
36
Q

How does the DSM-5 describe Separation Anxiety Disorder in Pediatric Psychiatry?

A
  • Excessive fear or anxiety concerning separation
  • Lasting 4 weeks in kids and 6 months in adults
37
Q

What is the treatment for separation anxiety in pediatric psychiatry?

A
  • SSRIs = 1st line
  • Psychotherapy with combo = mild anxiety
38
Q

How does the DSM-5 describe autism spectrum disorder in pediatric psychiatry ?

A
  • Deficits in social communications and interactions
  • Restricted, repetitive patterns of behavior, interests activities
39
Q

What are some of the hallmark signs & symptoms of ASD in pediatric psychiatry ?

A
  • Aggression, Hyperactivity, inattention, irritability, mood instability, self-harm, OCD…
  • Seizures? GI issues?
40
Q

What is the treatment of disruptive behaviors in ASD in pediatric psychiatry ?

A
  • Typical Antipsychotics: Haloperidol
  • Atypical Antipsychotics: Aripiprazole [6-17] & Reisperidone [5-16]
  • Mood Stabilizers
  • NO Lamotrigine or Levetiracetam = NO effect on irritablity
41
Q

How dose the DSM-5 describe disruptive mood dysregulation disorder in pediatric psychiatry ?

A
  • Temper outbursts verbally that are out of proportion compared to the situation [before 6 or after 18]
  • happens in 2 -3 settings [Home, School, with peers]
42
Q

what is the treatment for DMDD in pediatric psychiatry ?

A
  • Antidepressants - similar to depression, ADHD, or Anxiety
  • SSRIs & Stimulants = 1st line
43
Q

How is pediatric depression described in pediatric psychiatry ?

A
  • Kids: physical complaints, irritability, conduct problems, suicidal ideation
  • Teens: express feelings of depressions and suicidal behaviors
44
Q

What is the Depression treatment for pediatric psychiatry ?

A
  • Non-pharmacologic = 1st line [70% remission]
  • Antidepressants BOXED WARNING for suicidality [Paroxetine AVOID in kids]
  • Fluoxetine 8 yo
  • Escitalopram 12 - 17 yo
45
Q

What is the treatment by diagnosis and specifier for pediatric bipolar disorder?

A
  • Bipolar I w/o psychosis: Lithium
  • Bipolar I w/ psychosis: Lithium
  • Bipolar: Lithium
46
Q

How is pediatric PTSD described in pediatric psychiatry?

A
  • Very similar to adults [Reexperiencing, avoidance, hypervigilance]
  • Trauma-focused psychotherapy = 1st line
  • Pharmacotherapy: SSRIs = 1st line
47
Q

How is Child-hood onset schizophrenia described in pediatric psychiatry?

A
  • Visual hallucinations are more common than in adults
  • before 13 yo
  • Rare in kids
48
Q

Based on the DSM-5, what substances are abused?

A
  • Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Stimulants, Tobacco, Others
49
Q

How does the DSM-5 describe substance use disorder?

A
  • 2 of the following for 12 months
  • Large amounts than normal, Persistant desire, increased time spent to get substance, craving, getting in trouble, give up activities, use even tho you know its bad, tolerance, withdrawal
50
Q

What is the clinical course for substance use disorders?

A
  • late teens, early 20s
  • plan for setbacks - greatest during the 1st year
51
Q

What are the stages of alcohol withdrawal?

A
  • Stage 1: 6-8h; hyperactivity & craving alcohol
  • Stage 2: 24h; hallucinations
  • Stage 3: 1-2d; grand mal seizures
  • Stage 4: 3-5d; Delirium Tremens
52
Q

What are some of the risk factors for Delirium tremens in substance

A
  • Prior DTs - increase severity each time
  • # of detox
  • 1 pint of whiskey per day for 10 of 14 days
  • Withdrawal
  • Hepatic dysfunction
53
Q

What is the way that we treat alcohol withdrawal?

A
  • BENZO = drug of choice
  • CIWA < 8-10: Non-pharm
  • CIWA 8-15: Medicate
  • CIWA > 15: Complicated if untreated
54
Q

What is important to know about Lorazepam in alcohol withdrawal?

A
  • Can be used in liver dysfunction
55
Q

What are some of the other treatment considerations within alcohol withdrawal?

A
  • THIAMINE!
  • Carbamazepine & Valproate maybe
  • Phenytoin NOT effective
56
Q

What is the Wernicke-Korsakoff syndrome within Alcohol withdrawal?

A
  • Wernike’s Encephalopathy: Thaimine deficiency
  • Give 1000 mg Thaimine before dextrose fluids
  • Thaimine is a co-factor in glucose metabolism
57
Q

What is important to know about Disulfiram within Alcohol Withdrawal?

A
  • Blocks ADH - what metabolize alcohol
  • Causes unpleasant effects up to 14 days after D/C
58
Q

What is important to know about Acamprosate within Alcohol Withdrawal?

A
  • Abstinence Drug
  • Renal Elimination
  • BOXED WARNING: suicidality
  • Safe to use with alochol
59
Q

What is important to know about Naltrexone within alcohol withdrawal?

A
  • Decrease binge drinking
  • NEED to evaluate pain as it is a partial antagonist [Decrease pain relief from opioids]
  • Injection site reactions
60
Q

What are some ways that we treat the symptoms from Opioid withdrawal?

A
  • Muscle Aches: Tylenol or NSAIDS
  • Anxiety: Hydroxyzine or Benzo
  • N/V: Ondansetron
  • Diarrhea: Loperamide
  • Sweating: Clonidine or Lofexidine
61
Q

What Alpha-2 Agonist are used for opioid withdrawal symptoms?

A
  • Clonidine or Lofexidine
62
Q

What are some of the maintenance treatments of opioids use disorders?

A
  • Methadone: licensed treatment
  • Buprenorphine: combo with narcan
63
Q

What are the clinical pearls for Methadone in substance use disorder?

A
  • 3A4; 2B6, 2C19, 2D6
  • QTc Prolongation
64
Q

What are the clinical pearls for Buprenorphine in substance use disorder?

A
  • Give with Narcan
  • Sublingually
  • 3A4
  • Serotonin Syndrome
  • Respiratory Depression - partial agonist
65
Q

What is important to know about Buprenorphine ER injection?

A
  • Need to be on buprenorphine for 7 days before
  • Serotonin Syndrome

PHRM 845: Therapeutics III (25 decks)

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