Pediatric ADHD/Psych

Question 1

choices for ADHD treatment

Answer 1

stimulants
non stimulant- atomoxetine, viloxapine
CNS acting- clonidine, guanfacine
other- bupropion
(Not SSRI)

Question 2

which stimulant is more usual for initial therapy

Answer 2

methylphenidate

Question 3

when to use IR, ER formulations

Answer 3

Reserve IR for very young children– due to diversion, abuse potential

ER: 8 hr products for older children, 12 hr products for teens/adults

Question 4

what are some notable methylphenidate formulations

Answer 4

Concerta
Daytrana transdermal
Focalin, Methylin, QuiliChew, Metadate, Jornay
Quillivant ER suspension
Azstarys

Question 5

what are some counseling points for the transdermal patch formulation of stimulants

Answer 5

apply 2 hours before expected effects
remove after 9 hours, but can remove earlier as effects can last another 2 hours (especially for those with insomnia)

also can cause mild skin reactions, bleaching

Question 6

what are some notable amphetamine formulations

Answer 6

dextroamphetamine short acting (4hr)
Adderall (IR, XR, ODT)
Evekeo (4hr)
Dyanavel XR
Transdermal: Xelstrym
Vyvanse

Question 7

what is considered first line for a toddler with ADHD

Answer 7

behavioral therapy & parent training is preferred

meds only after 8-12 weeks, methylphenidate is first line

Question 8

some adverse effects of stimulants

Answer 8

reduced appetite, weight loss, growth impairment
insomnia, sleep disturbance
stomachache
headache
rebound symptoms
irritability

uncommon: dysphoria, skin discolored, tics, priapism, hallucination

Question 9

how to mitigate some of the adverse effects of stimulants

Answer 9

take high calorie meals at breakfast, bedtime. take meds after meals
give dose earlier in day
admin on full stomach

Question 10

when do we consider switching to a stimulant alternative for ADHD

Answer 10

when preference for no stimulants, lack of response, intolerable side effects, or other comorbidities, diversion

Question 11

key points to know for atomoxetine

Answer 11

response delayed 4-6 weeks
drug interactions with CYP2D6 (fluoxetine, paroxetine)
less efficacious than stimulants
concerning risk of suicidal ideation
assess for CV disease– stroke, MI

Question 12

key points to know for viloxazine

Answer 12

less effective than stimulants but onset 1-2 weeks and benefit by 4 weeks

Question 13

who is clonidine used for

Answer 13

NOT adults (blood pressure)

Question 14

when is guanfacine used

Answer 14

ADD to stimulants

Question 15

1st line stimulant for teens/adults

Answer 15

ER amphetamine

Question 16

pearls to note when using psychotropics in kids

Answer 16

PK: kids have a higher drug clearance so may require HIGHER dose
PD: may find differing responses, increased ADRs, suicidal ideation, disinhibition

Question 17

what is the general approach to pediatric depression

Answer 17

CBT
antidepressants are used in severe cases: avoid TCAs and paroxetine

fluoxetine, citalopram, sertraline ok. note FDA warning for suicidal ideation in ages<24

Question 18

why do we avoid benzos in kids

Answer 18

higher rates of disinhibition reactions in children; increased risk behaviors

Question 19

what can we use for psychotic states in kids

Answer 19

aripiprazole, olanzapine, quetiapine, risperidone

to reduce risk of EPS. we are concerned about sedation, EPS, weight gain, hyperlipidemia, hyperglycemia

Question 20

notes to know for autism spectrum disorders

Answer 20

we do not TREAT autism
can offer meds for ADHD, sleep, depression, anxiety, OCD, self injury/aggression