Pediatric ADHD/Psych Flashcards
choices for ADHD treatment
stimulants
non stimulant- atomoxetine, viloxapine
CNS acting- clonidine, guanfacine
other- bupropion
(Not SSRI)
which stimulant is more usual for initial therapy
methylphenidate
when to use IR, ER formulations
Reserve IR for very young children– due to diversion, abuse potential
ER: 8 hr products for older children, 12 hr products for teens/adults
what are some notable methylphenidate formulations
Concerta
Daytrana transdermal
Focalin, Methylin, QuiliChew, Metadate, Jornay
Quillivant ER suspension
Azstarys
what are some counseling points for the transdermal patch formulation of stimulants
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
what are some notable amphetamine formulations
dextroamphetamine short acting (4hr)
Adderall (IR, XR, ODT)
Evekeo (4hr)
Dyanavel XR
Transdermal: Xelstrym
Vyvanse
what is considered first line for a toddler with ADHD
behavioral therapy & parent training is preferred
meds only after 8-12 weeks, methylphenidate is first line
some adverse effects of stimulants
reduced appetite, weight loss, growth impairment
insomnia, sleep disturbance
stomachache
headache
rebound symptoms
irritability
uncommon: dysphoria, skin discolored, tics, priapism, hallucination
how to mitigate some of the adverse effects of stimulants
take high calorie meals at breakfast, bedtime. take meds after meals
give dose earlier in day
admin on full stomach
when do we consider switching to a stimulant alternative for ADHD
when preference for no stimulants, lack of response, intolerable side effects, or other comorbidities, diversion
key points to know for atomoxetine
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
key points to know for viloxazine
less effective than stimulants but onset 1-2 weeks and benefit by 4 weeks
who is clonidine used for
NOT adults (blood pressure)
when is guanfacine used
ADD to stimulants
1st line stimulant for teens/adults
ER amphetamine
pearls to note when using psychotropics in kids
PK: kids have a higher drug clearance so may require HIGHER dose
PD: may find differing responses, increased ADRs, suicidal ideation, disinhibition
what is the general approach to pediatric depression
CBT
antidepressants are used in severe cases: avoid TCAs and paroxetine
fluoxetine, citalopram, sertraline ok. note FDA warning for suicidal ideation in ages<24
why do we avoid benzos in kids
higher rates of disinhibition reactions in children; increased risk behaviors
what can we use for psychotic states in kids
aripiprazole, olanzapine, quetiapine, risperidone
to reduce risk of EPS. we are concerned about sedation, EPS, weight gain, hyperlipidemia, hyperglycemia
notes to know for autism spectrum disorders
we do not TREAT autism
can offer meds for ADHD, sleep, depression, anxiety, OCD, self injury/aggression
