Pediatric Drug Dosing and ADHD Medication Lecture PDFs

Question 1

Most common neurobehavioral disorder of childhood, who is more often diagnosed? (males or females)

Answer 1

ADHD, boys more than girls

Question 2

Some disorders mistaken for ADHD leading to increased diagnosis prevalence over the past years (4)

Answer 2

• opositional defiant disorder
• autism spectrum disorder
• intellectual disability
• anxiety and depression or bipolar

Question 3

ADHD etiology (4) and what is it NOT due to?

Answer 3

• Unknown, multiple factors
• genetics
• perinatal stress
• maternal smoking and alcohol use

-NOT due to low intelligence, poor parenting, or too much dietary sugar

Question 4

ADHD 3 hallmark symptoms

Answer 4

-inattention
-hyperactivity
-impulsivity
(subtypes domoinant in any of these or combined)

Question 5

ADHD diagnosis (3)

Answer 5

• Clinical/DSM5 diagnosis
• info from parents
• Neuropsychiagric EEG based assessment aid (NEBA) can assist

Question 6

Why is ADHD more often diagnosed in males than females?

Answer 6

Males are more likely to have the hyperactivity/impulsivity while females are more often inattentive type

Question 7

Untreated ADHD that continues into adulthood increases risk of…

Answer 7

…poor psychological development, substance abuse, unstable relationships, and accidents

Question 8

ADHD treatment principles (5)

Answer 8

• education for patient and caretaker
• plan for long term management
• identification of target outcomes
• medication and or behavior therapy
• followup

Question 9

Behavior therapy for ADHD

Answer 9

1st line for treatment of preschool age children with ADHD and strongly recommended in all groups, attempts to alter physical and social environment so it is easier for child to control behavior (school intervention and getting involved in sports!)

Question 10

Adult 1st line treatment for ADHD therapy

Answer 10

Amphetamines (greater effectiveness and equal tolerability compared to other ADHD meds over the short term) followed by regular followups to determine duration of therapy and re-evaluate

Question 11

Stimulant use for ADHD mech of action

Answer 11

• Help remove the disruptive behavior by improving attention and focus, not creating posiitive behavior but rather reducing negative
• blockage of reuptake of NE and dopamine or inhibition of MAO depending on agent (different classes use diff mechanisms so lack of response in one class does not preclude response to another class)

Question 12

Stimulant use for ADHD in children 3-5 years

Answer 12

Not recommended as may have deleterious effects on brain development

Question 13

Stimulant dosing (3)

Answer 13

• Started low and titrated upward to lead to optimal effects with minimal side effects
• Extended release helpful for students in school
• drug holidays required at least once a year

Question 14

Stimulant ADR’s (7)

Answer 14

• NVD
• Insomnia
• rebound inattention
• motor or vocal tics
• effects on growth maybe
• cardiotoxicity
• psychaitricc effects including psychosis and depression

Question 15

Stimulant drug interactions (2)

Answer 15

• MAOI’s coconcurrently can result in hypertensive crisis

- SSRI concurrent use may increase risk of serotonin syndrome

Question 16

Methylphenidate (ritalin, concerta) function

Answer 16

Most common stimulant drug employed and best tolerated for treatment of ADHD

Question 17

Concerta uses a non deformable capsule which uses an oral osmotic controlled release delivery system. Why?

Answer 17

Cannot be crushed and snorted because onset is delayed and duration is 10-12 hours, this prevents abuse

Question 18

Transdermal methylphenidate (daytrana) function

Answer 18

Same as methylphenidate oral but delay 2 hours making it diadvantage in the AM particularly when kids are getting ready for school

Question 19

amphetamines (adenys) function

Answer 19

As effective as methylphenidate at treating symptoms of ADHD, some responnd better to this,

Question 20

Dextroamphetamine and amphetamine salts (adderall) function

Answer 20

Comparable to methylphenidate but twice as potent, longer effect can lead to greater insomnia and appetite suppression

Question 21

Atomxetine (strattera) function

Answer 21

Unique drug approved for ADHD treatment in adults in children, only drug approved for ADHD in adults, no potential for abuse and thus not controlled substance, slower long term changes (a week or more to onset)

Question 22

Methyphenidate, amphetamine, dextroamphetamine and amphetamine salts ADR’s

Answer 22

• N/V/D
• sexual dysfunction in adults
• priapism rarely

Question 23

Clonidine and guanfacine (catapres, tenex respectively) function

Answer 23

Central a2 agonist traditinonally useful for hypertension but also for behavioral management, tic disorders, or insomnia (and 2nd line for ADHD) with low risk of abuse potential

Question 24

Clonidine and guanfacine ADR’s

Answer 24

• sedation

- dizziness

Question 25

Buproprion (welbutrin) function

Answer 25

Monocyclic antidepressant, weak dopa and norepi reuptake inhibitor, can be used off label for treatment of ADHD in adolescents and adults, can reduce behavioral symtpoms although less effective than stimulants, but may be used in patients with depression and ADHD

Question 26

Buproprion (welbutrin) ADR’s (4)

Answer 26

• eating disorder contraindication
• exacerbation of tics
• insomnia
• electrolyte disorders

Question 27

Pediatrics and elderly respond to drugs differently because of…

Answer 27

…more sensitive due to organ system immaturity or degeneration, drug effects are usually more intense or prolonged in both as a result

Question 28

Even when accounting for weight differences, infant response to drugs differs from adult seeing much higher…

Answer 28

….plasma drug conc

Question 29

Absorption oral in children

Answer 29

-variable due to irregular gastric emptying as well as low acidity 24 hours after birth

Question 30

Absorption IM in children

Answer 30

-slow and erratic, due to low blood flow thru muscle during first days of postnatal life, by early infancy, becomes more rapid than neonates and adults

Question 31

Absorption percutaneous in children

Answer 31

-because skin at young age is thin, it is greater in infants than older children and adults increasing toxicity

Question 32

Abosrption binding protein in children

Answer 32

-binding to albumin and other plasma proteins is limited in infant because of relatively low endogenous compounds, increasing plasma concentration

Question 33

Drugs that can pass the BBB require special precaution in ___

Answer 33

infants - not fully developed at birth

Question 34

Hepatic excretion in children

Answer 34

Decreased ability to metabolize many drugs at birth resulting in slow clearance rates and prolonged elimination half lives, at one year do metabolize certain drugs (depending on the enzyme that digests it) faster than adults until age of 2 then gradually declines

Question 35

Renal excretion in children

Answer 35

Significantly reduced at birth, renal blood flow and glomerular filtration all low during infancy, must give drugs at reduced dosage, adult levels of functions achieved by 1 year. Sensitivity over age 1 is more like that of adults,

Question 36

Age related drug ADR’s (3)

Answer 36

• growth suppression
• discoloration of developing teeth
• kernicterus

Question 37

Pediatric dosing approximation when not available on package insert

Answer 37

Based on age, weight, and surface area

Question 38

Pediatric dose should NEVER exceed…

Answer 38

…adult dose