Peds

Question 0

Moa of stimulants

Answer 0

Methylphenidate - dopamine reuptake blockade with minimal effect on NE, not much peripheral effect

Amphetamines - stimulate release of NE and DA in central and peripheral
Higher dose - may stim release of 5-HT

Question 1

Antacid effect on stimulants

Answer 1

Increase absorption of MPH

Decrease excretion of amphetamines

Question 2

Atomoxetine moa

Answer 2

Inhibit reuptake of NE in the CNS

Lacking good comparative data with stimulant so 2nd line
Metabolized by 2D6 so watch out for PM’s and intxn

Question 3

ADHD medication with risk of suicidality

Answer 3

Atomoxetine

Question 4

Moa of alpha 2 agonists guanfacine and clonidine

Answer 4

Stimulate inhibitory presumptive receptors regulating NE in CNS

• may be more effective at tx hyperactive than inattentive sx

Mirtazapine may reverse effects so use another antidepressant

Question 5

Long acting forms of stimulants that provide more symptom control early in day

Answer 5

Mph-LA

Or IR formulation of MPH or Dextro

Question 6

Stimulant to help control symptoms later in the afternoon

Answer 6

Mph-OROS (concerta, like tid)

Mixed amphetamine XR (adderall XR)

Question 7

Tourette’s diagnosis

Answer 7

Based on history not test
Yale global tic severity scale - 32 items on 5 pt scale - score >30 mod-severe, 20 is minimum for inclusion in clinical trials

TSSL = Tourette’s syndrome symptom list - 29 items on 5 pt scale - 0 no sx, 1 = one tic in 45 min, 2= 1 tic per 15-44 min, 3=tic per 4-14 min, 4= per 1-4 min, 5= 1 or more per minute

Question 8

Different kinds of tics

Answer 8

Simple motor twitch, blink etc
Simple vocal- cough scream etc
Complex motor - grooming behavior etc
Complex vocal - repeat others words or phrases or their own etc

Question 9

Pandas

Answer 9

PDF autoimmune neuropsychiatric disorder associated with streptococcus

May exacerbate tics assocd with strep infxn

Question 10

Tourette’s tx

Answer 10

Most effective drugs pimozide and haloperidol
But less well tolerated
Start same dose and target!!
Haldol 0.5mg qhs up to 1mg bid max 6mg/day
Pimozide 0.5mg qhs target 1mg bid max 3mg bid

Preferred - risperidone - less eps and td
Other SGA have less evidence of efficacy prob due to lower binding to D2 receptors vs FGA and risperidone

Risperidone

Question 11

Pimozide

Answer 11

Caution with 3a4 inhibitor because inhibitor may increase risk of arrhythmias

Question 12

Odd (oppositional defiant disorder) and cd (conduct disorder)

Answer 12

Odd - more about attitudes - annoying blaming touchy spiteful
Behavior for 6 months, with at least 4 from the attitude list
Cd- repetitive incidents of violating others rights or property , lying etc- 1 in 6 months and 3 in 12 months

Child behavior check list CBCL - 118 items in 3 pt scale 
Under 60 normal
60-63 borderline
Over 63 clinical significant 
Also cprs/ctrs/Iowa

Question 13

Retts disorder

Answer 13

Microcephaly

Question 14

Down syndrome

Answer 14

Small head
flat face
Small ears and mouth
Epicanthal folds

Question 15

Fragile X syndrome

Answer 15

Long thin face
Attention difficulties
Large ears
Recurrent otitis media

Question 16

Prader-Willi syndrome

Answer 16

Short stature
Small hands and feet
Strabismus

Question 17

CBCL

Child behavior check lost

Answer 17

Provides into on variety of child behavior problems
Parent reported used alkkg with teacher and student report
118 items on 3 pt scale
Measures internalizing and externalizeing behaviors
t score < 60 normal, 60-63 borderline, > 63 clinical range

Question 18

Meds with effectiveness for sx in CD and ODD (precursors of antisocial personality disorder)

Answer 18

Stimulants

Question 19

Meds to tx symptoms in developmental disorders

Answer 19

Antipsychotics for irritability and aggression