Summer E1 Neuro ADHD

Question 1

Pathophys of ADHD

Answer 1

Dysfx of NE, DA.. a disorder of self regulation or response inhibition

Question 2

ADHD

Med classes and Meds

Answer 2

Stimulants (DOC 6+yo, 70-90% respond)“-phenidate, amphetamines”

(Dex-)Methylphenidate, Dextroamphetamine-amphetamine(/amphetamine salts), Lisdexamfetamine

Nonstimulants (ABCG) Atomoxetine (#2 DOC), Bupropion, Clonidine, Guanfacine

Question 3

Stimulants

• MOA*
• Onset*
• Dosing*

Answer 3

• Block reuptake of DA, NE*
• Quick onset* 30 min+
• Start low*, titrate up to sx/AEs
• 3 mo trial*.. if no response, try other stim / consider other dx

Question 4

Stimulants

AE

Answer 4

Substance Abuse

Headache

Insomnia

Agitation, irritability, dyphoria

Tics

Growth suppression/delay

GI upset (PO, take 30-60 min before breakfast/ △dosing/LA)

Rebound sx with Short acting

Question 5

Stimulants

• Contraindications*
• Cautions*

Answer 5

CONTRA: Glaucoma

Severe HTN, CV disease

Anxiety

Hyperthyroid

Hx illicit drug / stim abuse (**Controlled substance)

CAUTION: Tics, Tourettes, Seizure

Question 6

Atomoxetine

• MOA*
• AE*
• Benefit*

Answer 6

• MOA* Selectively inhibits reuptake of NE, other NTs (sim to stim)
• AE* sim to stim
• Benefit* No abuse potential, not a controlled substance

Question 7

Atomoxetine

Interactions

Answer 7

CYP2D6 Interactions - Fluoxetine, Paroxetine

Question 8

Bupropion

• Uses*
• Contraindications*
• AE*

Answer 8

ADHD, Anti-depressant (NDRI), Smoking Cessation (Wellbutrin)

Contra** ****Seizure****, Eating disorders/**Bulimia

AE Activation of CNS (benefit for ADHD),

stimulant AEs (tachycardia, decr appetite, anxiety, tremors, nightmares)

Question 9

Clondidine, Guanfacine

MOA

Answer 9

Central α2 agonist, inhibit NE release presynaptically

Question 10

ADHD

Monitoring

Answer 10

Consult family/teachers - behaviors/learning

F/u q2-4 wks - efficacy, BP

later q3mo.. monitor ht/wt, AEs

Standardized rating scales