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Neuro Quiz 8 > Treatment of ADHD > Flashcards

Treatment of ADHD Flashcards

1
Q

DSM5 for ADHA

A

A. Onset of symptoms were present before age 12
B. Inattention symptoms (6 or more symptoms must be present for 6 months. At least 5 symptoms must be present for those 17 years or older)
C. Hyperactivity and Impulsivity symptoms (6 or more symptoms must be present for 6 months. At least 5 symptoms must be present for those 17 years or older)
D. Significant impairment must be seen in two or more settings
E. Symptoms must be documented by parent, teacher, and clinician

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2
Q

Non-Pharm Treatment

A

Behavioral Therapy (BT)
Divide work/school into manageable segments
Individualized educational program qualification
Organizer
Recognize triggers for distractions
Regular daily schedule with exercise and relaxation

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3
Q

Positive Reinforcement BT

A

child receives an award (e.g. more free time) when good behavior happens

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4
Q

Time-out BT

A

Child required to spend time alone in an area without things to do for negative behavior

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5
Q

Response cost BT

A

child loses free-time privileges for bad behavior

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6
Q

Token economy BT

A

child earns stars for good behavior, loses stars for negative behavior then cashes in the sum of stars at the end of the week for a prize

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7
Q

Children ADHD Treatment

A

1st Line Age 4-5: BT only
1st Line Age 6-18: Stimulants (long acting and use another chemical class if it fails)
2nd Line Age 4-5: Methylphenidate product
2nd Line Age 6-18: Atomoxetine, guanfacine ER or clonidine XR
If partial response received with stimulant then keep the stimulant and add another agent

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8
Q

Adult ADHD Treatment

A

Stimulant first line

Non-stimulant if patient has a history of substance abuse, uncontrolled HTN, cardiac disease or anxiety disorder

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9
Q

Methylphenidate Long Acting Products

A 
Metadate CR
Ritalin LA
Concerta
Daytrana (patch)
Quillivant XR
8-12 hours QD
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10
Q

Dexmethylphenidate Product

A

Foxalin XR

8-12 hours QD

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11
Q

Lisdexamphetamine Long Acting Product

A

Vyvanse

12 hours

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12
Q

Mixed Amphetamine Long Acting

A

Adderall XR

8-12 hours QD

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13
Q

Short acting Methylphenidate Duration

A

3-5 hours BID or TID

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14
Q

Intermediate acting Methylphenidate Duration

A

3-8 hours

QD or BID

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15
Q

Short Acting Dextroamphetamine Duration

A

3-5 hours BID

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16
Q

Intermidate Acting Dextroamphetamine Duration

A

5-8 hours QD or BID

17
Q

Short Acting Mixed amphetamine Duration

A

4-6 hours QD or BID

18
Q

Daytrana Patch

A

Provides 12 hours of symptom control when worn for 9 hours
Onset is 2 hours
Apply patch to hip and alternate

19
Q

Extended Release Capsules

A 
Ritalin LA
Metadate CD
Focalin XR
Adderall XR
Can be open and sprinkled on soft food
20
Q

Stimulant Side Effects

A 
Reduced Appetite/Weight loss
Insomnia
GI Upset
Headache
Irritability/Jitteriness
Rebound symptoms
Tics/Abnormal movements
21
Q

Reduce Appetite/Weight loss management

A

Eat high calorie meals when teh stimulant effects are low

22
Q

Insomnia management

A

Take last dose earlier in the day

23
Q

GI Upset management

A

Take meds with food

24
Q

Headache management

A

Divide dose, lower the dose, switch to long acting

25
Q

Irritability/Jitteriness management

A

Reduce dose

26
Q

Rebound symptoms management

A

Overlap stimulant dosing; change to long acting

27
Q

Tic/abnormal movements management

A

Reduce the dose or consider a non-stimulant

28
Q

Nonstimulant Options

A

Atomoxetine (Strattera)

Central Alpha 2 Agonists (guafacine ER and clonidine XR)

29
Q

Atomoxetine

A

Strattera
No abuse potential
SLower onset (2-4 weeks)
2D6 metabolism

30
Q

Central Alpha 2 Agonists

A

Clonidine and guanfacin
Not as affective
Adjuncts for partial response to stimulants, help with aggression and improve sleep

31
Q

Clonidine

A

Lots of hypotension and sedation due to imidazoline receptor binding

32
Q

Guanfacine

A

Selective for 2A so less hypotension and sedation

Neuro Quiz 8 (4 decks)

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