Psychiatric Conditions: ADHD

Question 1

ADHD symptoms

Answer 1

inattention
hyperactivity
impulsivity

Question 2

Inattention criteria

Answer 2

> 6 symptoms of inattention for children up to age 16
5 symptoms for ages 17+

symptoms have to have been present for at least 6 months and are inapproaite for the developmental lvl

Question 3

Hyperactivity & impulsivity criteria

Answer 3

> 6 symptoms of hyperactivity/impulsivity for children up to age 16
5 symptoms for ages 17+

Question 4

non stimulant medications that can be used for ADHD

Answer 4

Guanfacine ER (Intuniv)
clonidine ER (Kapvay)
can be used alone or in combo with other stimulants

Atomoxetine (Strattera) can be used 1st line if abuse concern, but usually after 2-3 meds dont work

Question 5

Treatment of ADHD

Answer 5

stimulants 1st line
Non stim 2nd line (Strattera)

add-ons = Guanfacine ER, Clonidine ER

to help sleep = Clondiine IR, Benadryl, melatonin

Question 6

Boxed warnings for Stimulants meds

Answer 6

have high potential for abuse and dependence

Question 7

What can Vyvanse capsule contents be sprinkled into

Answer 7

water, orange juice and yogurt

Question 8

Stimulant Contraindications

Answer 8

Dont use within 14 days of MAOi due to risk of hypertensive crisis

CI in comorbid heart failure, recent MI, arrhythmias or moderate-severe

CI in most patients with anxiety, tension, agitation, glaucoma, hyperthyroidism and hx of Tourette’s

Question 9

Stimulant warnings

Answer 9

can inc HR/BP due to inc DA/NE
priapism can occur
new-onset psychosis or exacerbation of preexisting psychosis
inc risk of seizures
loss of appetite common
visual disturbances
risk of serotonin syndrome is inc

Question 10

Brand name Methylphenidates

Answer 10

IR = Ritalin
ER tablet = Concerta (OROS delivery)
ER capsule = Ritalin LA
Transdermal patch = Daytrana

Question 11

Methylphenidate side effects

Answer 11

Insomnia
dec appetite/weight loss
headache
irritability
N/V
blurry vision
dry mouth

Question 12

Daytrana use notes

Answer 12

apply 2hr before desired time of effect, remove after 9hrs.
alternate hips

Question 13

Dexmethylphenidate brand name

Answer 13

Focalin, Focalin XR

Question 14

Dextroamphetamine/Amphetamine brand name

Answer 14

Adderall or Adderall XR

Question 15

Lisdexamfetamine brand name

Answer 15

Vyvanse

Question 16

Atomoxetine (Strattera) boxed warnings

Answer 16

risk of suicidal ideations

Question 17

Atomoxetine (Strattera) Contraindications

Answer 17

MAOi use within past 14 days
Glaucoma
severe cardiovascular disorders

Question 18

Atomoxetine (Strattera) warnings

Answer 18

aggressive behavior
rare but severe hepatotoxicity = 120 days within starting txm
serious cardiovascular events

Question 19

Atomoxetine (Strattera) side effects

Answer 19

dec appetite
insomnia
somnolence
dry mouth
HTN
Tachycardia
Ed
dec libido

Question 20

Central Alpha-2a adrenergic receptor agonists

Answer 20

Clonidine ER (Kapvay)
Clonidine IR (Catapres)
Guanfacine ER (Intuniv)

Question 21

Central Alpha-2a adrenergic Receptor agonist warnigns

Answer 21

dose depended cardiovascular effects
sedation, drowsiness
dont dc abruptly, can have rebound HTN, have to taper

Question 22

Central Alpha-2a adrenergic Receptor agonist side effects

Answer 22

dry mouth
smnolence
fatigue
dizziness
constipation
dec HR
Hypotension

Question 23

Guanfacine drug interactions

Answer 23

double dose if used with strong CYP3A4 inducers
1/2 dose if used with strong CYP3A4 inhibitors