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Flashcards in 3 - ADHD Deck (36):
1

What are the 3 hallmark symptoms?

-hyperactivity
-impulsivity
-inattention

2

When do symptoms present?

usually before age 12, can persist into adulthood

*late-onset ADHD can also occur

3

For the diagnosis of ADHD, what do the symptoms need to cause and where do they need to be present and for how long?

-need to cause interference with normal development
-present in 2 or more settings (home, school, sports, etc.)
-present for > 6 months

4

Medications are as effective as therapy, so why bother with therapy?

-Therapy provides coping methods for both child and parent/caregiver
-Gives the child tools to practise and use in the future when they potentially come off of ADHD medication

5

What are non-pharms?

-Therapy!! (very important)
-exercise
-sleep
-dietary restrictions (reduce sugars, dyes, preservatives) - this is not based on evidence but observation

6

What are the two MAIN classes of drugs for ADHD?

Stimulants:
-dextroamphetamine (Dexedrine)
-methylphenidate (Concerta, Ritalin)
-mixed salts amphetamine (Adderall)
-lisdexamfetamine (Vyvanse)

Non-stimulants:
-atomoxetine
-guanfacine
-clonidine

7

What is first line for ADHD?

stimulants

8

What are some contraindications to stimulant use?

-CV disease
-MAOi use
-History of drug abuse

9

How long should a trial of stimulants be?

3-4 week trial is reasonable

improvement in symptoms observed in the first week

reasonable to continue for 6-12 months

10

If no response at 3-4 weeks, then what?

switch stimulants

11

Can stimulants affect weight and height?

-Yes - long term stimulants may decrease height and weight
-Get a baseline measurement and then need to monitor growth every 3-6 months (dose-dependent s/e)

12

Are drug holidays a good idea?

Yes - good way to reassess need - do this for a few weeks in the summer.

13

If diversion of stimulants is suspected, what do you do?

Switch to a non-stimulant:
-Atomoxetine (Straterra)
-Guanfacine (Intuniv)

**lower abuse potential

14

Out of the stimulants, what is first line?

long-acting agents should be first line
-amphetamine, methylphenidate, lisdexamfetamine
-once daily dosing, less abuse potential

15

What is atomoxetine and who is it used for?

-NE reuptake inhibitior
-used for those > 6 yo with ADHD
-not a stimulant, not a controlled substance

16

How long do you need to treat for with atomoxetine to assess efficacy?

-6-12 weeks
-may take 3-4 weeks too see benefit

17

Contraindications to atomoxetine?

-CV problems
-narrow angle glaucoma
-MAOi use

18

List the alpha 2 agonists used for ADHD

-clonidine
-guanfacine

19

What ADHD symptoms do alpha 2 agonists help with?

-less benefit for inattention
-help with aggression, hyperactivity, impulsivity

20

Compare clonidine and guanfacine

Guanfacine has more selective neuronal activity and longer DOA, resulting in less sedation and less hypotension

21

Antidepressants role in ADHD?

2nd or 3rd line or adjunctive tx

22

What antidepressants can be used in AHDD?

-Buproprion (NDRI) - moderately effective for ADHD
-Venlafaxine (some evidence for it)
-TCAs (short term) - less effective than stimulants

23

Out of the antipsychotics, which one can be used for ADHD?

low doses of risperidone (does not help with inattention)

24

What stimulants are safe in pregnancy?

amphetamine and dextroamphetamine
*one study with 1.8 million pregnancies showed they were not associated with increase risk of congenital malformations or cardiac malformations

25

Caution which stimulant in pregnancy, especially 1st trimester?

methylphenidate (Concerta, Ritalin)

*may be associated with elevated risk of cardiac malformations

26

What are other options for ADHD in pregnancy?

TCAs, venlafaxine, bupropion
-appear to be safe
-but less effective for ADHD

27

For breastfeeding, is methylphenidate safe?

-transfer of methylphenidate into breast milk appears to be low, but effects on neurological development have not been studied
-monitor baby for agitation and poor weight gain

28

For breastfeeding, are amphetamines safe?

-they are transferred into breast milk
-but use appears to be safe, although neurological impact on the infant is also unknown
-monitor for insomnia, agitation, irritability and poor weight gain in the infant

29

Is atomoxetine safe in breastfeeding?

no studies done

30

Are alpha 2 agonists safe in breast-feeding? (clonidine and guanfacine)

-they may decrease milk production
-may cause side effects (ex. hypotension) in the infant so other options are preferred

31

Can risperidone be used in breastfeeding?

limited information about this, use other agents instead

32

Can you use TCA, bupropion or venlafaxine in breastfeeding?

yes, monitor baby for sedation, weight gain and irritability

33

Which one can be mixed in water?

Vyvanse

34

Which ones can be opened and sprinkled into soft foods?

Adderall XR
Dexedrine spansules
Vyvanse and Biphentin capsules

35

stimulants can exacerbate ___ in some individuals

tics

36

____ alone or in combination with stimulants is also effective in improving both ADHD and tic symptoms in patients with both conditions

clonidine

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