ADHD Flashcards
prevalence
- 6-12% school age children worldwide
- 5% adults
- boys roughly 3x more often than girls
- girls - more inattention, boys more hyperactivity and impulsivity
- hyperactivity less prominent in adolescence and adulthood - 4.4% adults
tx of ADHD
- effective tx modulates DA and NE function - increases DA and NE
- stimulants (amphetamine, dextroamphetamine, methylphenidate), non-stimulants (atomoxetine, guanfacine, clonidine), and other agents (bupropion, TCAs)
- behavioral intervention
diagnosis of ADHD
- must be present before age 12
- 6 or more sxs occur often and at frequency inconsistent for age
- for >17 yo must have 5 or more sxs
- sx present in two or more settings
- significant impairment in quality of social, school, or work functioning
- sx for at least 6 mos
- documented by parent, teacher, and clinician
Methylphenidate MOA and indications
Ritalin
MOA: blocks reuptake of NE and DA
-CNS stimulant medication
-not FDA approved for children <6 yo
-can also be used for narcolepsy, fatigue, and traumatic brain injury
-90% renal clearance
-black box warning - severe depression upon withdrawal, avoid abrupt discontinuation
methylphenidate adverse effects
- decreased appetite, weight loss, stomach ache, insomnia, irritability, anxiety, growth retardation
- uncommon/rare: dysphoria, tics, hypertension, hallucinations, nightmares
methylphenidate drug-drug interactions
- moderate: TCAs, carbamazepine
- methylphenidate causes increased phenobarbital, phenytoin, warfarin levels
- contraindicated with MAOIs (hypertensive crisis, MAOI must be discontinued for at least 14 days)
dextroamphetamine/amphetamine and lisdexamfetamine
Adderall
- not FDA approved for children <3 yrs
- black box warning
- MOA: releases NE from storage vesicles in nerve teminals and blocks NE reuptake
- other indications = narcolepsy
- same adverse effects as methylphenidate
dextroamphetamine/amphetamine DDIs
- moderate: TCAs, sodium bicarbonate
- major: citalopram, venlafaxine
- contraindicated: MAOIs (hypertensive crisis)
atomoxetine MOA
- not for children <6yrs
- black box
- MOA: selective NE reuptake inhibitor - increase DA; NO ADDICTIVE QUALITIES
- less effective than psychostimulants
- considered for pts with anxiety, insomnia, substance abuse
- other indications: bed wetting
atomoxetine DDIs
- moderate: CYP 2D6 inhibitors (i.e. TCAs, fluoxetine, paroxetine)
- major: atomoxetine potentiates increase in BP/HR with albuterol
- contraindicated: MAOIs (risk of serotonin syndrome)
adverse effects of atomoxetine
increased BP, HR, rash, weight loss, constipation, N/V, dissiness, ED, decreased libido
Guanfacine
MOA: selective alpha 2A receptor agonist - less SEs
- alternative for children intolerant to stimulants or add-on to stimulant
- ADE: somnolence, dizzines, HA, low BP, xerostomia, constipation
Clonidine
MOA: non-selective binds to Alpha 2A, TB, and 2C receptors
- alternative for children intolerant to amphetamines (children with tics); or add-on if inadequate response with stimulants
- ADEs: sedation, hypotension (may be less with ER)
behavioral interventions
positive reinforcement, time-out, response cost, token economy
1st line therapy for ADHD
stimulant medications (methylphenidate and dextroamphetamine)
