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ADD/ADHD Flashcards

(58 cards)

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1
Q

ADD/ADHD

A

All 5 must be present
Persistent pattern of inattention and/or hyperactivity/impulsivity
Several inattentive or hyperactive/impulsive sx were present prior to 12 years of age
Several inattentive or hyperactive/impulsive sx are present in >/= 2 settings (home, school, work)
Clear evidence that sx interfere with daily functioning (academic, occupational, social)
Sx do NOT occur during course of other psychotic disorders

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2
Q

Criteria for persistent pattern of inattention

A

> /= 6 sx for at least 6 months
Fails to give close attention to details or makes careless mistakes
Difficulty sustaining attention in tasks or play
Often does not seem to listen when spoken to directly
Often does not follow through on instructions failing to finish work
Difficulty organizing tasks and activities
Often avoids, dislikes, or is reluctant to engage in tasks requiring sustaining mental effort
Often loses things necessary for tasks or activities
Often easily distracted by extraneous stimuli
Often forgetful in daily activities

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3
Q

Criteria for persistent pattern of hyperactivity/impulsivity

A

> /= 6 sx for at least 6 months
Often fidgets tapping hands and feet or squirming
Often leaves seat when remaining seated is expected
Often runs or climbs in inappropriate situations
Often unable to play or engage in leisure activities quietly
Often on the go or driven by a motor
Often talks excessibely
Often blurts out answer prior to question completion
Often interrupts or intrudes on others

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4
Q

ADD/ADHD environmental triggers

A

Lead exposure
Low birth weight (< 1.5 kg)
Severe social deprivation as infant
Smoking during pregnancy

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5
Q

ADD/ADHD food triggers

A

Chocolate
Eggs
Peanuts

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6
Q

ADD/ADHD artificial dyes

A

Blue #1
Red #3
Yellow #5

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7
Q

ADD/ADHD pathophysiology

A

Decreased cerebral volume

Dysregulation of neurotransmitters

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8
Q

Decreased cerebral volume

A

Caudate nucleus
Cerbellar vermis
Prefrontal cortex (controls appropriate behaviors and inhibitions)

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9
Q

Dysregulation of neurotransmitters

A

DA (executive function, serial learning, sustaining attention, verbal fluency)
NE (mediating energy/fatigue, moderation of behavior based on social cues, motivation, sustaining attention)

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10
Q

Diet modifications for ADD/ADHD

A

Elimination diets (hyperactivity)
Increased essential fatty acids (inattention)
Vitamins and herbs

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11
Q

Essential fatty acids

A

EPA
DHA
Linolenic acid

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12
Q

Vitamins and herbs

A 
Attention related (gingko bilboa, ginseng)
Hyperactivity related (lemon balm, valerian root, zinc)
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13
Q

Simulants MOA

A

Increased NE and DA thru reuptake inhibitors

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14
Q

Stimulants ADR

A 
Appetite reduction
Dizziness
HA
Insomnia
Irritability
Nausea
Stomach pains
Weight loss
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15
Q

Stimulant administration considerations

A

< 16 kg: short acting
Sx only at school: short acting
Longer acting: Onset w/in 1 hour
High fatty meals: reduce absorption

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16
Q

Amphetamine based stimulants MOA

A

Increased release of DA through exchange mechanism by binding to DA transporter proteins inhibiting reuptake

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17
Q

Amphetamine metabolism

A

2D6

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18
Q

Amphetamine advantages

A

Predictable kinetics

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19
Q

Amphetamine disadvantages

A

Greater abuse potential
Greater growth suppression
Higher rates of worsening tics

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20
Q

Short acting amphet

A

Dexedrine

Dextrostat

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21
Q

Intermediate acting amphet

A

Adderall

Dexedrine spanules*

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22
Q

Long acting amphet

A

Adderall XR*

Vyvanse*

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23
Q

Methylphenidate MOA

A

Occupies DA and NE transporters inhibiting reuptake

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24
Q

Methylphenidate metabolism

Study These Flashcards
A

de-esterification

25
Methylphenidate advantages
Decreased appetite suppression Less likely to worsen tics Lessens risk of insomnia
26
Methylphenidate disadvantages
Erratic kinetics | Greater differences between brand and generic products
27
short acting methyl
Focalin Methylin Ritalin
28
Intermediate acting methyl
Metadate ER Methylin ER Methylphenidate SR Ritalin SR
29
Long acting methyl
``` Concerta (will see capsule in poop) Daytrana Focalin XR* Metadate CD* Ritalin LA* ```
30
ADD/ADHD non-stimulants
Alpha-2 agonists Atomoxetine Bupropion TCAs
31
Alpha-2 agonist metabolism
3A4
32
Alpha-2 agonist elimination
50/50 | Hepatic/renal
33
Alpha-2 agonist ADR
Fatigue HA Somnolence
34
Alpha-2 agonists
Clonidine | Guanfacine
35
Clonidine IR dosing
q6-12h 0.05 mg/d Titrated weekly by 0.05 mg/d Target 0.1-0.4 mg/d
36
Clonidine ER dosing
q12h 0.1 mg/d Titrated weekly by 0.1 mg/d Target 0.2-0.4 mg/d
37
Clonidine administration considerations
Food does not impact absorption Patch duration of therapy Children = 5 days Adolescents = 7 days
38
Guanfacine dosing
1 mg/d Titrated weekly by 1 mg/d Target 2-4 mg/d
39
Guanfacine administration considerations
ER: avoid high fatty meals IR: can be crushed
40
Atomoxetine approval
ADHD
41
Atomoxetine time to effect
6 weeks
42
Atomoxetine MOA
Selectively inhibits reuptake of NE
43
Atomoxetine dosing
Initiation: 0.5 mg/kg/d Titration: 1-2 mg/kg/d; start 1-2 weeks after initiation
44
Atomoxetine metabolism
2D6 | Highly protein bound
45
Atomoxetine ADR
Dizziness Fatigue Somnolence
46
Atomoxetine administration considerations
Capsule form only | May dissolve in 60 ml of juice
47
Atomoxetine place in therapy
After failing stimulants
48
Buproprion and ADHD
Off-label use
49
Bupropion time to effect
6 weeks
50
Bupropion MOA
Inhibits reuptake of NE and DA
51
Bupropion dosing
``` Initiation: 1.5 mg/kg/d Titration: -3 mg/kg/d -6 mg/kg/d or 300 mg max Over 7 days ```
52
Bupropion ADR
Insomnia Irritability Nausea
53
Bupropion CI
Seizure pts and eating disorders
54
Bupropion place in therapy
After failure of 1st and 2nd line options | Depression
55
TCA time to effect
4 weeks
56
TCA MOA
Inhibits reuptake of NE and serotonin
57
TCA ADR
Constipation Dizziness Sedation Weight gain
58
TCA place in therapy
3rd line

Pediatrics (9 decks)

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