ADHD Flashcards
(156 cards)
1
Q
Demographics of ADHD
A
more common in males, white children and adolescents
2
Q
ADHD is more common in people who…
A
have a first degree diagnosed relative
3
Q
ADHD is multifactorial, true or false
A
true
4
Q
What three factors feed into the diagnosis of ADHD
A
environmental, genetics, and physiological
5
Q
50% of children with a parent diagnosed with ADHD will also have ADHD
A
true
6
Q
median age of ADHD diagnosis
A
6 years old
7
Q
in preschool, ADHD manifests as what
A
hyperactivity
8
Q
in elementary school, ADHD manifests as what
A
inattentiveness
9
Q
/ children with ADHD will have the diagnosis in adulthood
A
1/3
10
Q
what are the comorbid conditions of ADHD
A
bipolar disorder (10%), mild tic (8-11%), AND there’s an increased risk of substance use and antisocial personality disorder
11
Q
What could happen if ADHD is left untreated
A
substance use and antisocial personality disorder
12
Q
four impacts of ADHD
A
poor academic performance, low self esteem, poor relationships, and employment difficulties
13
Q
how many symptoms in each domain must be present in order to diagnose with ADHD
A
at least 6 symptoms in each domain
14
Q
Adult ADHD diagnosis criteria
A
at least 5 symptoms are required for either of the two domains
15
Q
True or false, several inattentive or hyperactive symptoms must be present prior to age 18 to be diagnosed with ADHD
A
false, prior to age 12
16
Q
True or false, in order to be diagnosed with ADHD, several inattentive or hyperactive impulse symptoms are present in 3 or more settings
A
false, 2 or more settings
17
Q
What cultural populations have less ADHD diagnoses than white children
A
black and latinx children
18
Q
what are the two diagnostic domains for ADHD
A
hyperactivity and inattention
19
Q
what are the 9 symptoms in the inattention domain
A
careless mistakes
difficult sustaining attention
doesn’t seem to listen
fails to finish tasks
difficulty organizing tasks
avoids things that require a lot of mental effort
loses things
easily distracted
forgetful in daily activities
20
Q
9 Hyperactivity symptoms
A
fidgets
leaves seat a lot
runs and climbs
cannot play quietly
on the go
talks excessively
blurts out answers
difficult waiting turn
interrupts
21
Q
what category of drugs is used for ADHD
A
stimulants usually, some non-stimulants
22
Q
what kinds of drugs are stimulants
A
amphetamines or methylphenidates
23
Q
what are 9 non-stimulants used for ADHD
A
atomextine, Viloxazine, Clonidine ER, Guanfacine ER, atypical antipsychotics, Bupropion, Imipramine, Modafinil, and mood stabilizers
24
Q
What does RAS stand for
A
reticular activating system
25
Which gender is more likely to be diagnosed with ADHD
males`
26
Are adults or children more likely to be diagnosed with ADHD
children, adult rates 3-5%
27
Current trend of ADHD diagnosis
exponentially increasing
28
What are the top two causes of ADHD on the pie chart in the slides
Low body weight and heritable (genetics)
29
What is the main neurotransmitter implicated in ADHD
dopamine transporter
30
What 6 systems are implicated in ADHD
Dopamine transporter, COMT, cholinergic receptors, cholesterol metabolism, CNS development, glutamate receptors
31
ADHD causes reduced brain volume in certain areas, T/F
True
32
What is a metabolic change that happens in adults with ADHD
decreased cerebral glucose metabolism
33
What is a key clinical presentation of ADHD
symptoms must interfere with functioning and development
34
where is the circuity mechanism in the brain
medial prefrontal cortex
35
what is the name of stimulant compounds that mimic the effect of endogenous agonists of the sympathetic nervous system
methylxanthines (indirect-acting sympathomimetics
36
what is an example of a methyxanthine
caffeine
37
what receptor is antagonized by methylxanthines
adenosine receptors
38
are methylxanthines antagonists or agonists
antagonists
39
what is the result of methylxanthines on cAMP
increase cAMP, inhibit phosphodiesterases
40
what is the result of methylxanthines on ryanodime receptors
increase activity which increases intracellular ca2+
41
is adenosine receptor 1 (a1A) usually inhibitory or stimulatory on neurotransmitters
inhibitory linked
42
what receptor type is usually located in the cerebral cortex, hippocampus, cerebellum, thalamus, brain stem, and spinal cord
adenosine receptors
43
three effects that result from activation of adenosine receptors in the CNS
sedation, anxiolysis, anticonvulsant activity
44
one effect that result from peripheral activation of adenosine receptors
decrease heart rate
45
is A2A receptor usually inhibitory or stimulatory
stimulatory
46
what is A2A receptor responsible for
vasodilation
47
Where are A2B receptors located
glial cells
48
when are A3 receptors (4)
during excessive metabolism, seizures, hypoglycemia, stroke
49
How well do methylxanthines work on A3 receptors
not antagonized by methylxanthines
50
four common results of methylxanthines (7)
arousal, increased alertness, decreased fatigue, nervousness, insomnia, vasoconstriction, diuretic
51
What does VMAT stand for
vesicular monoamine transporter
52
what are the pathways called that are involved in abuse and addiction
reward pathways
53
what three neurotransmitters are examples of monoamine transporters
dopamine, norepinephrine, serotonin
54
what is one use of cocaine
local anesthetic
55
what are two examples of indirect-acting sympathomimetics
cocaine and amphetamines
56
what neurotransmitters does cocaine inhibit (3)
dopamine, norepinephrine, 5HT (serotonin)
57
why are amphetamines abused
they are highly rewarding
58
what are the effects of amphetamines (3)
increased ability to concentrate, wakefulness, alertness
59
are amphetamines selective or non-selective activators of monoamines
non-selective
60
What receptor is MDMA more selective for
5-HT (serotonin)
61
what is psychedelic revival associated with
MDMA (ecstasy, molly, love drug)
62
4 examples of amphetamines
dextroamphetamine, lisdexamfetamine, amphetamine, methamphetamine
63
What is unique about mydayis
mixture of amphetamine salts
64
two other uses for amphetamines besides ADHD
narcolepsy and weight loss
65
is adderall pure or a mix of salts
mix of salts
66
what does atomoxetine do
norepinephrine transporter NET reuptake inhibitor
67
is atomoxetine for adults or children
adults only
68
whats the brand name of atomoxetine
strattera
69
what ADHD drug is also approved for narcolepsy
modafinil
70
What two transporters are inhibited by solriamfetol (sunosi)
NET and DAT
71
What does TONES stand for and what drug is associated with it
Treatment of Obstructive sleep apnea and Narcolepsy Excessive Sleepiness with solriamfetol
72
can stimulants be used for narcolepsy
yes
73
can antidepressants be used for narcolepsy
yes
74
can anxiolytics be used for narcolepsy
no
75
what receptor does pitolisant act on
histamine 3 receptor antagonist/inverse agonist
76
do stimulants stimulate the reuptake of neurotransmitters
NOOOOOO they inhibit the reuptake of neurotransmitters
77
What two things do stimulants inhibit
NET and DAT, which inhibit the reuptake of norepinephrine and dopamine which increases the amount in the synapse
78
do stimulants cause the release of neurotransmitters from the presynaptic terminal
YEAH
79
stimulants do what to monoamine oxidase
INHIBIT
80
atomoxetine and viloxazine mechanism of action
selective inhibition of norepinephrine reuptake
81
guanfacine and clonidine mechanism of action
selective a2a agonist
82
how quickly can we see the result of stimulants
short period of time, can adjust dose over a short period of time
83
when should dose of stimulant be given
morning, avoid giving at night
84
how many times a day are IR doses given (recommended)
twice a day at least
85
True or false, pediatric patients should have their stimulant dose calculated based off of weight and height
false, not found to be impactful
86
What kind of dose is preferred for patients under 16kg
IR because limited low-dose availability of long-acting stimulants
87
you can use two different stimulants
false, keep it the same
88
you can use two different dosage forms of stimulants
true
89
how should the dose be adjusted if a patient experiences late afternoon symptoms
change to ER formulation
90
what age is mydayis 12.5 mg recommended for
13-17
91
What is the dose of mydayis for adults
25mg/day
92
what is the dosage form of daytrana (methylphenidate)
patch
93
what are the directions for daytrana
apply patch to outside of hip 2 hours prior to needed effects, remove after 9 hours and alternate hip daily
94
daytrana is beneficial only for...
patients who already respond to methylphenidate
95
what is the only patch form of stimulant
daytrana
96
what is the brand name of lisdexamfetamine
vyvanse
97
what should you know about vyvanse (lisdexamfetamine)
its a prodrug that is converted to dextroamphetamine
98
lisdexamphetamine should only be used if the patient responds to
dextroamphetamine
99
what is a counseling point of Jornay PM
take dose in the evening between 6:30PM and 9:30pm
100
what is the brand name of methylphenidate hydrochloride
Jornay PM
101
What are the adverse effects of stimulants (11)
appetite lose
abdominal pain
headaches
sleep disturbances
decreased growth
hallucinations
increased BP
Increased HR
sudden cardiac death
priapism
raynauds
102
How to manage reduced appetite and weight loss
eat high calorie meals when stimulant effects are low (breakfast or dinner)
103
how to manage stomach ache
take on full stomach, lower dose if possible
104
how to manage insomnia
dose earlier in the day, lower dose, consider sedating med at bedtime
105
how to manage headache
divide dose, give with food, give analgesic
106
how to manage rebound symptoms
longer-acting stimulant trial, atomoxetine, antidepressant
107
how to manage irritability and jitteriness
assess for co-morbid condition, reduce dose, consider mood stabilizer or atypical antipsychotic
108
what should be done to manage priapism or raynauds
discontinue the med
109
what are two uncommon adverse effects
hallucination and sudden cardiac death
110
how to manage sudden cardiac death
assess risk of cardiac structural abnormality and family history, if concerned do a cardiac ECHO
111
how to manage hallucinations
discontinue stimulant, reassess diagnosis, use mood stabilizer or antipsychotic
112
7 things to monitor on stimulants
appetite, behavior, blood pressure, heart rate, sleep, growth rate, ECG (sudden cardiac death)
113
what two drugs are alpha 2 agonists
guanfacine ER and Clonidine ER
114
three counseling points of guanfacine ER
onset of action is about a month, should be taken once a day, and is a cyp3a4 substrate
115
what is the generic name of intuniv
guanfacine ER
116
what is the generic name of kapvay
Clonidine ER
117
What should be done when discontinuing Clonidine and Guanfacine... why
must taper dose down, prevent rebound hypertension
118
what is the generic name for strattera
atomoxetine
119
how do you dose atomoxetine (strattera)
weight based dosing
120
what is the target of atomoxetine
NET inhibitor
121
what is the target of Viloxazine
NET inhibitor
122
what is the generic name of Qelbree
Viloxazine
123
what is the age for atomoxetine
6 years and older
124
what substrate is atomoxetine
2D6
125
What is a counseling tip for Viloxazine
its a capsule, swallow whole or put in applesauce
126
what substrate is violoxazine
2D6/UGT stubstrate
127
what does Viloxazine inhibit besides NET
1A2 inhibitor
128
side effects of atomoxetine and viloxazine (3)
increased HR
increased BP
Increased suicidal thinking
129
what is the boxed warning for viloxazine and atomoxetine
increase in suicidal thinking
130
what are the side effects of guanfacine and clonidine (5)
decreased HR
Decreased BP (orthostasis)
somnolence
dizziness
rebound hypertension if abrupt dc
131
what are the monitory parameters of non-stimulants
appetite, behavior, blood pressure, heart rate, growth rate, LFTs, sleep
132
what should be monitored if they take atomoxetine
LFTs
133
is bupropion approved for ADHD
not FDA approved
134
when should bupropion be used for ADHD
when concerned about misuse or side effects of stimulants
135
what does bupropion inhibit
2d6 inhibitor
136
what is a contraindication of bupropion
seizures and eating disorders
137
what is an adverse effect of modafinil (provigil)
SJS/TEN
138
compare the efficacy of tricyclic antidepressants and methylphenidate
methylphenidate is more effective than tricyclic antidepressants for ADHD
139
what is a concern of tricyclic antidepressants
sudden cardiac death in children, lethal in overdose
140
can mood stabilizers or atypical antipsychotics be used for ADHD
may be used if there is comorbid bipolar disorder, conduct disorder, or intermittent explosive disorder
141
what atypical antipsychotic is often seen in ADHD
valproate
142
can antipsychotics be used as monotherapy for ADHD
NOOOOOO
143
what is the first line treatment for ADHD in preschool children
parent training in behavior management (PTBM)
144
what is the second line treatment for ADHD in preschool children
PTBM and FDA approved med
145
what is the first line treatment for elementary and middle school children
PTBM and FDA approved med
146
what is the first line treatment for adolescents with ADHD
FDA approved med and maybe PTBM
147
what is the first line med for preschool
methylphenidate
148
what drugs class should not be used in preschool children for ADHD
non-stimulant
149
what is first line med for ADHD elementary age and adolescents
stimulants
150
what is second line drug for children above preschool
atomoxetine, guanfacine, clonidine
151
what can be used as adjunctive treatment
guanfacine and clonidine in addition to stimulants
152
is methylphenidate long acting or short acting
both
153
when could lisdexamphetamine potentially be trialed
after at least 6 weeks on methylphenidate
154
what is the first line med for adults with ADHD
methylphenidate or lisdexamphetamine or dextroamphetamine or atomoxetine if unable to tolerate above meds
155
third line ADHD drugs
bupropion, clonidine, imipramine, modafinil, atypical antipsychotics
156
is guanfacine ER recommended in adults
noooooo
