ADHD Flashcards
(31 cards)
What is the way that ADHD is characterized?
- By symptoms of inattention, hyperactivity & impulsivity
What is the pathogenesis of ADHD?
- NOT well defined BUT is due to imbalences in catecholamine metabolism (like dopamine and Norepi) - why stimulant meds are given
Stimulants = Increase dopamine and Norepi levels
What is considered first line for the treatment of ADHD?
- Parent Training for Behavior managment is 1st line for kids 4 - 5 yo
- ADHD MEDS are 1st line for those > 6 yo
What is the DSM-5 Diagnostic Criteria for Inattention? What are the symptoms?
- > 6 symptoms of Inattention for kids to 16 yo (> 5 if 17 yo or older)
- Symptoms: Fails to pay attention, cant hold attention, not listening to someone talking to them, doesnt follow instructions, cant finish tasks, bad organization, avoids tasks that requires mental effort, forgetful…
What is the DSM-5 Criteria for Hyperactivity & Impulsivity? What are the symptoms?
- > 6 symptoms of hyperactivity-impulsivity for kids to 16 yo (> 5 for 17 yo or older)
- Symptoms: fidgets, leaves seat unexpectedly, runs around Inappropriately, unable to play quietly, “on the go”, talks excessively, blurts out anwsers, cant wait their turns…
What are some of the following conditions that must be met in order to disgnose someone with ADHD?
- Several symptoms (of both) present before age 12
- Symptoms must have been present in 2 or more settings (i.e.; home, school, work, with friends…)
- Symptoms are NOT caused by other disorders
What are some natural products that can help with ADHD?
-
- Fish oils not recommended BUT do have some cognitive help
- Melatonin can be used fro sleep in those taking stimulants
What are some of the Drug Treatments for ADHD?
- Stimulants (1st line) - normally the long acting are better for maintaining symptoms
- Non-stimulants - normally tried after stimulatns do not work well enough (after 2 - 3 meds)
What are some of the patient friendly formulations for stimulants that patients can use?
- Capsules can be opened (Adderall, Ritalin and Vyvanse)
- Chewable Tabs
- ODTs
- Patches (daytrana)
- Suspensions
What are some of the saftey concerns for the stimulant medications?
- All are C-II and must be dispensed with a MedGuide
What are some of the boxed warnings for the stimulant medications
- ALL have a high risk of abuse and dependence - could lead to substances use disorders and addiction
What are some of the contraindications for the Stimulant medications;
- DO NOT use within 14 days of an MAOi due to hypertensive crisis risk
What are some of the warnings for the stimulant medications?
- Abuse and Missuse (boxed warning)
- Increased HR and BP - could lead to serious cardio events
- Prispism (Refer to ED section)
- New onset psychosis or exacerbation of it
- loss of appetite - leads to decrease growth in kids
- Serotonin syndrome
What are some of the stimulant medications that are used for ADHD?
- Methylphenidate (Ritalin - IR Tab, Concerta - ER Tab, Daytrana - Patch, Jornay PM - ER Cap)
- Dexmethylphenidate (Focalin, Azstrays)
- Dextroamphetamine/Amphetamine (Adderall)
- Lisdexamfetamine (Vyvanse)
- Methaphetamine
ALL should be titrated up every 7 days and do not need to be tapered off
What is the MOA for the Stimulant medications?
- Blocks the reuptake of Norepi and Dopamine
What are some dosings for Methylphenidate used for ADHD?
- Start at 5 mg BID - Ritalin
- Start 18 - 36 mg QAM - Concerta
What are some side effects for Methylphenidate used for ADHD?
- Insomnia, Decreased Appetite/Weight Loss, Headache, Irritability
What are some things to monitor for with methylphenidate used for ADHD?
- ECG prior to start (bc of HR/BP)
- Height and Weight (bc of decreased appetite/weight loss)
What are some additional notes for methylphenidate used for ADHD?
- OROS delivery (Concerta ER): outer coat dissolves fast to give immediate action and the rest is released slowly - ghost tab is possible
- Jornay PM: best used in the evening
- Daytrana: apply to hip 2 hours before you would need it - remove 9 hrs, alternate hips, discard by flushing it down toilet
What are some additional notes for Dexmethylphenidate used for ADHD?
- Active isomor of methylphenidate - to convert from Methyl to Dexmethyl = 1/2 total daily dose
What is Azstrys and what are some additional notes about it?
- Serdemethylphenidate/ Dexmethylphenidate (Capsule)
- Serdexmethyl is a Prodrug to Dexmethyl = extended duration
What are some additional notes for Dextroamphetamine/ Amphetamine used for ADHD?
- IR products (Adderall, Zenzedi) approved in kids > 3 yo [Except Evekeo]
- NO Dextroamphetamine in kids < 5 yo
- DO NOT take with acidic foods (juices or vitimans) - decrease absorption
What are some additional notes for Lisdexeamfetamine used for ADHD?
- Low abuse potental
- Prodrug
- If injected or snorted; the fast effects (“Rush”) is muted
What are the non-stimulants that are used for ADHD?
- Selective Norepinephrine Reuptake Inhibitors (Atomoxetine [Strattera], Qelbree)
- Centrally-Acting Alpha-2 Adrenergic Receptor Agonists (Clonidine ER [Kapvay], Guafacine [Intuniv]]
