ADHD

Question 1

Which sex is most affected by inattentive ADHD?

Answer 1

Female

Question 2

How many symptoms are required to make a diagnosis of ADHD?

Answer 2

6+

Question 3

Before what age do the symptoms need to be present and how long do they need to be present for?

Answer 3

12

6 months

Question 4

When is atomoxetine (Strattera) considered the first line therapy for ADHD?

Answer 4

When family history of substance abuse is present
Patient currently has tics
Patient has a comorbid anxiety disorder

Question 5

What are some second line options for treating ADHD?

Answer 5

Clonidine
Guanfacine
(Alpha-2 agonists)

Question 6

What are some third line agents?

Answer 6

Bupropion- NE/DA reuptake inhibitor

Imipramine- TCA

Question 7

What type of psychotherapy is beneficial for these patients once their symptoms are under control?

Answer 7

Behavioral parenting training

Question 8

What are the key components of ADHD?

Answer 8

Inattention
Hyperactivity
Impulsivity

Question 9

What is the incidence of ADHD?

Answer 9

3 to 5 percent

Question 10

Which neurotransmitters are lacking in patients with ADHD? Which part of the brain are they predominatily missing?

Answer 10

DA and NE

Prefrontal cortex

Question 11

Which aspect of the brain is responsible for selecting what an individual focuses on?

Answer 11

Dorsal anterior cingulate gyrus

Question 12

Which part of the brain is responsible for sustaining attention on a topic?

Answer 12

Dorsolateral prefrontal cortex

Question 13

Impairment in what cortex appears to be resbonsible for hyperactivity?

Answer 13

Prefrontal motor cortex

Question 14

Impairment of which cortex results in impulsivity?

Answer 14

Orbitofrontal cortex

Question 15

What other conditions must a child with ADHD be evaluated for?

Answer 15

Oppositional defiant disorder

Conduct disorder

Question 16

What 3 things will medication help with, if the child WANTS to do them?

Answer 16

1. Sitting still
2. Focusing
3. Think before they act

Question 17

What will medicaiton not help a patient do?

Answer 17

Make good decisions

Question 18

What would distinguish early onset bipolar-disorder from ADHD? Both have restlessness and distractibility.

Answer 18

Bipolar patients will have an affective component

Question 19

Blood levels of what mineral should also be checked?

Answer 19

Lead

Question 20

Which seizure disorder should be evaluated?

Answer 20

Petit mal seizures

Absences seizures

Question 21

What are some signs it could be a seizure disorder?

Answer 21

Child has staring spells

Child will not be “thinking” of something else

Question 22

What condition has a very similar presentaiton to a patient with ADHD and ODD?

Answer 22

Bipolar disorder

Question 23

What is the first line medication for ADHD?

Answer 23

Stimulants

Question 24

What are the two classes of stimulants used to treat ADHD?

Answer 24

Methyphenidate

Amphetamine

Question 25

What are the common adverse effects of stimulants?

Answer 25

``` Decreased appetite Insomnia Irritablity Dysphoria Headacht Tics ```

Question 26

What is the benefit of using stimulants?

Answer 26

Rapid onset | Wear off by the end of the day

Question 27

What is the MOA of atomoxetine?

Answer 27

Selective inhibitor of presynaptic NE transporter

Question 28

What are the disadvantages of atomoxetine?

Answer 28

Slower onset | 24 hr duration of action

Question 29

Both atomoxetine can decrease a patient's appetite, what medications can be prescribed with may help increase appetite as well as sleep?

Answer 29

Clonidine | Guanfacine

Question 30

If imipramine is prescribed what two things must be monitored in the patient?

Answer 30

Blood levels | ECGs- QT prolongation

Question 31

In what conditions is bupropion contraindicated?

Answer 31

Seizure disorders | May also exacerbate tics

Question 32

How with the inattentiveness of a patient with anxiety differ from a patient with ADHD?

Answer 32

``` ADHD - External stimuli - Pleasurable behaviors Anxiety - Internally focused - Ruminative and worried ```

Question 33

What are the two types of presentation for ADHD?

Answer 33

1. Inattentive presentation | 2. Hyperactive/Impulsive presentation