ADHD

Question 1

some symptoms of inattention an how many for how long do you need

Answer 1

6 or more symptoms for 6 months
not close atention to detail, doesnt listen when spoken to, does not follow through, trouble organuzing, avoids things requiring mental effort, easily distracted, forgetful

Question 2

how many symptoms of hyperactivity-impulsivity for how long

Answer 2

6 or more symptoms for 6 months to an extent that is disruptive

Question 3

symptoms of hyperactivity

Answer 3

fidgets
gets up from seat often 
runs or climbs everywhere
trouble playing quietly 
on the go 
talks excessively

Question 4

symptoms of impulsivity

Answer 4

blurts out answers before question finished
trouble waiting for turn
interrupts or intrudes

Question 5

4 criteria for ADHD

Answer 5

some symptoms present before age 12
some impairment is present in 2 or more settings
clinically significant impairment in social, school, work functioning
symptoms dont happen due to other disorder

Question 6

ADHD diagnosis

Answer 6

symptoms of inattention or hyperactivity and impulsivity present during childhood and cause functional impairment in 2 diff settings for 6 months
clear evidence that symptoms interfere with social, school, work functioning

Question 7

3 types of adhd

Answer 7

predominantly inattentative
predominately hyperactive-impulsive
combined

Question 8

do stimulants impact children who dont have adhd

Answer 8

yes

Question 9

whats a reason for more people with adhd

Answer 9

less strict criteria

ex. increased age to 12, less symptoms in adults

Question 10

is adhd heritable

Answer 10

yes

Question 11

common co-morbidities with adhd

Answer 11

anxiety
tic
oppositional defiant disorders

Question 12

useful baseline info

Answer 12

height 
weight
severity 
psychiatric and development history 
medical history esp cardiac
eating and sleeping patterns
economics
potential for abuse

Question 13

adhd rating scaler

Answer 13

conners
skamp
snap4
cbcl

Question 14

what did we learn from the big MTA trial

Answer 14

medication management alone or combined with behavior treatment are nearly equally effective and superior to behavior treatmetn alone or community based treatmetn

Question 15

when would we consider behavioural therapy alone

Answer 15

mild
diagnosis uncertain
patient <6

Question 16

when is combined behavioural and meds better than meds alone

Answer 16

oppositional behaviour/aggressive symptoms
internalizing symptoms
parent child interaction difficulties

Question 17

what was noted after an 8 year follow up

Answer 17

no diff between the 4 interventions

Question 18

3 factors that could influence medicaiton choice

Answer 18

cost
history of drug abuse
comorbid symptoms

Question 19

methyphenidate short acting

Answer 19

ritalin

Question 20

disadvantages of short acting

Answer 20

bid or tid dosing
symptoms may return between doses
lunchtime dose has to be at school 
stigma
compliance

Question 21

advantage of short acting

Answer 21

cheap

Question 22

methyphenidate sustained release products

Answer 22

biphentin

concerta

Question 23

advantages of biphentin

Answer 23

covered part 1
lots of different strengths for easy titration
capsules can be opened and sprinkled

Question 24

when might you want to use a long acting in the morning and immediate when they get home

Answer 24

long acting to get them through the school day then short later if theyre having difficulty doing homework so that they can still sleep

Question 25

disadvantages of concerta

Answer 25

cost compared to the generic | weird doses so titration issues

Question 26

biphentin delivery system

Answer 26

outer layer immediate release | inside coating delayed

Question 27

concerta delivery system

Answer 27

fluid comes in and pushes out the medcation to a certain point

Question 28

3 methyphenidate based psychostimulants

Answer 28

ritalin concerta biphentin

Question 29

3 amphetamine based psychostimulants

Answer 29

dexedrine adderall vyvanse

Question 30

if a patient fails on a sitmulant should they be tried on another

Answer 30

yes

Question 31

short acting amphetamine

Answer 31

dexedrine

Question 32

disadvantage of adderal

Answer 32

expensive and not covered by pharmacare

Question 33

adderall delivery system

Answer 33

50% of beads are immediate release the others are delayed

Question 34

what is the point of the pro drug vyvanse

Answer 34

no therapeutic advantage but less prone to be abused

Question 35

vyvanse delivery system

Answer 35

enzymes cleave the prodrug progressively releasing the active product

Question 36

is vyvanse an advanntage

Answer 36

he doesnt think so

Question 37

non stimulant options

Answer 37

strattera - SSRI | intuniv - alpha2 agonist

Question 38

which pills can be crushed/ sprinkled

Answer 38

``` dexedrine adderall vyvanse ritalin biphentin ```

Question 39

which pills need to be swallowed whole

Answer 39

concerta strattera intuniv

Question 40

advantage of strattera

Answer 40

comorbid conditions once daily no substance abuse

Question 41

disadvantages of strattera

Answer 41

cost not covered BA increased in 2D6 poor metabolizers no long term evaluation

Question 42

adverse effects of strattera

Answer 42

``` decrease appetite ab pain somnolence lower growth CV issues suicidal liver failure ```

Question 43

how does intiuniv work

Answer 43

increase blood flow to prefrontal cortex

Question 44

intuniv diff from clonidine

Answer 44

less sedation and diziness | longer half life

Question 45

med if have phsyical aggression

Answer 45

stimulants | may add amoxetine if persists

Question 46

med if have anxiety

Answer 46

use slow titration of stimulants | consider SSRI if persists

Question 47

med if have depression

Answer 47

treat condition causing most impairment first then reasses

Question 48

med if have insomnia

Answer 48

try stimulant early in theday | consider adjunctive insomnia treatment or switch to atomoxetine

Question 49

med if have substance abuse disorder

Answer 49

consider atomoxetine | stimulants with lower abuse - concerta

Question 50

med if have tic disorder

Answer 50

stimulants | alpha 2 agonist if persist

Question 51

safety concerns for stimulants

Answer 51

black box - sudden cardiac death | affect growth

Question 52

monitoring for stimulants

Answer 52

evaluation of CV status | baseloine ECG, HR, HP

Question 53

sitmulant? side effects

Answer 53

``` insomnia anorexia headache weight loss new onset tics irritable ```

Question 54

do adhd drugs increase risk of suicide

Answer 54

no

Question 55

role of drug holidays

Answer 55

sometimes people stop during summer holdays or spring break can interfere with social functions and starting and stopping may cause irritability not the best idea

Question 56

short term and long term beenfits of medication

Answer 56

helps test scores in the short term no long term data

Question 57

how long should someone be treated

Answer 57

possible to grow out of adhd | should reasses every few years and see if drug is still needed