ADHD Flashcards
(17 cards)
prevalence
- 6-12% school age children worldwide
- 5% adults
- boys roughly 3x more often than girls
- girls - more inattention, boys more hyperactivity and impulsivity
- hyperactivity less prominent in adolescence and adulthood - 4.4% adults
tx of ADHD
- effective tx modulates DA and NE function - increases DA and NE
- stimulants (amphetamine, dextroamphetamine, methylphenidate), non-stimulants (atomoxetine, guanfacine, clonidine), and other agents (bupropion, TCAs)
- behavioral intervention
diagnosis of ADHD
- must be present before age 12
- 6 or more sxs occur often and at frequency inconsistent for age
- for >17 yo must have 5 or more sxs
- sx present in two or more settings
- significant impairment in quality of social, school, or work functioning
- sx for at least 6 mos
- documented by parent, teacher, and clinician
Methylphenidate MOA and indications
Ritalin
MOA: blocks reuptake of NE and DA
-CNS stimulant medication
-not FDA approved for children <6 yo
-can also be used for narcolepsy, fatigue, and traumatic brain injury
-90% renal clearance
-black box warning - severe depression upon withdrawal, avoid abrupt discontinuation
methylphenidate adverse effects
- decreased appetite, weight loss, stomach ache, insomnia, irritability, anxiety, growth retardation
- uncommon/rare: dysphoria, tics, hypertension, hallucinations, nightmares
methylphenidate drug-drug interactions
- moderate: TCAs, carbamazepine
- methylphenidate causes increased phenobarbital, phenytoin, warfarin levels
- contraindicated with MAOIs (hypertensive crisis, MAOI must be discontinued for at least 14 days)
dextroamphetamine/amphetamine and lisdexamfetamine
Adderall
- not FDA approved for children <3 yrs
- black box warning
- MOA: releases NE from storage vesicles in nerve teminals and blocks NE reuptake
- other indications = narcolepsy
- same adverse effects as methylphenidate
dextroamphetamine/amphetamine DDIs
- moderate: TCAs, sodium bicarbonate
- major: citalopram, venlafaxine
- contraindicated: MAOIs (hypertensive crisis)
atomoxetine MOA
- not for children <6yrs
- black box
- MOA: selective NE reuptake inhibitor - increase DA; NO ADDICTIVE QUALITIES
- less effective than psychostimulants
- considered for pts with anxiety, insomnia, substance abuse
- other indications: bed wetting
atomoxetine DDIs
- moderate: CYP 2D6 inhibitors (i.e. TCAs, fluoxetine, paroxetine)
- major: atomoxetine potentiates increase in BP/HR with albuterol
- contraindicated: MAOIs (risk of serotonin syndrome)
adverse effects of atomoxetine
increased BP, HR, rash, weight loss, constipation, N/V, dissiness, ED, decreased libido
Guanfacine
MOA: selective alpha 2A receptor agonist - less SEs
- alternative for children intolerant to stimulants or add-on to stimulant
- ADE: somnolence, dizzines, HA, low BP, xerostomia, constipation
Clonidine
MOA: non-selective binds to Alpha 2A, TB, and 2C receptors
- alternative for children intolerant to amphetamines (children with tics); or add-on if inadequate response with stimulants
- ADEs: sedation, hypotension (may be less with ER)
behavioral interventions
positive reinforcement, time-out, response cost, token economy
1st line therapy for ADHD
stimulant medications (methylphenidate and dextroamphetamine)
alternative pharm therapy for ADHD
bupropion and TCAs
long term control of ADHD
multimodal treatment including pharmacotherapy and behavioral intervention
