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Pharm Final UNIT!!!! > ADHD Management > Flashcards

ADHD Management Flashcards

1
Q

What are the requirements for an ADHD diagnosis?

A

Hyperactivity/ impulsivity or inattention:

  1. Occur often
  2. Present more than one setting
  3. Present before age 12
  4. Impair function
  5. Be excessive
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2
Q

What are examples of ADHD that require attention of a specialist to treat ADHD?

A
  1. Intellectual disability
  2. History of abuse
  3. Developmental disorder
  4. Visual or hearing impairment
  5. Severe aggression
  6. Children unresponsive to treatment
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3
Q

Who is to be involved and what target goals are to be set?

A
  • Include pt, family, and school personnel

- 3-6 targetable outcomes at 1 time that are realistic, achieveable, and measureable

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4
Q

What type of therapy is 1st line for kids diagnosed at 4-5 (preschool age)?

A
  • Behavioral therapy (administered by parents or teachers)

- Add medications if target goals not met (Methylphenidate)

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5
Q

What is the recommended 1st line tx for school age kids (>6) for ADHD?

A

Stimulant plus behavioral therapy

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6
Q

What is monitoring schedule for ADHD drugs?

A

Weekly to once every 3-6 months based on stage of pharmacology treatment

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7
Q

What are important considerations of initiating pharmacotherapy in children with ADHD?

A
  • Child is 6 or older
  • School will cooperate in administration and monitoring
  • Child has normal heart rate and normal blood pressure
  • Child is seizure free
  • Substance abuse among household members is not a concern (IR stimulants)
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8
Q

If there are risk factors to ADHD pharm treatment what should be done?

A

-Comprehensive CV focused pt history, family Hx, and physical exam

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9
Q

Before starting adolescents on ADHD pharm treatment what should be done?

A

Assess them for substance use/abuse

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10
Q

What considerations must be taken when deciding on drug agents to assist in pharm tx of ADHD?

A
  • Time of day target sx
  • Duration of desired coverage
  • Coexisting tic D/O (avoid stimulant)
  • Substance abuse in family member at residence
  • Expense
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11
Q

What three stages exist for pharm treatment in ADHD?

A
  • Titration
  • Maintenance
  • Termination
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12
Q

What is the most common practice for a pt to start pharm therapy for ADHD?

A

On the weekend

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13
Q

What is good good practice for prescription writing for ADHD kids?

A

Writing multiple prescriptions so pharmacy supplies multiple bottles for administration at school

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14
Q

What is the general titration period for ADHD med and monitoring of patients on these drugs?

A
  • 1 to 3 months

- Close follow-up usually every week

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15
Q

What is the recommended way to titrate with ADHD drugs?

A

Start lowest dose and titrate every 3-7 days until core sxs improve to 4-50% or until ADRs unacceptable

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16
Q

What is the thought on drug holidays with stimulant medication?

A

Not routinely recommended; Case by case basis

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17
Q

What are the ADRs associated w/ stimulant use?

A
  • Decreased appetite
  • Poor growth
  • Dizziness
  • Insomnia/nightmare
  • Mood lability
  • Rebound sx
  • Tics
  • Psychosis
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18
Q

How should ADHD pts take their medication to avoid decreased appetite?

A
  • Administer at or after a meal

- Nutrient dense meals; high fat meals delay onset and increase peak concentrations of some formulations

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19
Q

How is poor growth controlled w/ stimulant use?

A

Drug holidays IF growth trajectory crosses 2 major percentiles for growth

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20
Q

How is dizziness managed with stimulant use?

A

Ensure adequate hydration/ fluid intake and try long-acting formulations if associated only at peak concentrations

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21
Q

How is insomnia/nightmares managed when using stimulants?

A

Change in dosing schedule (change to short acting, take earlier in the day, or omit)

22
Q

How is mood lability managed in ADHD stimulant use?

A

Switch to long acting formulation; If still present referral for mood disorder evaluation

23
Q

How is rebound managed in stimulant use?

A

Sx/ ADRs occur as medication wears off; Step down to lower dose late in day

24
Q

How are tics managed w/ stimulant use?

A

Try different dose or stop medication to see if drug-related

25
Q

How is psychosis managed w/ stimulant use?

A

Verify appropriate dose and adherence; if correct stop drug and send to mental health for evaluation

26
Q

How is diversion/misuse managed w/ stimulant use?

A
  • Monitor prescription refills

- Try long- acting preparations

27
Q

How is termination of therapy monitored?

A

Similar to starting, every few days/weeks to check for sx return

28
Q

What is important to know about stimulants as a drug class?

A

Controlled substance (II)

29
Q

What are severe ADRs associated w/ stimulant use?

A 
Cardiac arrhythmia (especially during 1st few days)
BP/Hr elevation
30
Q

If an ADHD pt has a CV risk, how should they be managed?

A

work-up and/or referral should occur

31
Q

What are contraindications of stimulant use?

A
  • Symptomatic CV disease
  • Moderate/severe HTN
  • Seizure disorders
  • Hyperthyroidism
  • Motor tics or tourettes syndrome
  • Glaucoma
  • Agitated states
  • Anxiety
  • Drug abuse hx
  • Concurrent use/ use w/in 14 days of MOAI
32
Q

What are the type of stimulants?

A
  • Methylphenidate -dexmethylphenidate

- Amphetamines

33
Q

What is the MOA of the stimulants to treat ADHD?

A

Block reuptake of NE and DA into presynaptic neurons

34
Q

What is the PK information for short acting methylphenidate?

A
  • Initial effect 20-60 minutes

- Duration of action 3-5 hours

35
Q

What is the PK information for long acting methylphenidate?

A

Onset and duration very by formulation

36
Q

What are types of methylphenidate long acting drugs?

A

Metadate, Concerta, Quilivant, Ritalin

37
Q

What are types of methylphenidate short acting drugs?

A

Methylin, Ritalin

38
Q

What type of drug is available of dexmethylphenidate?

A

Focalin

39
Q

What drugs are amphetamines?

A

Adenzys, Dexedrine, Procentra & Adderall

40
Q

What amphetamine drug is useful in use to discourage misuse? How does it work?

A

Lisdexamfetamine, prodrug activated after oral ingestion

41
Q

What non-stimulant drug is used to treat ADHD?

A

Atomoxetine

42
Q

When would Atomoxetine be preferred over stimulants?

A

Those w/ or family w/ substance abuse, tics, significant ADRs w/ stimulants

43
Q

What is important PK/management information about Atomoxetine?

A
  • Requires 1-2 weeks for initial response and up to 4 weeks for maximal effect
  • Dose every day and do not use drug holidays
44
Q

What ADRs are associated with Atomoxetine?

A
  • Weight loss
  • Suicidal thinking (BBW)
  • Abd pain/N/V
  • Decreased appetite
  • Rare sudden death
  • CV issues
45
Q

What are contraindication of Atomoxetine?

A
  • Concurrent use/ use w/in 14 days of MAOI
  • Glaucoma
  • Current/ past pheochromocytoma
  • Severe CV disorder
46
Q

When would alpha-2-adrenergic agonists be used to treat ADHD?

A

When stimulants or Atomoxetine can not be used or are not effective

47
Q

What are the alpha-2-adrenergic agonists used to treat ADHD?

A
  • ER Clonidine

- ER Guanfacine

48
Q

What is useful about ER Clonidine/ Guanifacine?

A

They can be used as adjuncts to stimulants

49
Q

When would antidepressants be used to treat ADHD?

A

Nothing else works use TCAs or Bupropion

50
Q

What is important to know about stimulant use in adults w/ ADHD?

A

-Are not as effective and have greater potential for ADR CV risk than in children

51
Q

How are adults managed with ADHD?

A

-Normally stimulants unless substance abuse and tx w/ Atomoxetine or Bupropion

Pharm Final UNIT!!!! (6 decks)

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