ADHD Meds Flashcards
Symptoms of ADHD by Category
- inattention
- hyperactivity
pts. can be primarily hyperactive, inattentive or both
Inattention
- cannot focus on details; careless mistakes
- cannot finish tasks which require attention
- difficuty oragnizing tasks and to dos
- cannot listen when spoken too
- easily distracted
- forgetful in daily activities
Hyperactvity
- figet/squiring
- leaves seat when not supposed to
- talks excessively
- trouble waiting their turn, inturrupts others
- runs, climbs when no appropriate/restless
Diagnosis of ADHD
- for those 4-16
- those 17+
Diagnosis : Age 4-16
- 6 or MORE symptoms of inattention/hyperactivity/impuslivity for at least 6months inappropriate for developmental level
Diagnosis: Age 17+
- 5 or MORE symptoms of inattention/hyperactivity/impulsivity
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with the following criteria also being met
- occuring in 2+ settings like at school/work and at home
- not another disorder
- clear evidence that these sx. interfer with social, school or work
- the symptoms of inattentive/hyperactive were present before the age of 12 for those diagnosed after 12
rating scales such as the ADHD scale, Connors & Vandervbilt Scale are used to help dx. ADHD
Treatment Approach to ADHD
Rule out other conditions
- behavior/mood d/o
- autism
- learning disabilities
discuss treatment v no treatment
Goals of Treatment
- to reduce symtpoms: remain seated in class, finish HW etc.
Treatment by Age for ADHD
4-6 y/o
6-12
12-18
most stimulant medicationsa re approved for ages 6+
For those age 4-6
- initiate nonpharm first: with evidence based parent-training in behavior management (PTBM) + classroom modification
- methlypehnidate (stimulant) can be used if behavior intervention does not provide significnat improvement
For those age 6-12
- behavioral modification + FDA_approved meds
For those 12-18
- behavioral modification/interventions + FDA-approved meds
all ages: stimulant medications preferred over non-stimulant meds first line
need to be titrated to acheive max benefit with tolerate side effects
Non-Pharmacologic Interventions for ADHA management
Combined behavioral thearpy + stimualnt therapy has best improvements & combo with therapy decreases the dose needed of the medication to use
Preschool & School age
- PTBM
- classroom management instructions from teacher
Adolsecent
- breaking up homewokr assignments & using structured organizer/scheduler
Adults and Adolecents
- ADHA specific CBT and metacognitive therapy
not a LO
ADHA Medications: two classes
- what meds in each class
ADHA Meds
Stimulants (first line, preferred)
- methylphenidate
- amphetamines
- come short and long acting formulations: Class II substances
- long acting formualtions: containt a mix of IR and ER
Non-Stimulants
- SNRIs (atomoxetine/viloxazine)
- Alpha-2-agonists (clonidine/guanfacine)
ADHD Medications: Stimulants
Initiating Stimulants
considerations for : Dose, Duration and Formulation
Initiating Stimulants
Dose: low doses initally, titrating up to the effective doses to best dose with minimal side effects
Duration: deside how long you need the medication to work
- once daily med long-acting vs multiple short acting
- this duration can influence adverse effects
Formulation
- tablets, capsules, liquids, patches
- medication adhearance (are they taking long-acting s. short)
- generic vs. brand
ADHD Meds: Stimulants
- discuss pt. response to stimulants, generics, formulations and tolerance
Stimulant Med
- methylpendiate v amphetamines
Pt. Reponse
- can vary between the methylpenidate and the ampetamines
- can vary based on genertic and name brand
Benefits
- typically seen within 1-3 weeks of initiation while adjusting dose
Tolerance
- can occur over time, and may need adjustments of dosing
- some side effects can become more tolerable and diaappear with continued use
- in general: ADHD symptoms tend to decrease with age & lead to less of a need for medication
not a LO
Stimulant ADHD meds: MOA
Methlyphenidate MOA
- Blocks the reuptake of NE (norepi) and DA (dopamine) into the presynaptic neuron
- this seems to increase time in cleft, and stimulat the cortex and subcortical structures similar to how the amphetamines do
Amphetamines: MOA
- promote RELEASE of catecholamines (NE and DA) from the storage site in teh presynaptic neuron into the cleft
Stimulant ADHD Medications
BBW
BBW: CNS stimulants have a high abuse potential and dependence
- specifcally amphatamines: misue can lead to sudden death/cardiovascual effects
Take Caution in…
- those with hx. of drug dependence or alcoholism
- longer acting formulations are preferred in this pop.
Contraindications of Methylpenidate & Amphetamines
Methylphenidate
- cannot be used with 14 days of MAOI or during treatment with MAOI
- cannot be used in those with marked anxiety, tension, agitation
- Cannot be used in those with glaucoma
- tourretes hx. or family hx. of tourettes/tics
Amphetamines
- cannot be used within 14 days of or during MAOI theray
- cannot be used in those with marked anxiet, tension or agitation
- cannot be used in those with glaccoma
- not for those with advnaced atherosclerosis, symptomatic CVD, mod/severe HTn
- not for those withhyperthyroid
- those with hx. of drug abuse
Stimulant Abuse Potentiatl & Symptoms of Abuse
Stimulat Abuse
- CNS stimulants have high abuse potential, and potential addiciotn
Symptoms of amphetamine abuse
- increased HR, RR, BP or sweating
- hyperactivity, restlessless, tremor or insomnia
- dilated pupils
- decreased appetite
- flushing, abd pain or vomiting
- anxiety, psychosis, aggression, sucidial or homicidal ideation
Names
methylpenidate
amphetamines
not a lecture ob.
Methylpenidate
- ritalin, IR or ER
- concerta (ER)
- short acting: give 30 mins before meals
- long acting: give in the AM with food
ampehtamines
- adderall (IR)
- mixed amephtamines adderall ER
- vyvanse (prodrug: less abuse potentil)
- short acting: with or without food
- long acting: am with food
efficacy of long acting 1 daily or short acitn BID is viratully the same
Side Effects of Stimulants
3 most common seen
others
Side Effects of Stimulant Meds
Psychatric
- mood disturbances (aggitation/irriable - depression)
- anxiety or panic attacks
- psychosis
Cardiovascualr
- increased HR and BP
Growth Suppression
- due to decreased appetite, decreased high/weight
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GI-related
- dry mouth
- decreasd appetite
- nausea
CNS
- insomina
- sombie-like
- tics/abnormal movements
peripheral vasculpathy: decrease peripheral flow
Managing the Side Effects of the Stimulant Medications
reduced appetite/WL
insomina/agitation
rebound sx./wearing off
Managing Side Effects
Reduced Appetite
- give high cal. meal at low-times (breakfast/bed)
- scheudle snacks
Insomina/Jittery
- decrease the dose
- give it earlier in the day
- avoid other stimulants (coffee)
- change fro IR to ER
- assedd for comorbid conditions: bipolar
Rebound/effects wearing off
- consider long-acting
- add a dose of short-acting in the PM
