ADHD & Stimulant Agents Flashcards
(84 cards)
Are primary sx the same?
No, primary sx vary.
Some pts are more inattentive, while others are more impulsive
What’s are the core sx of ADHD?
Inattention
Hyperactivity
Impulsivity
What’s the primary tx for ADHD?
Stimulant meds, primarily methylphenidate formulations (Concerta, others) and lisdexamfetamine (Vyvanse )
What’s the rationale behind using stimulants in ADHD?
Is to raise dopamine and norepinephrine levels.
Cuz in ADHD, it is thot there is a lack of dopamine/ a lack of functioning dopamine receptors/ some defects in the dopamine pathway
What’s dopamine catalyzed into?
2 primary catecholamines
Epinephrine
Norepinephrine
Other than genetics, what may alter the brains pattern of catecholamines use in some pts, which leads to ADHD sx?
Stressors
What class of controlled substance are stimulants?
C II
How long are the scripts usually for? Advantage of this duration?
Scripts are usually written for a month at a time.
Makes it convenient to check:
BP
HR
Weight & height (in children)
What should counseling of stimulants include?
Don’t share with others
Store in a safe place
What other conditions are ADHD meds used for?
Narcolepsy
Shift work sleep disorder
Which of the ADHD sx remain as the child grows up? Which can decrease?
Inattention and impulsivity often remain as pt ages
Hyperactivity can be decreased
List inattention sx
Fails to pay attention Has trouble holding attention Doesn't pay attention when someone is talking Doesn't follow through on instructions Fails to finish school work Has difficulty organizing tasks Avoids or dislikes tasks which require mental effort Loses things Is easily distraction Forgetful
Howz the diagnosis of inattention made?
A) children up to 16 yrs
B) 17 yrs to adults
A) 6 or more inattention sx
B) 5 or more inattention sx
+
Sx of inattention has been present for at least 6 months
Sx of inattention are inappropriate for developmental level
Sx of hyperactivity and Impulsivity
Often fidget and squirms Leaves seat unexpectedly Runs about when not appropriate Unable to play quietly Is "on the go" as if "driven by a motor" Talks excessively Blurts out answers Has trouble waiting his/her turn Interrupts or intrudes others
Howz the diagnosis of hyperactivity and Impulsivity made?
A) children up to 16 yrs
B) 17 yrs to adults
A) 6 or more inattention sx
B) 5 or more inattention sx
+
Sx of hyperactivity-Impulsivity has been present for at least 6 months
Sx of hyperactivity-Impulsivity are inappropriate for developmental level and are deemed disruptive
What other conditions need to be met to be diagnosed with ADHD?
Several inattentive or hyperactive sx we’re present before 12 yrs
Sx must have been present in 2 or more setting (at home, work, with friends or relatives)
Sx interfere with functioning
Sx not caused by another psychiatric disorder
What’s the first line tx for ADHD?
Stimulants
When stimulants don’t work well enough (after trials of 2-3 agents) whats the alternative?
atomoxetine (Strattera)
Whens atomoxetine (Strattera) used as first line?
When prescribers are concerned about possibility of abuse by patient or family
Which stimulants are tried first?
Methylphenidate
OR
Lisdexamfetamine (Vyvanse) - prodrug of dextroamphetamine
Which meds are often used as adjunctive tx?
Guanfacine (approved in extended-release formulation “Intuniv”)
OR
Clonidine (in the extended-release formulation “Kapvay”)
(It’s common to see Concerta + Intuniv OR Vyvanse + Kapvay
Howz the immediate-release formulation of Clonidine used?
To help pts sleep at night
Which med is more commonly used for ADHD pts to sleep at night?
Diphenhydramine
List natural pdts that are used for ADHD?
Fish oils with/without Primrose oil
SAMe
St. John’s wort
Ginkgo
