ADHD Therapeutics - Brian Haggblom Flashcards
(49 cards)
What are the three core types of ADHD?
- Inattention (20-30%)
- Hyperactivity (5-15%)
- Combination (55-65%)
What are some characteristics of the inattention type of ADHD?
Inability to complete tasks, sustain attention, organize work
What are some of the characteristics of the hyperactive type of ADHD?
Inability to inhibit motor behaviors or responses.
What is the percent of people in the US who have ADHD?
4.4%
What percentage of children in the US have ADHD in 2011? When is it diagnosed?
11%. It is diagnosed at ages 4-17 years old.
Where in the US is the greater concentration of these recent diagnoses?
In the South
What abnormalities in the brain are exhibited in those with ADHD?
Executive function
Memory impairments
Information processing speed deficits
Decrease in catecholaminergic nature of brain circuits (low dopamine and NE in frontal)
Is there a genetic link in ADHD?
Yes, there seems to be. Risk is increased 2-8 times in parents/siblings/children.
What possible causes of ADHD are being researched?
- Brain injury
- Exposure to environmental (lead) during pregnancy/at young age
- Alcohol/tobacco use during pregnancy
- Low birth weight
- Premature birth
Is it thought that eating too much sugar or watching too much TV causes ADHD?
No, but they might make symptoms worse.
What are requirements for diagnosis common to all three types of ADHD?
- Symptoms need to be present prior to age 12
- must be present in 2 or more settings
- must significantly interfere with reduced level of functioning
- Rule out other causes for symptoms (other mental disorders)
As you get older and have ADHD, what types of things are you more at risk for?
- Increased risk of self-injury
- Driving mistakes
- Education hardships
- Substance use
- Persistence of symptoms
- Employment hardships
What are the goals of ADHD treatment?
- Improved relationships, improved academic performance, improved rule following
- Decreased hyperactivity symptoms, impulsivity symptoms, inattention symptoms.
- Promote independence
What non-pharmalogical treatment modalities are available for treating ADHD?
- Behavioral interventions (apps that block out social media)
- School based interventions (sit next to teacher)
- Social skills training (help with fighting, impulsiveness)
- Dietary interventions (fatty acid supplementation?)
What are the first line therapy for ADHD?
Stimulants, including methylphenidate and amphetamines.
What are the second-line therapy for ADHD?
Non-stimulants, such as atomoxetine, alpha-2 agonists, bupropion, TCA’s
Methylphenidate
- CNS stimulant
- blocks reuptake of NE and dopamine
- Fast onset
- CYP3A4 metabolism
- interacts with carbazepines, MAOIs, TCAs
Amphetamines
- CNS stimulant
- blocks reuptake of NE and dopamine
- Fast onset
- CYP2D6 metabolism
- interacts with paroxetine, fluoxetine, bupropion, MAOIs
What interval should you titrate by for stimulants in ADHD treatment?
Weekly to monthly to evaluate dose.
What is the latest in the day that you should take an IR stimulant?
4pm. Can also take a morning and a noon dose. ER can take only once a day in the morning.
How many stimulants should you try before moving on to a second-line agent?
Probably two stimulants, but it really depends on the patient.
What dosage forms are available for stimulants?
- Capsules (swallowed or sprinkled)
- Suspension
- Solution
- Chewable tablets
- Transdermal patch (Daytrana - place on hip and alternate each day. Wear for 9 hours)
What are some side effects that you can experience with stimulants? What can help?
- Dry mouth (chew gum)
- Insomnia (give as early as possible, d/c evening dose, sedating drug @ bedtime)
- Irritability (evaluate for comorbid bipolar disorder, reduce dose, consider mood stabilizer)
- Diminished appetite (eat a high calorie meal when the stimulant effects are low)
- Increased BP/HR (monitor closely)
- Hallucinations (d/c stimulant)
How much does HR and BP usually increase with a stimulant?
3-5mmHG increase in BP and 5bpm increase in heart rate
