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Flashcards in Block 4 Lecture 2 -- ADHD Deck (79)
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1

What have been the most significant developments for ADHD drugs in the past 10 years?

drug formulation (LA, ER)

2

How do males and females differ in ADHD presentation, referral, diagnosis?

males:
-- 6-10x more likely to be referred
-- more externalizing behaviors
-- 3x more likely to be diagnosed
-- more likely to have co-morbid neuropsychiatric issues

3

What CNS "pathways" are involved in attention?

1) Alerting pathways
2) orienting pathways
3) working memory pathways
4) executive control pathways

4

What regions are involved in CNS alerting pathways?

1) locus coeruleus
2) HT
3) PFc
4) parietal cx
5) reticular activating system in the brainstem

5

What regions are involved in CNS orienting pathways?

1) parietal cx
2) visual cx
3) auditory cx

6

What is the function of the locus coeruleus?

-- NE synthesis
-- ANS control center

involved in the CNS alerting pathways

7

What regions are involved in the CNS executive control pathways?

1) PFc
2) limbic area
3) basal ganglia
4) cerebellum

8

What regions are involved in the CNS working memory pathways?

1) PFc
2) cingulate cx
3) entorhinal cx
4) hippocampus
5) Amygdala

9

What is the function of CNS orienting pathways?

1) tune spatiotemporal representation of relevant sensory stimuli
2) increase focus on a specific stimulus

10

What is the function of CNS working memory pathways?

process and focus info about sensory stimuli or tasks
-- over seconds to mins

11

What is the function of the executive control CNS pathways?

integration and organization of information

12

What genes are HYPOTHESIZED (not proven) to be mutated/involved in ADHD?

1) DAT
2) D4/D5 DAr
-- exon 3 7-repeat allele yields blunted response to DA
3) DBH

13

What are the theories for ADHD pathology?

1) genetic
2) DA deficiency hypothesis

14

What is the basis for the DA deficiency hypothesis?

1) stimulants work for 80% of pts
2) some imaging studies show DA/DAr deficits
3) animal studies support DA's role in motor control, attention, and impulsivity

15

What is the basis for the genetic theories of ADHD?

one of the most heritable neuropsychiatric conditions!
-- 3-8x higher incidence if a parent has ADHD

16

What are the weaknesses of the DA deficiency hypothesis?

1) literature doesn't support one theory for ALL parts of ADHD
2) literature doesn't support co-morbidities solely due to DA deficit

17

What are risk factors for ADHD?

1) heredity
-- most significant!
2) labor/delivery complications
3) sub-optimal family environment
4) in utero tobacco smoke or lead exposure
5) developmental drug/alcohol exposure
-- NOT directly caused by bad parenting, tv, etc.

18

What are co-morbidities of ADHD?

1) cigarette smoking
2) conduct disorder
3) bipolar disease
4) depression, anxiety, OCD
5) learning disabilities
6) tourettes
7) sleep disturbances
8) sensory dysfunction
9) pervasive disorders (Asbergers)

19

What are the most common co-morbidities of ADHD?

1) learning disabilities! (40%)
2) conduct disorder (25%)
-- males much more than females
3) bipolar (10%)

tourettes (40-80% of tourettes pts have ADHD)

cigarette smoking is 2-3x the age-adjusted rate
-- as symptoms increase, more likely to smoke

20

What are the 3 presentations of ADHD?

1) primary inattention
2) primary hyperactivity/impulsivity
3) combined inattention and hyperactivity/impulsivity

21

What are the possible diagnoses for a patient with symptoms?

-- mild, moderate, or severe
-- primary inattention, primary hyperactivity/impulsivity, or combined

-- +/- autism spectrum disorder

presentation can vary across years

22

How did DSM-IV differ from the current DSM-V?

1) presentations called "subtypes"
2) sxs had to appear before 6 yo
3) no mild/mod/severe
4) no ASD co-diagnosis
5) no differences for older patients

23

What is the Vanderbilt ADHD diagnostic parent rating scale?

a tool that differentiates oppositional-defiant disorder, conduct disorder, and anxiety/depression from ADHD

24

MoA of methylphenidate:

blocks DAT and NET
-- DAT moreso than NET

25

What kind of system is methylin ER? What are counseling points?

methylcellulose polymer / wax matrix;
-- 8 hour release
-- swallow whole
-- may still require BID admin

(same as ritalin SR)

26

What kind of system is ritalin SR? What are counseling points?

intermediate-acting

methylcellulose polymer / wax matrix;
-- 8 hour release
-- swallow whole
-- may still require BID admin

(same as methylin ER)

27

What kind of system is Metadate CD/ER? What are counseling points?

intermediate-acting

IR/ER bead mixture
-- CD is caps, ER is tabs
-- can open and sprinkle on food

28

What kind of system is Ritalin LA? What are counseling points?

intermediate-acting

IR/ER beads formulated in SODAS

29

What are the short-acting forms of MPH?

1) MPH -- Ritalin, Methylin
2) Dex-MPH -- Focalin

30

What are the intermediate-acting forms of MPH?

1) Methylin ER, Ritalin SR
-- methylcellulose/wax polymer matrix
2) Metadate ER, Metadate CD
-- ir/er beads
3) Ritalin LA
-- sodas