Childhood ADHD and other psychiatric illnesses

Question 1

What is the most common childhood psychiatric disorder (3-5% population)?

Answer 1

ADHD

Question 2

What is the proposed cause of ADHD?

Answer 2

Possible genetics, 4-5fold increase if first degree relative; 5-fold increase if sibling.
environment factors, smoking, heavy metals

Question 3

What is the effect of neurotransmitters in ADHD?

Answer 3

Deficiency of norepinephrine and dopamine at synapse in frontal and neostriatial systems.

Question 4

What are the 3 main symptoms of ADHD?

Answer 4

Inappropriate inattention, impulsivity, hyperactivity

Question 5

This involves not finishing tasks, not seeming to listen, being easily distracted, difficulty concentrating, difficulty sticking to play.

Answer 5

inappropriate inattention

Question 6

This involves acting before thinking, shifting excessively, difficulty organizing work, increased need for supervision, difficulty waiting in lines.

Answer 6

impulsivity

Question 7

This involves excessive running/jumping, difficulty staying seated, excessive movement during sleep

Answer 7

hyperactivity

Question 8

Drugs of choice for ADHD are?

Answer 8

CNS stimulants such as methylphenidate, dextroamphetamine

Question 9

If the patient has no perceived benefit from the medication this is?

Answer 9

pharmacodynamic failure

Question 10

If the patient has some improvement from the medication this is?

Answer 10

pharmacokinetic failure

Question 11

How are short acting CNS stimulants usually dosed?

Answer 11

BID to TID to reach daily dose

Question 12

Which drug is a prodrug of dextroamphetamine and is long acting without requiring a sustained release design?

Answer 12

Vyvanse, lisdexamfetamine dimesylate

Question 13

Headache, decreased appetite, GI complaints, insomnia, exacerbation of tics, delayed growth are side effects of?

Answer 13

CNS stimulants

Question 14

What is the Brand name, initial dose, and max dose of Amphetamine-dextroamphetamine?

Answer 14

Adderall
3-5yrs 2.5mg/day ; max 40mg/day
6yrs 5mg/day ; max 40mg/day

Question 15

What is the Brand name, initial dose, and max dose of dextroamphetamine?

Answer 15

Dexedrine, Dextrostat
3-5 yrs 2.5mg/day; max 20mg/day
6 yrs 5mg/day; max 40mg/day

Question 16

What is the Brand name of dexmethylphenidate?

Answer 16

Focalin

Question 17

What is the brand name of methamphetamine?

Answer 17

Desoxyn

Question 18

What is the Brand name, initial dose of amphetamine-dextroamphetamine er?

Answer 18

Adderall XR

6 yrs 10mg

Question 19

What is the Brand name, initial dose of dextroamphetamine?

Answer 19

Dexedrine spansules

6 yrs 5mg

Question 20

What is the Brand name, initial dose of lisdexamfetamine dimesylate

Answer 20

Vyvanse

6 yrs 30mg

Question 21

What is the Brand name, initial dose of methylphenidate?

Answer 21

Metadate CD/ER, methylin, Ritalin, concerta, daytrana, quillivant XR
6 yrs 20mg
Daytrana 10mg/9 hour
Concerta 18mg

Question 22

This drug is a non-stimulant agent for ADHD, it is a SNRI.

Answer 22

Atomoxetine (Strattera)

Question 23

What interact occurs with Atomoxetine?

Answer 23

CYP2D6

Question 24

Somnolence and anorexia are side effects of?

Answer 24

Atomoxetine

Question 25

What drugs are alpha2 agonist used for ADHD?

Answer 25

Clonidine (Catapress, Kapvay) | Guanfacine (Tenex, Intuniv)

Question 26

This drug is about 65% efficacy for ADHD, takes about 6 weeks, may exacerbate tics, cause insomnia, and inhibits reuptake of NE/DA.

Answer 26

buproprion (wellbutrin)

Question 27

This drug is 70% efficacy for ADHD, has bad side effect profile, and must be titrate on and off use.

Answer 27

imipramine (TCA)

Question 28

This drug inhibits reuptake of SE/NE, and may cause increase in blood pressure.

Answer 28

Venlafaxine (effexor)

Question 29

This is a chronic familial disorder having motor tics and one vocalization tic.

Answer 29

Tourette's disorder

Question 30

How long much tics have occurred for a diagnosis? more common in males or females?

Answer 30

1 year, common in males

Question 31

What drugs are used for Tourette's disorder and what is their potential to cause EPS?

Answer 31

Haloperidol, Pimozide = risk EPS, symptoms regress in 48-72hours Clonidine = no risk for EPS, 50% effective

Question 32

This is the repeated involuntary or unintentional voiding of urine by day or night.

Answer 32

Enuresis

Question 33

What are diagnostic criteria for enuresis?

Answer 33

2 episodes per week for 3 months child is at least 5 years old impairment of social function distress

Question 34

How is enuresis treated non-pharmacologic?

Answer 34

Education | Behavior/ condition methods may take 3-4 months but are 70% effective

Question 35

What drug for enuresis is 70-85% effective, and is dosed 25mg qhs increasing 25mg per week if needed.

Answer 35

Imipramine

Question 36

What drug is a synthetic analog of ADH, is 70% effective in enuresis?

Answer 36

Desmopressin acetate

Question 37

What counseling point should be told about desmopressin acetate?

Answer 37

Evening fluids should be limited to 8 ounces to prevent hyponatremia or water intoxication