Childhood Disorders Flashcards
ADHD
may result from alterations in the orbitofrontal cortex causing impulsivity and hyperactivity
or
inadequate tuning of the dorsolateral prefrontal cortex and the dorsal anterior cingulate cortex leading to sustained or selective attention deficits
Tx aims to increase DA and NE signaling
Treatment options for ADHD
Methylphenidate based (Methylphenidate, Concerta, Metadate CD, Focalin, Daytrana)
Amphetamines (Adderall, Dextroamphetamine, Lisdexamfetamine)
Others (Atomoxetine, Clonidine, Guanfacine)
Methylphenidate (Ritalin)
Mechanism: increase neurotransmission in central NE and DA systems (allosteric noncompetitive inhibitor of both NE and DA reuptake transporters)
Uses: ADHD, Narcolepsy
Other: multiple forms, all well absorbed orally, most abused drug on college campus
Effects: Increase attention, concentration, focus, talkativeness, vigilance, and wakefulness; decreased fatigue and appetite; increased mood, elation, euphoria, and self confidence
Side Effects: Abdominal pain, nausea, and weight loss
Restlessness, anxiety, insomnia, agitation, convulsions
Caution: increase seizure risk in epileptics, avoid in patients with glaucoma, high abuse potential
Concerta
extended release tablet of methylphenidate, oral osmotic delivery, 12 hour duration of action, not affected by food
Metadate CD
provides efficacy throughout the day, biphasic release, affected by food
Focalin
d-isomer of methylphenidate, prescribed at 1/2 of usual dose
Daytrana
methylphenidate patch, for children 6-12
Amphetamines
Mechanism: increase neurotransmission in central NE, DA, and 5HT systems (dose related release) block reuptake of NE, DA, and 5HT, inhibition of MAO
Use: ADHD, Narcolepsy
Other: a lot more side effects, absorbed by GI tract, metab by liver, excreted in urine
Effects: increased attention, concentration, talkativeness, vigilance, and wakefulness; decreased fatigue and appetite; increased mood, elation, euphoria, and self confidence
Side effects: Abdominal pain, nausea, and weight loss
Restlessness, anxiety, insomnia, agitation, convulsions
Cautions: avoid in patients with CVD and glaucoma
High abuse potential, avoid with an MAOI, not for previous drug users
Atomoxetine (Strattera)
Mechanism: selective NE reuptake inhibitor
Use: ADHD
Other: non stimulant used in treatment of kids >6 adolescents and adults, metabolized by CYP2D6, careful in poor metabolizers, no abuse potential
Side Effects: abdominal pain, nausea, weight loss, headache, insomnia, somnolence, fatigue, aggression, urinary retention, orthostasis, psychotic symptoms
Cautions: avoid in patients with CVD, poor metabolizers, patients using an MAOI
Alpha 2a adrenergic agonists
Clonidine or Guanfacine
considered second line, good for reducing aggression, be careful in patients with Hx of CVD
Treatment options of Oppositional Defiant Disorder and Conduct Disorder
ADHD medications (methylphenidate, amphetamines, clonidine, guanfacine)
Mood stabilizers (Lithium and Sodium valproate)
Atypical antipsychotics (Risperidone and Aripiprazole)
Use of ADHD meds in ODD and CD
may need higher doses
may need to use alpha 2a adrenergic agonists with methylphenidate
Mood Stabilizers in ODD and CD
CD may be precursor for bipolar
Lithium controls aggression
can combine with an antipsychotic
Approach to treatment of Autism Spectrum Disorder
Treat the symptom
Inattention and Hyperactivity: Methylphenidate, alpha 2a adrenergic agonists, atomexatine, risperidone, SSRIs or Buspirone
Disruptive Behavior: Risperidone, other atypical, alpha 2a adrenergic agonists, mood stabilizers, anti epileptics, SSRIs
Repetitive Behavior Rigidity: Fluoxetine, Clomipramine, Risperidone
Sleep problems: Melatonin, Risperidone, SSRI
Tourette’s
likely due to disinhibition in portico-striatal-thalamic-cortical loops, with an overly active caudate nucleus
increased density of presynaptic dopamine transporters and an increased density of postsynaptic D2 dopamine receptors, suggesting increased uptake and release of dopamine
