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phm 701 neuro/psych/sub abuse > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

Lab findings in ADHD

A
  • Dec total brain volume
  • Dec activity in prefrontal and anterior cingulate cortex
  • Lack of connectivity of ventral striatum
    -Default mode network overactivity
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2
Q

Symptoms of ADHD

A
  • Inattention
  • Hyperactivity
  • Impulsivity
  • 6 or more present for more than 6 months in children, adults 5
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3
Q

ADHD Diagnosis pearls

A
  • always drug test (in order to rule out alternative causes)
  • evaluate every child 4-18 with behavioral or academic problems
  • significant impairment in 2 or more settings
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4
Q

Consequences of untreated ADHD

A
  • delay in language, motor, and social development
  • inc incidence of conflicts
  • inc risk of suicide attempts in early adulthood
  • inc prevalence of SUD + incarceration
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5
Q

Preschool/school age ADHD non pharm practices

A
  • parent/family edu
  • training on behavioral mod
  • behavioral class management (BCM)
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6
Q

Adolescents ADHD non pharm practices

A
  • break up assignments into segments
  • structure schedule
  • behavioral peer intervention
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7
Q

Adults ADHD non pharm options

A

-ADHD CBT
-Metacognitive therapy ( 2h/w x 12 weeks)

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8
Q

Dietary supplements in ADHD

A
  • lack of evidence but if there’s deficiencies treat it
  • iron-zinc may inc stimulate effectiveness, omega 3
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9
Q

Predominant ADHD first line

A

Methylphenidate > Amphetamine

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10
Q

Predominant ADHD inadequate response to first line

A

Atomoxetine, Viloxazine, Guanfacine, Clonidine, Bupropion

Try combos or tca next

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11
Q

Tourette’s

A

DA antagonist or a2 agonist (Clonidine)
- if patient has some response add on stimulant or atomoxetine or alternative

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12
Q

Bipolar/severe aggression (ADHD comorbidity)

A

Atypical APS, Lithium, Anticonvulsant
- if pt has some response add on A LOW DOSE stimulant (AE: mania)

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13
Q

Anxiety/ Depression (ADHD comorbidity)

A

Antidepressant (SSRI)
- if pt has some response add stimulant, no response use alternative

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14
Q

Stimulants MOA in ADHD

A

Block DA & NE uptake, inc catecholamine release, in monoamine oxidase (which inc DA in prefrontal cortex)

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15
Q

Immediate release amphetamines

A
  • mixed amp- IR salts (5-20)
  • amp sulfate IR (5-40)
  • odt (10-40)
  • d-amp-IR/liquid (2.5-40)
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16
Q

Stimulant AEs

A
  • psychiatric (mania/psychosis, aggression, sever anxiety) DOSE REDUCE
  • small cardiac changes ( 5 bpm inc)
  • dose related dec growth (drug free trial yrly)
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17
Q

Stimulants DDI (6)

A
  • MAOI (avoid, 14 day washout)
  • psycho-stimulants ( coffee, sildenafil, nicotine)
  • anti acids, ppis, H2RAs inc absorption of IR, dec absorption of ER MPH
  • Antacids dec excretion of AMP (requiring lower doses)
  • CYP2D6 inhibitors can inc AMP salt exposure (paroxetine & fluoxetine) requiring lower doses
  • Alcohol can cause stimulant dumping
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18
Q

Common stimulant SE and ways to help (6)

A
  • reduced appetite/ weight loss= high calf meal when stimulant effect low (AM/QHS)
  • stomach ache= take with food or dec dose
  • insomnia = give earlier in the day, dec last dose of day or give it earlier, give sedative meds ( guanfacine, Clonidine, melatonin, cypro)
  • headache = Divide dose, take with food, give analgesic
  • rebound sumptuous= LA stimulant, atomoxetine, antidepressant
  • irritability/jitteriness= comorbid condition, dec dose, mood stabilizer/ atypical antipsychotics
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19
Q

Uncommon stimulant effects (5) and what to do

A
  • dysphoria/euphoria
  • zombie like state
  • tics
  • HTN
  • hallucinations (D/C, reassess, mood stabilizers)
  • dec dose consider alternative
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20
Q

Immediate release advantages

A

low cost, less insomnia, fewer growth related ADE

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21
Q

Delayed release advantages

A

Med adherence

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22
Q

Delayed release AMP

A
  • mixed AMP-XR salts (5-30mg)
  • AMP sulfate ER suspension (6.3- 12.5)
  • AMP XR ODT (6.3-12.5)
  • D-AMP- ER (5-40 mg)
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23
Q

Clinical pearls about AMP ER Soln

A

-2.5- 5mg
- se: epistaxis(nose bleeds), upper abdominal pain, allergic rhinitis

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24
Q

Clinical pearls about AMP XR ODT/Suspension

A
  • food delays time to peak
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25
Clinical pearls about Mydayis ( Mixed AMP Salts ER)
-onset 1-2 hrs, last 16 hours - triple time release beads within capsules to reduce medication wearing off (better control)
26
Amphetamines moa at high doses
Stimulate serotonin release and acts as serotonin agonist
27
Transdermal MPH formulation
- indication 6-17 years - 10, 15, 20, 30 - apply 2 hrs b/f needed effect - apply to hips only (SE: chemical run throughout body) - max wear 9 hrs - 1-3 hr effect after removal - BBW site rxns: erythema/contact sensitization, chemical, leukoderma/hypopigmentation
28
Transdermal AMP formulation
- approved for 6 and up including adults - 4.5, 9, 13.5, 18 - apply 2 hr prior - multiple sites (rotation) - max wear for 9 hrs - effects last 3 hours after removal - <10% of drug this present after disposal - app site rxns: pain, itchiness
29
Methylphenidate clinical pearls
- Can use used in seizure patients - Less DDIs (can use with CYP2D6 concerns) - Used to treat tics - Men have inc bioavail
30
Amphetamine CI
- history of CV disease ( mod- severe HTN, HF, recent MI )
31
SNRI in ADHD
- Atomoxetine - Viloxazine *full benefit takes 6-8 weeks, behaviors may worsen initially
32
SNRI AE
- upset stomach, psychiatric & cardio effects (not recommended in HD) - Fatigue, sedation, dizziness - liver toxicity w/ long term use - renal dose adj
33
SNRI BBW
New onset sucidiality
34
SNRI DDI
- QT prolongation w/ TCA & APS - Atomoxetine conct inc by paroxetine and fluoxetine - Vuloxetine is strong CYP1A2 inhs
35
Which MPH products are 30/70
MPH ER MPH ER Chew MPH CD (beads)
36
Which MPH are 50/50
MPH LA DEX-MPH-XR
37
Clinical pearls about MPH XR ODT (Contempla)
- do not push blister pack, peel back foil - dissolve in tongue
38
Clinical pearls about Jornay PM (MPH ER)
- take in the evening (8 pm) - drug first layer takes 10hr to dissolve, second layer dissolves through the day -14 hr from dose to peak effect - 2 drug compartments
39
a2 agonist
Clonidine 0.1 QHS or BID max .4 Guanfacine 1-4 mg QD, max 7
40
a2 agonist ae
- sedation/dizziness/hypotension -constipation -heart block -dont take w/ high fat meal
41
bupropion
- 50-300 mg QD - metabolized faster in prepubertal children BID dosing
42
Bupropion AE
- appetite suppression - seizures
43
TCA Monitoring and AE
- 4 wks to see max effects -AE sedation, constipation, lethal overdose, rapid HR, weight gain, heart block
44
Lithium/ Anticonvulsants in ADHD
- treats aggression, explosive behaviors, impulsivity -BPD & ADHD
45
APS in ADHD
- 1st gen: chlorpromazine & Haloperidol treats hyperactivity; EPS concerns - 2nd gen treats severe aggression; metabolic risk
46
What to use in patients with SUD
- Atomoxetine, a2 agonist, bupropion -low doses of stimulates ER only
47
treatment for tics
-MHP, clonidine, guanfacine, atomoxetine
48
What products are appropriate for 3-5 year olds
Only IR products MHP & AMP
49
Neuropathic pain def
pain caused by a lesion or disease of the somatosensory nervous system; nervous system damage
50
Nervous System Damage
- inc nerve firing - dec inh of neuronal activity - sensitization causing amplification and sustain sensory
51
presentation of neuropathic pain
- Spontaneous; continuous or intermittent - Hyperalgesia: inc pain from painful stimuli - Allodynia: pain from non-painful stimuli
52
Counseling for neuropathic pain
- Meds should not be taken on prn basis - Take days to weeks for max effect - Will dec pain NOT resolve it -always initiate non pharm
53
Painful Diabetic Neuropathy Patho
- Damage to peripheral nerves and abnorm electric connections causes hyper excitability and activation of NMDA
54
PDN Treatments
-TCA, SNRI, Gabapentinoids +/- Na channel blockers - Topical Capsaicin or Lidocaine
55
Post herpetic Neuralgia
- Reactivation of varicella-zoster virus (shingles) - distribution along dermatomes - sensory damage leads to dec neuritic density
56
PHN treatment
- TCA, Antiepi (gaba, pregab, divalproex), Tramadol, opioids -lidocaine (focal!) and capsaicin
57
Lower back pain
- cyclical mechanism
58
LBP treatment
1. NSAIDS 2. Tramadol or Duloxetine 3. Opioids (last line)
59
Fibromyalgia
- enhanced sensitivity to stimuli (heat and cold) in all 4 quadrants - fog (fatigue & sleep) - women - neuroendocrine abnormalities - genetics
60
Fibromyalgia Treatment
Amtriptyline, Duloxetine or Milnacipran, Tramadol, Pregab, Cyclobenzapine
61
TCA Pearls
-Notriptyline, Despramine, Amitriptyline, Imipramine -AE: beers list NO IN ELDERLY, delayed onset, cardiotoxic
62
SNRI AE and CI
- Duloxetine, Venlafaxine, --AE: Serotonin syn; --CI: Hepatic impairment, ESRD - Milnacipran --AE: BID, HTN
63
Gabapentinoids
-Renal dose adj; crcl<15 lowest -pregablin is a control -both have slower onset
64
opioids in pain
Last line Tramadol (lower addiction profile) and Tapentadol
65
Capsaicin
dont stick on sensitive areas -ae burning

phm 701 neuro/psych/sub abuse (3 decks)

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