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PHM701 > Final - ADHD > Flashcards

Final - ADHD Flashcards

1
Q

When must onset of symptoms occur for an ADHD diagnosis?

A

before 12 years

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2
Q

At what age do most diagnoses for ADHD occur?

A

6-11 (school age)

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3
Q

What are some non-pharm treatments for ADHD? (5)

A

parent/family education, behavioral classroom management (BCM), behavioral peer interventions (BPI), CBT, metacognitive therapy

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4
Q

What is first-line treatment for ADHD? (2)

A

methylphenidate/dexmethylphenidate or dextroamphetamine/amphetamine salts

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5
Q

What is second-line treatment for ADHD (or if inadequate response)? (5)

A

atomoxetine, viloxazine, guanfacine, clonidine, bupropion

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6
Q

What is first-line treatment for Tourette’s disorder? (2)

A

dopamine antagonist or alpha-2 agonist

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7
Q

What is second-line treatment for Tourette’s disorder? (3)

A

add stimulant, atomoxetine, or alpha-2 agonist

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8
Q

What is third-line for Tourette’s disorder? (2)

A

alternative dopamine antagonist or alpha-2 agonist

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9
Q

What is first-line treatment for bipolar disorder and/or severe aggression? (3)

A

atypical antipsychotic, lithium, anticonvulsants

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10
Q

What is second-line treatment for bipolar disorder and/or severe aggression?

A

add stimulant

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11
Q

What is third-line treatment for bipolar disorder and/or severe aggression? (2)

A

alternative dopamine antagonist or additional mood stabilizer

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12
Q

What is first-line treatment for anxiety or depression (w/ADHD)?

A

antidepressant

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13
Q

What is second-line treatment for anxiety or depression (w/ADHD)?

A

add stimulant

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14
Q

What is third-line treatment for anxiety or depression (w/ADHD)?

A

alternative antidepressant

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15
Q

What is the MOA of methylphenidate and amphetamines? (3)

A

block dopamine and norepinephrine reuptake, increase catecholamine release, inhibit MAO

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15
Q

What are the AEs of stimulants? (3)

A

psychiatric, cardiac (increase HR), stunted growth

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16
Q

What is the management for reduced appetite/weight loss? (2)

A

high calorie meals, cyproheptadine at bedtime

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17
Q

What is the management for insomnia? (3)

A

give dose earlier in day, lower the later dose, add sedating medication at bedtime

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18
Q

What is the management for rebound symptoms? (3)

A

long-acting stimulant trial, atomoxetine or antidepressants

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19
Q

What is the management for irritability/jitteriness? (3)

A

assess for comorbidity, reduce dose, consider mood stabilizer or atypical antipsychotic

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19
Q

What is the management for zombie-like states, tics, and HTN/pulse changes? (2)

A

reduce dose or change medication

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20
Q

Explain the pearls for MPH iR (Ritalin, Methylin)?

A

taken in 2-3 divided doses

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21
Q

Explain the pearl for MPH ER (Metadate ER, Quillivant XR)?

A

30:70 IR:ER

22
Q

Explain the pearls (2) for MPH ER Chew (Quillichew)?

A

30:70 IR:ER and tablets scored

23
Explain the pearls (2) for MPH CD (Metadate CD)?
30:70 IR:ER and can sprinkle
24
Explain the pearls (3) for MPH LA (Ritalin LA)?
50:50 IR:ER, can sprinkle, best for more severe morning symptoms
25
Explain the pearls (2) for MPH XR suspension?
requires shaking and good for 4 months
26
Explain the pearl for MPH OROS?
swallow whole/do not crush
27
Explain the pearl for MPH MLR (Aptensio XR)?
better for rebound afternoon symptoms
28
Explain the pearl for MPH MLR-02 (Adhansia XR)?
none
29
Explain the pearl for MPH XR-ODT (Cotempla XR-ODT)?
hard to switch cause of weird dosing (requires new titration)
30
Explain the pearls for MPH transdermal patch (Daytrana)? (2)
BBW for skin reactions and tics occur more often
31
Explain the pearls (2) for Dex-MPH IR?
no greater benefit over MPH and 1/2 the dose of MPH
32
Explain the pearls (2) for Dex-MPH-XR?
50:50 IR:ER, afternoon symptom control not as good as OROS
33
Explain the pearl for Dex-MPH/Ser-Dex-MPH?
risk of suicidal ideation
34
Explain the pearls (2) for MPH PM?
slow absorption, administer in evening
35
Which methylphenidate-containing products are dosed twice or more a day? (2)
MPH IR (Ritalin, Methylin) and Dex-MPH IR
36
Which methylphenidate-containing products have onset of effect greater than an hour? (6)
MPH ER, ER Chew, XR-ODT, transdermal patch, Dex-Ser, and PM
37
Which methylphenidate-containing products are dosed in the morning? (6)
MPH ER, ER Chew, LA, XR Suspension, OROS, Dex
38
What ages is methylphenidate approved for according to the FDA?
6+
39
Which amphetamine-containing products are approved in children 3+? (2)
mixed AMP-IR and AMP sulfate-IR
40
Explain the pearl for mixed AMP-XR salts? (2)
50:50 IR:ER and can sprinkle
41
Which AMP products require a retritation when switching? (3)
AMP ER solution, XR-ODT, and ER suspension
42
What are the AEs for AMP sulfate-XR solution? (3)
epistaxis, allergic rhinitis, GI
43
Explain the pearl for lisdexamfetamine?
designed for less abuse potential
44
Which amphetamine-containing products can be dosed multiple times a day? (4)
mixed AMP-IR, AMP sulfate-IR, AMP sulfate-ODT, and d-AMP IR
45
Explain the pearls for Mydasis? (3)
13+, can NOT convert, and formulated to reduce wearing off peaks
46
What is a contraindication for AMP-containing products?
cardiovascular diseases
47
Where can Daytrana be applied? Where can Xelstrym?
hip only; hip+
48
Which brands of stimulants are approved in ages 3+? (3)
Dexedrine, Evekeo, Adderall
49
Compare and contrast atomoxetine to viloxazine? (3)
atomoxetine is 1-2 doses, takes longer for max benefit, and duration of effect is half that of viloxazine
50
What are AEs for the norepinephrine reuptake inhibitors? (3)
GI, psychiatric, QTc prolongation
51
What are contraindications for norepinephrine reuptake inhibitors? (3)
BBW for new-onset suicidality, liver (viLoxetine) and renal problems, CYP inhibitors
52
Compare and contrast clonidine to guanfacine ER? (3)
clonidine is more sedating, is 1-2 doses and duration of effect is half that of guanfacine
53
What are other treatments for ADHD? (4)
bupropion, TCAs, lithium/anticonvulsants, and antipsychotics
54
When might lithium be a good choice for an ADHD patient? (3)
aggression, explosive behavior, impulsivity
55
Which patient groups need higher doses of stimulants?
oppositional-defiant/conduct disorder with ADHD

PHM701 (14 decks)

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