Lecture IDK - ADHD Flashcards
(50 cards)
DSM-5 ADHD Diagnostic criteria
Persistent pattern of inattention, or hyperactivity that clearly interferes with or reduces academic, social or occupational functioning
Must occur for > 6 months
Symptoms present before age 12 and in more than 1 setting
Must have > 6 symptoms of inattention or hyperactivity-impulsivity
Symptoms not manifestation of mood/anxiety disorder, personality disorder, substance into/withdrawal, etc
What changes for ADHD criteria at age 17?
> 5 criteria for inattention if develop after age 17
Inattention vs Hyperactivity
Inattention = fail to focus, hard to maintain attention, cant listen, follow instruction, finish schoolwork, etc
Hyperactivity = cant stop talking, sitting still, always on the go, interrupt, fidget
ADHD risk factors
Family HX of ADHD
perinatal stress
low birth weight
mom smoking during preg
TBI
severe early ox deprivation
adverse partent/child relationship
Genetics
DA/NE transporter gene
Twins 90% concordance n siblings too
Clinical Course + Comorbidities
onset during preschool years
diagnosis during school age
progress into adolescence
sleep & learning disorders, substance use disorder, psychiatric conditions, oppositional defiant disorder = dont listen to rules
pathophysiology ADHD
focused in Dopamine, dec dopamine in space
dysfunction with dopamine transporter
txm for ADHD
1st line = methylphenidate or amphetamine
2nd = atomoxetine
3rd = bupropion or TCA
Duration of ADHD treatment
if symptom free for 1 yr, need for med should be assessed
frequent attempt drug holidays when appropriate
Non-pharm ADHD therapy
family focused = 10-20 sessions, teach how to respond to actions
School focused = smaller classrooms other stuff
child focused = how to remove distractions n how to improve concentration
Methylphenidate MOA
CNS stimulant, inhibits reuptake of DA and NE
Methylphenidate PK
time to peak can be delayed by high-fat breakfast
Methylphenidate dosing
dont give within 6hrs of bed time
can use IR for breakthrough or wear off dosing along with LA dosages
concerta info
IR release Outer coat
semipermeable membrane that will control release of drug
Low conc released first then mid-day high conc drug is expelled
allows longer duration and limits abuse potential
Aptensio XR
combo of IR and ER
40% = IR, 60% = ER later in day
Methylphenidate CD Caveats
2 peaks in lvls
Ritalin LA Caveats
2 peaks in lvls
Quillivant XR Caveats
recon, shake before giving, store at room temp
** contains Benoni acid which is metabolite of benzyl alc; potential for allergic reaction**
Concerta Caveats
2 peaks, most likely find capsule in stool
Avoid w/ GI obstruction or narrowing
Daytrana Caveats
** apply to hip, leave for 9hrs, inflamed skin/heat inc absorption**
** caution switching oral to patch, patch higher bioavailability, lower 1st pass**
may cause severe allergic reaction n spread past patch site
recent warning patch labeling perm loss of skin color at app site
Focalin XR Caveats
2 peaks in lvls
Amphetamine MOA
stim release of DA n NE
Block DA/NE reuptake
Amphetamine PK
time to peak maybe delayed by his-fat breakfast
Lisdexamfetamine prodrug -> Dextroamphetamine
Amphetamine dosing
dont give within 6hrs of bed time
can use IR for breakthrough or wear off dosing along with LA dosages
All stimulant CI and Boxed warnings
Warnings = abuse potential + sudden cardiac death w/ pre-existing conditions
CI = Cardiovascular instability, hyperthyroidism, Glaucoma, Agitated States, H/x drug abuse, within 14 days of MAOI
