Pediatric Psych Treatment

Question 1

Stimulants- Available Drugs

Answer 1

Methlyphenidate
Dexemethylphenidate
Amphetamine Salts

Question 2

Stimulants- Mech of Action

Answer 2

Block reuptake of NE and DA in presynaptic neurons

Increase DA in synaptic cleft

Da improves attention
NE dampens noise, increases inhibition

Question 3

Stimulants- Absorption, Distribution

Answer 3

Can be short or long acting
Titrate to optimum dose
MPH has faster onset, but Adderall (amphetamine salts) has longer lasting effect

Question 4

Stimulants- Adverse Effects/Contraindications

Answer 4

Black box warning= chance of sudden death–> contraindicated in structural cardiac abnormalities, cardiomyopathy, serious rhythm abnormalities

temporary growth slowing

Adderall= more stomachaches and sad mood than MPH

Question 5

Methylphenidate- Clinical Use

Answer 5

first line for ADHD

patients at least 6 y/o

Question 6

Amphetamine salts- Notes

Answer 6

Patients at least 3 y/o

Question 7

Methylphenidate- Brand Names

Answer 7

Ritalin
Ritalin LA/SA 
Metadate CD/ER
Concerta
Daytrana

Question 8

Dexemthylphenidate- Brand Names

Answer 8

Focalin

Question 9

Amphetamine Salts- Brand Names

Answer 9

Dextroamphetamine
Mixed amphetamine salts- ADDERALL
Vynase

Question 10

Non-Stimulants (Selective NE Reuptake Inhibitors)- Available Drugs

Answer 10

ATOMOXETINE

Question 11

Selective NE Reuptake Inhibitor (Atomoxetine)- Mech of Action

Answer 11

Inhibit presynaptic NE transporter, Increase NE in synaptic cleft.

Question 12

Selective NE Reuptake Inhibitor (Atomoxetine)- Absorption, Distribution

Answer 12

dosed by weight

Question 13

Selective NE Reuptake Inhibitor (Atomoxetine)- Clinical Use

Answer 13

suggested second line for ADHD

patients at least 6 y/o

Question 14

Selective NE Reuptake Inhibitor (Atomoxetine)- Adverse Effects/Contraindications

Answer 14

caution in children that are Cyp2D6 slow metabolizers= higher peak concentrations

Question 15

SSRIs- Available Drugs

Answer 15

FLUOXETINE
Citalopram
ESCITALOPRAM
FLUVOXAMINE
SERTALINE
Paraoxetine

Question 16

SSRIs- Mech of Action

Answer 16

increase 5-HT in the synaptic cleft

Question 17

SSRIs- Adverse Effects/Contraindications

Answer 17

Black box warning= increased risk of suicidal thinking and behaviors during first few months of treatment

Question 18

Fluoxetine- Clinical Use

Answer 18

MDD- age >8y/o

OCD- age >7y/o

Question 19

Escitalopram- Clinical Use

Answer 19

MDD- age 12-17

Question 20

Fluvoxamine- Clinical Use

Answer 20

OCD age >8y/o

Question 21

Sertaline- Clinical Use

Answer 21

OCD age >6y/o

Question 22

Citalopram, Escitalopram- Notes

Answer 22

Most selective for 5-HT, no effect on NE

Question 23

Sertaline, Paroxetine- Notes

Answer 23

Most potent 5-HT reuptake inhibitors

Question 24

SNRIs- Available Drugs

Answer 24

Venlafaxine
Mirtazapine
Duloxetine
Desvenlafaxine

Question 25

SNRIs- Mech of Action

Answer 25

increase 5-HT, DA, and NE in the synaptic cleft

Question 26

SNRIs- Clinical Use

Answer 26

off-label use only

Question 27

SNRIs- Adverse Effects/Contraindications

Answer 27

Black box warning= increased risk of suicidal thinking and behaviors during first few months of treatment

Question 28

Typical Antipsychotics- Available Drugs

Answer 28

Haloperidol Chlorpromazine Thioridazine

Question 29

Typical Antipsychotics (Haloperidol, Chlorpromazine, Thioridazine)- Mech of Action

Answer 29

Block postsynaptic D2 receptors and presynaptic dopamine autoreceptors

Question 30

Typical Antipsychotics (Haloperidol, Chlorpromazine, Thioridazine)- Clinical Use

Answer 30

Acute, short-term for aggression, delirium, or when treatment with atypical antipsychotics fail

Question 31

Typical Antipsychotics (Haloperidol, Chlorpromazine, Thioridazine)- Adverse Effects/Contraindications

Answer 31

NMS (NEUROLEPTIC MALIGNANT SYNDROME) | Contrindicated in prolonged QT interval, ventricular tachycardia, arrhythmias

Question 32

Atypical Antipsychotics- Available Drugs

Answer 32

``` RISPERIDONE Clozapine Olanzapine Quetiapine Ziprasidone Aripiprazole ```

Question 33

Atypical Antipsychotics (RISPERIDONE, Clozapine, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole)- Elimination

Answer 33

metabolized by CYP450 system

Question 34

Atypical Antipsychotics (RISPERIDONE, Clozapine, Olanzapine, Quetiapine, Ziprasidone, Aripiprazole)- Adverse Effects/Contraindications

Answer 34

NMS (NEUROLEPTIC MALIGNANT SYNDROME) safer than the typical antipsychotics Risperidone- increased appetite, fatigue, dizziness, drooling Contraindicated in prolonged QT interval, ventricular tachycardia, arrhythmias

Question 35

Lithium Carbonate- Mech of Action

Answer 35

Blocks Phosphoinositol (PI) activity Inhibit cAMP Stabilize neuronal excitement

Question 36

Lithium Carbonate- Elimination

Answer 36

Excreted unchanged by the kidney | Children have higher clearance & shorter half life than adults= reach steady state faster

Question 37

Lithium Carbonate- Clinical Use

Answer 37

First line treatment for bipolar in children- age >12 irritability impulsivity aggression may have protective effect against suicidality

Question 38

Lithium Carbonate- Adverse Effects/Contraindications

Answer 38

GI symptoms, polyuria, polydipsia, enuresis, fatigue, fine hand tremor, osmotic diarrhea Contraindicated in renal disease, cardiovascular disease, dehydration, hyponatremia, co-administration of diuretics or ACE inhibitors

Question 39

Antiepileptics- Available Drugs

Answer 39

``` DIVALPROEX SODIUM Carbemazepine Oxacarbazepine Lamotrigine Topiramate Gabapentin ```

Question 40

Divalproex Sodium- Clinical Use

Answer 40

First line treatment for Bipolar in children- age >18 irritability impulsivity aggression

Question 41

Divalproex Sodium- Adverse EffectContraindications

Answer 41

GI symptoms, weight gain, drowsiness, hair loss hepatotoxicity, liver failure rarely pancreatitis, thrombocytopenia, polycystic ovaries