Sherwood ADHD Lecture
About this set
Created by:
kfrigginmoney on February 21, 2012
Subjects:
ADHD, psychopharmacology, therapeutics
Description:
It was actually done by that one dude but who's keeping track anyway really
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62 terms
Terms | Definitions |
|---|---|
 True or false: ADHD is frequently overdiagnosed and overtreated. | False; it is underdiagnosed and undertreated |
| (Boys/Girls) are more likely to have ADHD (select one) | Boys, 4x more likely |
| What is the pathophysiology behind ADHD? | Thought to be associated with functional and anatomic dysfunction in the frontal cortex and basal ganglia areas. This is associated with increased expression of D2 receptor gene, as well as the dopamine transporter gene, and also the D4 receptor gene. |
| What neurotransmitters are involved with ADHD's pathophysiology? | In order of importance, greatest first: Dopamine, norepinephrine, serotonin. |
| What are some nongenetic factors that can predispose someone to developing ADHD? | Fetal Alcohol Syndrome Lead poisoning Meningitis Pregnancy complications (mostly related to smoking) Adverse parent-child relationships Being poor |
| What are the broad DSM-IV TR criteria for ADHD? | - Some symptoms must be present prior to 7 years of age - Impairment from symptoms must be present in 2 or more settings - Clinically significant impairment in social, academic, or occupational functioning - Symptoms must be independent from other psychiatric disorders |
| What are the criteria for inattention? | Six or more of the following for at least 6 months: - Fails to give attention to stuff and makes careless mistakes - Difficulty sustaining attention in tasks or play - Does not seem to listen when spoken to directly - Does not follow through on instructions - Difficulty organizing tasks and activities - Avoids activities that require concentration - Loses items necessary for tasks or activities - Easily extracted by external stimuli - Forgetful in daily activities |
| What are the criteria for hyperactivity? | 6 or more for at least 6 months: - Fidgets with hands or feet or squirms in seat - Leaves seat in situations where one remains seated - Runs around or climbs things - Difficulty playing or engaging in leisure activities quietly - acts as if "driven by a motor" - Talks excessively |
| What are the criteria for impulsivity? | - Blurts out answers before questions have been completed - Difficulty awaiting turn - Interrupts or intrudes on others |
| True or false: activity level does not change in ADHD children based on the situation | True; a child will be hyper pretty much all the time, but in cases where being calm is expected, their relative hyperactivity will be much higher. |
| The medical exam for ADHD screening is meant to rule out what physical causes? | Seizures, sleep disoders, and medication side effects Differentiate from a developmental disorder, mood disorder, BPD, Tic disorder, or normal childhood behavior. |
| Who should be screened for ADHD? | Everyone between 4-18 years of age. Also people with: - Academic or behavioral problems - Symptoms of inattention, hyperactivity, or impulsivity |
| What is it about ADHD that makes differential diagnosis so difficult? | ADHD is comorbid with so many other disorders, such as: - Depression - Conduct disorder - Anxiety disorder - Tic disorder, and more... |
| What is the recommended therapy for children diagnosed with ADHD at 4-5 years of age? | 1st line: behavioral therapy 2nd line: methylphenidate |
| What is the recommended therapy for children diagnosed with ADHD at 6-11 years of age? | 1st line: stimulants with or without behavioral therapy 2nd line: nonstimulants with or without behavior therapy |
| What is the recommended therapy for patients diagnosed with ADHD at 12-18 years of age? | 1st line: FDA approved ADHD medication of any sort, with or without behavior therapy |
| What characteristics in pre-school age children would make them good candidates for methylphenidate? | Greater than 9 months symptoms Dysfunction both at home and in preschool/daycare Inadeqeuate response to behavioral therapy |
| Which stimulant has the greatest efficacy? | None, they all have equal efficacy. |
| What are contraindications for stimulant use? | - Heart disease or suggestive symptoms - Glaucoma - Use of MAO-I within 14 days prior - history of drug abuse - Moderate to severe hypertension - Agitated states |
| What are the major (marked in red) side effects of stimulants? | Tics, insomnia, headache, abdominal cramps, and stunted growth |
| What is the children and adolescent daily dosing range for methylphenidate? | 0.3-2.0 mg/kg |
| Methylphenidate has a greater effect on __________ than _________ compared to other stimulants (two words for each blank) | mental activites; motor activities |
| What has greater bioavailability, the IR or ER form of methylphenidate? | They're equal |
| How is methylphenidate metabolized? What ramifications does this have for drug-drug interactions? | Metabolized by de-esterification; less chance of drug-drug interactions |
| What stimulants would be ideal for a patient who is considered to have high risk of substance abuse? | Concerta, Daytrana, Vyvanse |
| What is the children and adolescent daily dosing range for amphetamine salts? | 0.1-1.5 mg/kg |
| Let's say a patient starts on one kind of stimulant, but doesn't have improvement in all symptoms; for instance, they have improved concentration, but they are still much too fidgety. What would be a good treatment modification? | Switch to another type of stimulant, they may respond better to one that works with their brain better. |
| How are amphetamine salts metabolized? | Oxidized by CYP2D6 - Excreted in urine 50% unchanged, 50% metabolites |
| How is it that dextroamphetamine is approved for kids under 6, while methylphenidate is not? | Dextroamphetamine was tested back before standards were a bit stricter. Also, you can still give kids under 6 methylphenidate, it is just off-label in that case. |
| In what cases should atomoxetine be considered the first-line therapy for ADHD? | If the patient has: - A history of substance abuse - Comorbid anxiety - Tic disorder |
| How is atomoxetine dosed for children and adults under 70 kilograms? (initial, target, max dose) | 0.5 mg/kg 1.2mg/kg 1.4mg/kg or 100mg, whichever is less |
| How is atomoxetine dosed for children and adults over 70 kilograms? (initial, target, max dose) | 40mg 80mg 100mg |
| How is atomoxetine metabolized? | CYP2D6 glucuronidation 80% excreted in urine |
| True or false: atomoxetine can be discontinued without tapering. | True |
| How is guanfacine dosed? | 1-4mg PO QD |
| How is guanfacine metabolized? | CYP3A4 |
| True or false: Guanfacine can be discontinued without tapering. | False; can have rebound hypertension in withdrawal |
| True or false: Only the extended-release oral and extended-release patch forms of clonidine are approved by the FDA for ADHD. | False; the patch is not approved, the ER oral form is. |
| For which drug are the IR and ER forms not equivalent? | Clonidine |
| How is bupropion dosed for ADHD? | 3-6mg/kg/day or 150-300mg/day in divided doses |
| What is the dosing of Focalin (dexmethylphenidate)? Max dose? | 5-10mg BID. Max: 20mg |
| What is the dosing of Focalin XR (dexmethylphenidate extended-release)? Max dose? | 5-20mg QD Max: 30mg (children) 40mg (adults) |
| What is the duration of effect for dexmethylphenidate IR? | 3-5 hours |
| What is the duration of effect for dexmethylphenidate XR? | 8-12 hours |
| What's so special about Daytrana? | Onset occurs 2 hours after applying the patch. Effect persists for 3 hours after removing it. |
| What is the duration of action of immediate release amphetamine salts? | 4-6 hours |
| What is the duration of action of extended release amphetamine salts? | 8-12 hours |
| What is the usual dose of immediate release amphetamine salts? | 10-40mg QD or in divided doses |
| What is the usual dose of extended release amphetamine salts? | 10-30mg QAM |
| What is the duration of action of immediate release dextroamphetamine? | 4-6 hours |
| What is the duration of action of extended release dextroamphetamine? | 5-8 hours |
| What is the usual dose of immediate release dextroamphetamine? | 5-15mg BID |
| What is the usual dose of extended release dextroamphetamine? | 5-30mg QD or 5-15mg BID Max: 40mg/day |
| How is Vyvanse dosed? | 30-70mg/day |
| What TCAs are approved for ADHD? | None of them are approved, technically, but the ones mentioned in the slides are imipramine (1-4mg/kg/day) and nortriptyline (0.5-2mg/kg/day). |
| What MAOIs can possibly be used for ADHD? | Tranylcypromine and selegiline |
| What is the drug that causes sedation and induces appetite in children? | Cyproheptadine |
| How often should you monitor weight, height, eating and sleeping patterns in ADHD patients? | Give a baseline measurement, then follow up every 3 months. P.S. the slide says to do a periodic CBC, differential, and platelets, but as someone who used to receive treatment for ADHD, i never remember doing this, so, shrug |
| What should you remember when monitoring therapeutic response to pharmacotherapy in ADHD patients? | Monitor frequently Done using rating scales (Child Behavioral Checklist, ADHD Rating Scale-IV) With stimulants, the effects are seen very quickly - can be titrated quickly, as in every 3-7 days |
| Describe the typical adult with ADHD. | A divorced white dude out of work |
| What ADHD drug has a tri-phasic release? | Concerta |
| What ADHD drugs have bi-phasic release? | All of the extended-release stimulants |
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