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ADHD Therapeutics (Dr. Castro)
Terms in this set (50)
The AAP considers ADHD a _____ disease, and this by definition has _____.
(requires ongoing management)
Besides medications, it is important for patients with ADHD to undergo _______.
ADHD is characterized by the DSM-V with 2 main things.
2. Hyperactivity and impulsivity
How many symptoms of inattention are needed for a diagnosis?
6+ for at least 6 months
MUST have negative impact on activites
How many symptoms of hyperactivity/impulsivity are needed for a diagnosis?
6+ for at least 6 months
MUST negatively impact social/ other activities
What class are ADHD medication?
When considering ADHD it is important to rule out _____.
First degree relatives of an individual with ADHD are _____ times more likely to have ADHD.
What are the 3 types of ADHD?
1. Combined type
3. Predominantly inattentive
Onset of symptoms must occur before _____.
7 years of age
Non-pharmacologic therapy for ADHD?
Diet treatment for ADHD?
- Omega 3
- Additive/Preservative- Free diet
- Oligoantigenic elimination diet
2 "classes" of pharmacological therapy for ADHD
Stimulant pharmacological therapy (5 options)
Non-stimulant pharmacological therapy for ADHD (5 options)
2. Central Alpha-2 Adrenergic agonists
What pharmacological therapy is considered first line?
Which pharmacological therapy is considered second line?
What is considered the best option for treatment for a patient with ADHD?
Combination of behavioral therapy and pharmacological therapy
The desired outcomes of treatment must be _____.
(e.g. be able to sit an a chair for 20 mins, completes homework assignments)
Parent training and behavioral interventions examples:
Positive rewards for good behavior and structured limit setting are considered first line before meds in ages 3-5
There is a universal belief that avoidance of ____ and ____ improves ADHD symptoms.
Which mineral supplements are recommended in patient with ADHD?
MOA for methylphenidate and amphetamines?
- Block dopamine and norepinephrine reuptake
- Increase catecholamine release
- Inhibit monoamine oxidase
Stimulants are considered to be ______ over psychotherapy.
Which form of stimulants are the preferred treatment?
Delayed release drugs
(Once-daily formulations are preferred)
Benefits to once-daily stimulant formulations.
- Better medication adherence
- Lower cost
- Less insomnia
- Potentially fewer growth effects
Lisdexamfetamine brand name?
T/F: Lisdexanfetamine is a prodrug?
- Longer time to onset of effectiveness
- May provide a smoother blood level compared with extended-release formulations
- It is intended to pose less abuse potential
Psych. adverse effects of stimulants.
Aggression or violent behavior
Severe anxiety/panic attacks
Cardiac adverse effects of stimulants
Sudden unexplained death has been added to ADHD stimulant drug labeling
- Increased heart rate
- Increased BP
- Caution in patients with known cardiac abnormalities
- Consider baseline ECG if history suggests cardiac abnormality
Growth adverse effects of stimulants
- ADHD stimulants can effect growth, but the effects are minimal/insignificant in children
- Amphetamines may be associated with more growth effects than methylphenidate
- Children should be given a drug-free trial every year
- Not considered a contraindication
T/F: Patients who have a history of schizophrenia have a contraindication to stimulant ADHD drugs?
Non-stimulant drug approved for use in ADHD in adults?
Amoxetine brand name?
T/F: the therapeutic benefit of amoxetine may not be seen for 6-8 weeks.
Adverse effects of amoxetine?
- GI upset
- Psych/ cardiac side effects
- Warning for severe liver injury
- Fatigue, sedation
- FDA warning for new-onset suicidality
Drugs that are central alpha-2 adrenergic agonists (2)
Guanfacine ER (Tenex)
Clonidine ER (Catapres)
Central Alpha-2 adrenergic agonist MOA?
Inhibit NE release presynaptically
Increase blood flow to the PFC postsynaptically
Side effects of guanfacine/ clonidine?
- Dose dependent sedation
Side effects of IR clonidine?
- Rebound hypertension
- Heart block
- Sudden death
Bupropion brand name
- Weak DA and NE re-uptake inhibitor
- No significant effect on 5-HT or MAO
T/F: Bupropion is FDA approved for the treatment of ADHD?
T/F: Studies showed that patients experienced more side effects with buproprion than with methylphenidate.
TCAs used in the treatment of ADHD?
TCAs are considered ____ line treatment for ADHD.
T/F: TCAs have the highest risk of cardiac side effects?
Bupropion adverse effects?
- Should not be used in children (or any patient) with seizure disorder or eating disorder
- May exacerbate tics
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