Card Set Information

2010-05-08 23:54:09

Therapeutics 3
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  1. Prevelance of ADHD?
    • 3-7% of all children
    • male>female 9:1
  2. Symptoms of ADHD in children 3-5 years old?`
    • inattention
    • hyperactivity
    • impulsivity
  3. Symptoms of ADHD in children 6-12 years old?
    incomplete hw, careless errors, struggle to follow instructions, unable to stay seated, talk non-stop, interrupts, hard to wait their turn, defiant
  4. Symptoms of ADHD in 13-18 year old teens?
    disorganized, procrastinate, inner restlessness, too many things at once, dangerous driving, defiant, poor self-esteem, anger, poor peer relationships
  5. Symptoms of ADHD in adults?
    • broken into personally and professionally
    • divorce, broken relationships, fear, restlessness, risk taking, unplanned pregnancy, criminal activity, late appointments, unfinished multi-tasker
  6. Name the comorbidities along with ADHD\
    • children- oppositional defiant disorder (ODD) (50%)
    • adults- anxiety disorder (47%)
    • other- depression, bipolar disorder, tic disorder
  7. How would you diagnose a patient with ADHD?
    • DSM-4
    • scales- specific for age
    • parent, teacher, patient
  8. Name the 3 types of ADHD
    • Predominantly inattentive (females, adolescents)
    • predominalty hyperactive-impulsive- (15% in children, virtually non-existant in adults)
    • combined
  9. What is the primary method to treat ADHD?
  10. What is the primary choice of medication to treat ADHD?
    stimulants: methylphenidate, dexmethylphenidate, mixed amphetamine salts, lisdexamphetamine
  11. Name the short-acting stimulants.
    • methyphenidate (Ritalin)
    • dexmethlyphenidate (Focalin)
    • amphetamine (Dexadrine)
    • mixed amphetamine salts (Adderall)
  12. Frequency of methylphenidate CD (Methadate CD)?
    • bid dosing
    • covers 8 hours
    • immediate release
    • 30% released immediately then 70% delayed release
  13. release of methylphenidate (Ritalin LA)
    • covers 8 hours
    • 50% of dose immediately released
    • 50% released 3-4 hours later
  14. Frequency of Focalin XR
    covers 12 hours
  15. Onset of methylphenidate (Daytrana) patch?
    onset of 2 hours, coverage of 3 hours after removal of patch
  16. Duration of Adderall XR
    8 hours
  17. Duration of lisdexamphetamine (Vyvanase)?
    12 hours
  18. Describe the steps in first initiating a new ADHD dose.
    • ped guidlines applied to adults too
    • immediate release for starting therapy
    • titrate every 3 to 5 days
    • go to ER form once immediate release dose is reached.
  19. efficacy of stimulants?
    • higher doses = better outcome
    • 70% of adolescents and children respond
    • 25-78% of adults respond
  20. How would you treat the SE of tics with ADHD tx?
    • not common <1%
    • d/c if clearly worsened
    • alternative tx
    • anti-tic (haldol, pimozide)
  21. What would the emergence of depression or mood lability indicate?
    • toxicity or rebound
    • reduce, d/c
    • add antidepressant/antimanic
    • CBT
    • rule out substance abuse
  22. If sleep disturbances become an issue, what can you do?
    • check sleep patterns, adjust time of med
    • add clonidine, trazodone, mirtazepine, melatonin
  23. What medication can increase appetite in a patient who is experiencing appetite suppression as a SE?
    cyproheptadine 2 mg qid
  24. Name a non-stimulant med
    • atomoxetine (Strattera)
    • efficacy usually seen after 2-6 weeks
    • some patients say after 3-4 months it doesn't work anymore
  25. Name some atomoxetine SE
    • Tachycardia, arrgythnia, sudden death
    • hypertentsion
    • hepatotoxicity
  26. If a patient is on a 2D6 inhibitor such as paroxetine and fluoxetine what needs to happen to the atomoxetine dose?
    needs to be reduced
  27. Name a stimulating anti-depressant that can be used for ADHD
    bupropion (Wellbutrin)