ADHD

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Author:
alvo2234
ID:
205146
Filename:
ADHD
Updated:
2013-03-05 18:31:46
Tags:
GIWA
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Description:
PT I Exam
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  1. what are the DSM-IV multiaxial assessment diagnosis
    • 1- clinical disorder
    • 2- personality d/o
    • 3- general medical conditions
    • 4- psychosocial and or environ problems
    • 5- global assessment of functioning
  2. prevailing theories of the pathophysiology of ADHD
    • 1. CNS dysfunction in NE and DA
    • 2. decreased blood flow to frontal lobe on PET scans
    • 3. decreased frontal and temporal lobe volume
  3. DSM-IV diagnosis for ADHD
    • present for at least 6 mths
    • present prior to age of 7
    • present in two or more settings
    • 6 or more inattention and hyperactivity sx
  4. reasons for false ADHD symptoms
    • age appropriate activity in children
    • IQ mismatch
    • defiant disorder
    • conduct disorder
    • bipolar disorder
    • personality disorder
    • medication (bronchodilators, antipsychotics)
  5. non pharmacological treatment for ADHD
    • 1. famil, school, work education and accomodation
    • 2. CBT
  6. 1st line agents for the treatment of ADHD
    • stimulants:
    • -MPH
    • -AMP
  7. 2nd line agents for the treatment of ADHD
    • non-stimulants:
    • atomoxetine
    • buproprion
    • TCAs
    • modafinil
    • alpha agonists
  8. contraindications for stimulant use
    • recent substance abuse
    • seizure, tourettes, or tic disorders
    • history of mania or psychosis
    • cardiac disorders
    • recent MAOI use
    • narrow angle glaucoma
    • breastfeeding
  9. equivalence of MPHs and AMPs
    MPH and AMP are equally efficacious but not potent; AMPs are twice as potent as MPHs
  10. immediate release vs long acting
    • 1. they are equally efficacious
    • 2. avoid multiple dosing if possible
    • 3. no need to titrate on IR then switch to LA
    • 4. initial treatment for very small children is IR
  11. MOA of MPH
    blocks DA uptake of central adrenergic neurons
  12. types of MPH
    • MPH
    • dex-MPH (focalin)- the more potent isomer
  13. short acting MPH agents
    • ritalin (MPH)
    • methylin (MPH)
    • focal (dex-MPH)
  14. when do you administer doses of short acting MPHs
    before breakfast and before lunch
  15. ritalin and methylin dosing
    5-60mg BID or TID
  16. focalin dosing
    2.5-20mg BID
  17. long acting MPH
    • 1. ritalin SR
    • 2. methylin ER
    • 3. Metadate ER

    *release MPH slow over 6-8 hrs
  18. long acting 1st generation MPH dosing
    • methalyn ER, ritalin SR, metadate ER;
    • 10-60mg BID
  19. 2nd generation MPH long acting
    • metadate (30/70)
    • ritalin (50/50)
    • focalin XR (50/50)
    • concerta- simulates TID dosing
  20. metadate CD dosing/release
    20-60mg daily (30/70)
  21. Ritalin LA dosing/release
    20-60mg daily (50/50)
  22. concerta dose/release
    18-72mg daily simulates TID dosing
  23. focalin dosing/release
    5-40mg daily (50/50)
  24. Daytrana
    • transdermal MPH patch
    • slower onset than other MPH products (2hrs)
    • effects may last 3 hrs after removal
  25. amphetamine IR preparations
    • adderall
    • dexadrine
  26. adderall dosing from ages 3-5yrs
    • 2.5 mg QD
    • max dose; 40mg
  27. adderall dosing for pts 6 or >
    • 5mg QD or BID
    • max dose; 60mg
  28. AMP long acting preparations
    • adderall XR
    • dexedrine spansule
    • vyvase
  29. adderall XR release percentage
    50/50
  30. dexedrine spansule release percentage
    50/50
  31. adderall XR dosing
    10-30 Q AM
  32. dexedrine spansule dosing
    5-40mg QD
  33. vyvanse dosing
    30-70mg daily
  34. stimulant AE
    • anorexia-most common
    • insomnia
    • irritability/anxiety
    • GI upset
    • tachycardia (more common in AMP)
    • --ensure BP is controlled before initiation
    • growth suppression
    • sudden unexplained death
    • abuse
  35. atomoxetine MOA
    NE reuptake inhibitor
  36. atomoxetine rare AE
    hepatotoxicity
  37. how long to see clinical effects in strattera
    may take up to 4 wks
  38. what is the black box warning on strattera
    may inc risk of suicidality
  39. alpha agonists used to treat ADHD
    • clonidine (kapvay)
    • guafacine (intuniv)
  40. Intuniv and Kapvay are FDA approved for what
    to treat ADHD in children 6-17 years of age
  41. how long does the effects of clonidine and guanfacine delay
    4-6wks
  42. what are 3rd line agents used to treat ADHD
    • 1.TCAs;imipramine (tofranil),nortriptyline (pamelor)
    • 2. buproprion


    *not FDA approved
  43. safety concerns for TCAs in treating ADHD
    • EKG at baseline
    • lower seizure threshold
    • anticholinergic
    • check drug levels
  44. SE of alpha agonist
    • sedation
    • hypotension
    • dizziness
  45. CMAP ADHD algorithms
    • 1. MPH/AMP
    • 2. other agent
    • 3. try different stimulant
    • 4. atomoxetine
    • 5. alpha-agonist
    • 6. TCA, buproprion, combo 

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