Adhd

Front 1

ADHD - Core symptoms (3)

Back 1

HII:
- Hyperactivity
- Inattentiveness
- Impulsivity

Front 2

ADHD is seen as early as age ___.

Back 2

3

Front 3

ADHD - Is an ECG required for every patient prior to starting stimulant therapy?

Back 3

No, according to CADDRA guideline, only those who have a personal or family history of cardiac problems, or raised blood pressure or heart rate on examination.

Front 4

ADHD - Diagnosis

Back 4

1. Inattention or hyperactivity/impulsivity
2. Onset before 7 years
3. Symptoms present in 2 or more settings
4. Significant impaired functioning
5. Duration at least 6 months

Certain symptoms may predominate: inattentive vs hyperactive vs combined subtypes

Front 5

ADHD - Non pharmacologic choices

Back 5

- Behavioral therapies(CBT) - not as effective as pharmacotherapy

- Mind body therapies such as neurofeedback or hypnosis(currently studied)

- Eliminating certain foods from diet such as sugars, dyes, or preservatives(observational evidence only)

Front 6

ADHD - Patients who do not respond to one type of stimulant should switch to another after ___ weeks.

Back 6

3-4 weeks

Front 7

ADHD - Onset of psychostimulants should be within ___. An adequate trial of stimulant is considered to be ____.

Back 7

2 days but may take up to 2 weeks

3-4 weeks.

Front 8

ADHD - At least ___ % of patients on psychostimulants will have a significant decrease in core ADHD symptoms.

Back 8

70%

Front 9

ADHD - CADDRA stands for

Back 9

Canadian Attention Deficit Disorder Resource Alliance

Front 10

ADHD - Advantages of long acting psychostimulants (3).

Back 10

- Duration is up to 12 hours, possible compliance increase

- Decreased abuse potential

- Decreased risk of rebound hyperactivity

Front 11

ADHD - Disadvantages of long acting psychostimulants (2)

Back 11

- More expensive

- Difficult to tiitrate initially

Front 12

ADHD - Immediate release formulations of methylphenidate and dextroamphetamine have durations of ___ hours.

Back 12

3-6 hours

Front 13

ADHD - Long acting and Extended Release formulations of methylphenidate and dextroamphetamine have durations of ___ hours.

Back 13

8-12

Front 14

ADHD - The longest duration psychostimulant is ___.

Back 14

Lisdexamfetamine (up to 14 hours)

Front 15

ADHD - Not in the amphetamine class but also has stimulant effects that help ADHD. Not officially approved for it though. Name and dose.

Back 15

Modafinil.

170-425mg/day.

Front 16

ADHD - Second line therapy

Back 16

- Norepinephrine Reuptake inhibitor: Atomoxetine (Strattera) --> not classified as a stimulant

- Antidepressants: TCAs(desipramine, imipramine, nortripyline), Buproprion, Venlafaxine.

- Alpha 2 Agonist: Clonidine

Front 17

ADHD - Atomoxetine MOA

Back 17

Norepinephrine Reuptake Inhibitor

Front 18

ADHD - Atomoxetine onset of effect

Back 18

3-4 weeks

Front 19

ADHD - Atomoxetine dosing

Back 19

- Dosing depends on weight.

- Less than 70kg: 0.8-1.2mg/kg/day (titrate up)

- More than 70kg: 40-80mg/day

Maximum 100mg/day regardless of weight.

Front 20

ADHD - Are which antidepressant class is not useful?

Back 20

SSRI's

Front 21

ADHD - If using TCAs must do this before. Why?

Back 21

Do a baseline ECG.

Because TCAs have a quinidine like effect on the heart(QT prolongation)

Front 22

ADHD - TCAs may require ___ weeks to take effect.

Back 22

3-4 weeks.

Front 23

ADHD - Can antipsychotics be used as treatment?

Back 23

Only if all other options have been tried.

Only good for behavioral symptoms (ie not good for inattentiveness).

Risperidone: 0.25-0.5mg po HS.

Front 24

ADHD - Kids on stimulant medications are generally shorter than kids not on it (True or False)

Back 24

True (kids will catch up in adolescence but likely permanently attenuated)

Front 25

ADHD - Capsules such as Adderall XR, Dexedrine spansules, Vyvanse, and biphentin capsules can be opened up and sprinkled on soft foods like ice cream, applesauce or yogurt (True or False)

Back 25

True. But must consume within 30 minutes. Also do not chew.

Front 26

ADHD - Treatment is generally lifelong, however parents may..

Back 26

Try a drug holiday (try weaning their kids off for 2-3 weeks in the summer to re-assess behavior and see if they require for new school term.

Front 27

ADHD - Side effects of psychostimulants

Back 27

- Headaches (goes away in 1-3 weeks)
- Abdominal pain
- Nausea
- Dry mouth (dexedrine)
- GI upset
- Insomnia (take meds early in day, avoid caffeine, naps)
- Irritibility
- Decreased appetite/Anorexia (give with high calorie meals)

These are usually transient and go away.
Any neurologic or psychological symptoms then stop taking. Can make tics worse.

Front 28

ADHD - Side effects of atomoxetine

Back 28

Similar to psychostimulants(N/V/HA) but especially increase in BP and HR

Front 29

ADHD - Dextroamphetamine is CI in pregnancy (true / false)

Back 29

False. It has the most evidence vs MP and atomoxidine.

Low birthweight but no teratogenicity.

Front 30

ADHD - Atomoxidine has risk of suicidal ideations (true/false)

Back 30

True.

Although risk is small, should discuss with pts and family.

Front 31

ADHD - Psychostimulants are approved for kids aged ___ years.

Back 31

at least 6 years old

Front 32

ADHD - Buproprion MOA. Is it effective for ADHD?

Back 32

Norepinephrine and Dopamine reuptake inhibitor

Moderately effective as per RCTs.

Front 33

ADHD - Venlafaxine MOA. Is it effective for ADHD?

Back 33

Noepinephrine and Serotonin reuptake inhibitor

Unlabeled use for ADHD, not studied. Possibly effective especially with adult ADHD.

Front 34

ADHD - Clonidine MOA. Is it effective for ADHD?

Back 34

Alpha 2 adrenergic agonist - 2nd or 3rd line use for ADHD.

It primarily reduces symptoms of aggression, hyperactivity, not inattentiveness.