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41 Cards in this Set
- Front
- Back
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Components of AHDH (3)
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1. Hyperactivity
2. Impulsivity 3. Innattention |
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Hyperactivity: components
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squirms / fidgets
cannot stay seated runs / climbs obsessively on the go cannot play quietly driven |
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impulsivity: components
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blurts out answers
cannot wait turn intrudes/ interupts |
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inattention
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careless
doesn't listen no follow through avoids or dislikes tasks req attention cannot organize loses imp things easily distractable forgetful |
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Criteria for ADHD
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6's
- 6+ hyperactive or impulsive components OR 6+ inattention components - for 6+ months - some s/s <7yo - significant impairment - impairment is in 2+ settings - excludes other mental disorders |
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comorbidities with adhd
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associated disabilities: LD, language, motor
tics sleep disorders |
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what is the most common comorbidity with ADHD
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oppositional defiant
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what percentage of school age children have ADHD
total males females |
8-10%
males ~9% females ~3% |
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name some scales used to dx ADHD in the medical setting
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Connors Rating Scale (main one)
ADHD Rating Scale IV NICHQ Vanderbilt Assessment Scale |
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what are the 4 classes of meds used in ADHD
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Stimulants
Antihypertensives Antidepressants SNRI - selective norepi re-uptake inhibitor |
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what are the 2 types of stimulant meds used in ADHD
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methylphenidates
amphetamies |
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what is the MOA of stimulant meds
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improves transmission across the nerve to improve stimulation --> improves concentration
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what are the most common reasons for ONCE DAILY dosing of meds
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1. extended coverage is needed for longer periods (afterschool activ, social interactions, homework hours tough)
2. problems with in-school dosing (privacy, security of meds) |
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what are the amphetamines:
1. short acting 2. intermediate acting 3. long-acting |
short-acting (rare)
DEXEDRINE TABS intermediate-acting ADDERALL DEXEDRINE SPANSULES long acting ADDERALL XR VYVANSE |
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how long does adderall XR last?
Vyvanse? |
Adderall XR - 8hrs
Vyvanse - 10-12hrs |
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why does Vyvanse have a lower abuse potential
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there is not as much of a good feeling from the equivalent oral dose of an amphetamine
(it's a prodrug) |
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what are the types of methylphenidates?
short acting intermediate acting long acting patch |
short:
RITALIN METHYLIN intermediate acting METADATE FOCALIN long acting CONCERTA METADATE CD RITALIN LA FOCALIN XR patch DAYTRANA |
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what methylphenidate comes in oral solution and grape chewables?
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Methylin
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how long is the Daytrana patch recommended to stay on?
when should it be taken off and why? |
9 hrs
take off after school otherwise can affect sleep |
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what SNRI is used for ADHD
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amoxetine
(Strattera) |
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when is amoxetine (Strattera) taken, how often?
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once daily in the AM
(or can divide BID) |
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when/why would you consider switching/starting with amoxetine (Strattera)
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concerned about abuse potential/current substance abuse
severe side effects of stimulants |
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what are important adverse effects to monitor for with amoxetine (Strattera)
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suicidal ideation/behaviors
clinical worsening unusual change in behavior change |
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what are the alpha-2 agonists used for ADHD
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CLONIDINE (CATAPRES)
GUANFACINE (TENEX) |
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how is clonidine administered for ADHD? what is the common use in ADHD?
what are the side effects? |
transdermal patch
for sleep induction SFx: sedation, rebound HTN |
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what is Guanfacine used for in ADHD? what is the benefit?
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used as an alternative to clonidine for sleep.
less sedating and somewhat effective against tics |
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what are the side effects of the stimulant meds, in general
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Insomnia
Anorexia Rebound / irritable Dysphoria Dullness stomachache HA Tics / Compulsive behv Overfocus / Staring |
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what is the most common adverse effect with stimulants
who's at greatest risk? |
APPETITE SUPPRESSION
smaller, younger children are at higher risk worst with Concerta |
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what can be done to combat decreased appetite? what is the concern?
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concern : decreased growth
intervention: - give AFTER meals - increase caloric intake - more snacks / nutritional supplements such as boost or pediasure - breakfast - eat SOMEthing - very hungry when it wears off, so have them eat then (good snack after school) - drug holidays (weekends, etc) - start with lowest dose |
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what is done for behv rebound/ irritability
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decrease the afternoon dose
try a sustained release stimulant med to last until close to bedtime |
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what is the connection btween TICS and ADHD
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can have Tics with ADHD that may have nothing to do with the meds or may be exaccerbated or brought on by meds
50% of children with Tourettes also have ADHD most resolve w/ or w/o stopping meds |
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what is the management of tics
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observe
reduce stimulant dose try a diff stimulant add clonidine or guanfacine (tenex) |
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what are the sleep problems that can come from the stimulants
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delay in falling asleep
night awakenings |
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what to do about sleep problems
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*remember, can be function of ADHD OR the meds*
eliminate/reduce afternoon dose elim caffeine add low dose of clonidine 30 min before bedtime sleep hygeine / bedtime routine no TV before bed |
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when do you seen HA and stomachaches in ADHD
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early in treatment
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what is the management of HA and stomachaches in ADHD
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take meds with meals
smaller, more freq meals decrease dose switch stimulant |
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who is eligible for IEP or 504 or help through IDEA
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3-21yo children with disabilities
child having trouble learning in school due to mental, physical or emotional disabilities children < 3yo eligible for early intervention svcs through Infants and Toddlers Prg |
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what is the difference between IEP and 504's
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IEP is special education - accommodations (svc and support), more formalized
504 is more general accommodations, like a plan for the classroom |
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possible classroom accommodations for ADHD
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preferential seating
copies of notes behavior contract highlighted textbook second set of bks taped class materials assignment book extended time on hmwk study guide extracredit opp testing accommodations |
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what are some strategies for the home environment for a kid w ADHD
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focus on strengths
keep daily schedule cut down distractions organize the house - places for things and activities, like homework limit choices use charts and checklists set small, reachable goals |
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what are adolescents who have ADHD at risk for
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substance use
conduct disd depression anxiety personality disorders |
