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52 Cards in this Set
- Front
- Back
Child/Adolescent Psychopharmacology
what is the controversy in this field? |
Controversy related to the developing brain in children and adolescents
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Drug classifications? 6
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• Stimulants
• Antidepressants • Antipsychotics • Mood stabilizers • Anxiolytics • Alpha Adrenergic antagonists that drugs are really the Seine the only one we haven't talked about is the stimulants |
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DSM disorders 7
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• Attention Deficit-Hyperactivity disorder &
• Disruptive behavior disorders • Mood disorders • Anxiety disorders • Autism & pervasive development disorder • Tics and Tourette’s disorder • Psychotic disorders |
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Disruptive Behavior Disorders 4
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• Attention Deficit-Hyperactivity Disorder
• Intermittent Explosive Disorder • Oppositional Defiant Disorder- Conduct Disorder- |
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What is the number one DSM disorder we encountered in this age group
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Attention deficit hyperactivity disorder
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When you're trying to get a diagnosis in this age group but must you do?
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Talk to the parents, get a good family history, get an idea of when the symptoms started, and look at the target symptoms you have to treat it is time
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Disruptive behavior disorders are common in
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Schools
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What disorder is this? period of extreme rage w/ an aggressive outburst; grossly out of proportion to the incident
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Intermittent explosive disorder
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What disorder is this? parent training therapy & child therapy; hostile, defiant, or negative behavior towards authority
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Oppositional defiant disorder
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Would this order is this? parent training therapy & child therapy- routinely violating the rights of others and lacking empathy
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Conduct disorder
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What do you do when a child has irritability, aggression, impulse control?
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Treat the target symptoms and underlying or comorbid conditions
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How do you treat the target symptoms of the irritability aggression, and impulse control?
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Atypical antipsychotics and
mood stabilizers |
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What are the usual or underlying comorbid conditions for irritability, aggression, impulse control?
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ADHD
depression bipolar disorder |
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What is the atypical antipsychotic usually used in children
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Low dose risperdal
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Medications to treat Irritability, Aggression, Impulse Control? These will not be on the exam
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• Thorazine: initial dose 10mg (150mg to 375mg)- high EPS
• Haldol 0.5mg (1 to 10mg daily)- high EPS • Abilify 5mg (10 to 20mg) • Fanapt 2mg (12 to 24 mg daily) • Zyprexa 1.25mg (5 to 15mg daily) • Invega 1mg (12 mg daily) • Seroquel 12.5mg (100-550mg daily) • Risperdal 0.25mg (0.5to 4 mg daily)- has been studied the most; improves the ability to interact socially & control behavior better • Geodon 5mg (40-140mg daily) |
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Which to medications are FDA approved for children though we try to stay away from them because of EPS?
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Thorazine and Haldol
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All of the other medications have the risk of developing what?
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Metabolic syndrome
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Which medication has been studied the most in children
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Risperdal improves the ability to interact socially & control behavior better than have that reactive type of lashout explosion
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What are the three types of ADHD
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Hyperactive
inattentive combined |
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Which type of ADHD is the impulsive type
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Hyperactive
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Which type of ADHD is a separate neurological base for this d/o- doesn't respond as well to stimulants?
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Inattentive
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Which type of ADHD doesn't respond well to stimulants?
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Inattentive
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ADHD is a diagnosis of what?
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Exclusion which means you have looked at all other types of differential diagnoses
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Treatment of ADHD is extremely _______.
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Effective
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What happens when you don't treat ADHD?
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They can have long-term effects on the brain some areas rooming smaller in size such as the cerebellum the frontal lobe and the temporal lobes
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What is the percentage of children if untreated or ADHD that will continue on through adulthood?
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40%
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In what age group is this diagnosis usually found ADHD?
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They can show up in preschool
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In infants and toddlers with ADHD who happens?
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You have a hard time trying to calm them down or to soothe them
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What is a symptom of ADHD?
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Hyperactivity
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What does ADHD look like? 3
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Poor concentration
disorganized forgetful |
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ADHD must have an early?
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Must have an early onset
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There was a study done about moms who drank during pregnancy when do the signs and symptoms of ADHD come out and why?
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Usually the signs and symptoms won't come out until age 9, the fetus has lower brain growth, there is less organization, this child will have issues with neurotransmitters and usually won't be able to control impulses
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Does ADHD run in families?
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Yes, it is highly genetic
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What happens to children of ADHD if it is not treated?
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They continue to be disruptive, they continue to have low self esteem, they are not achievers in school, they are always falling behind, and their socially not getting along with everyone so it's a snowball effect. We have huge disability problems and also problems with substance abuse in this population
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What are some of the differential diagnoses for ADHD if the child has restlessness and inattention?
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Rule out bipolar disorder in the prodromal phase, anxiety, social anxiety disorder, PTSD, child abuse, depression- situational stress or otherwise, boredom
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ADHD stimulants have instantaneous what?
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Effects
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ADHD stimulants
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Dexmethyphenidate (Focalin)-
Methylphenidate (Ritalin, Concerta, Metadate) Dextroamphetamine (Dexedrine) Mixed preparation: dextroamphetamine amphetamine Lisdexamphetamine: Vyvanse |
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ADHD stimulants
Dexmethyphenidate (Focalin)- when does this peak |
In one hour
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ADHD stimulants
Dexmethyphenidate (Focalin)- it has a half-life of |
Two hours
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ADHD stimulants
Dexmethyphenidate (Focalin)- what age groups can use this |
Kids six and up
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ADHD
• Stimulants Where the XR products? And they last up to how many hours? |
Methylphenidate (Ritalin, Concerta, Metadate) eight hours
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ADHD
• Stimulants how long does Ritalin last |
Eight hours
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ADHD
• Stimulants how long this concerta last |
12 hours
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ADHD
• Stimulants what is the mixed preparation |
dextroamphetamine amphetamine (Adderall)
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ADHD
• Stimulants that are all can be taken by kids ages what |
3 to 5
>6 5 mg 5y/o 2.5g |
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ADHD
• Stimulants how do you start these drugs |
Start out w/ IR release and titrate up to the dose that will be used in long acting product
Recommend that they start on the weekend (so parents can see effects) |
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Stimulants treat what kind of symptoms?
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All core symptoms of the disorder
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stimulants are regulated by who?
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DEA
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Stimulants are controlled substances what class are they
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Scheduled to which means they cannot be called in, it must be renewed every month and picked up in person
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Stimulants have a rapid onset of action which is?
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30 minutes to one hour; lasts anywhere from 8 to 12 hours with the XR products
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Where the FDA indications for stimulants? 4
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ADHD- inattentive and hyperactive
impulsive types narcolepsy refractory depression |
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What are the side effects of stimulants? 7
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• Decreased appetite; Weight loss
• Height retardation (2-3 inches shorter) • Insomnia, nervousness, restlessness • Dizziness or lightheadedness is common • Headaches • Nausea • Dry mouth |