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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
Drug classifications? 6
• 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
DSM disorders 7
• Attention Deficit-Hyperactivity disorder &
• Disruptive behavior disorders
• Mood disorders
• Anxiety disorders
• Autism & pervasive development disorder
• Tics and Tourette’s disorder
• Psychotic disorders
Disruptive Behavior Disorders 4
• Attention Deficit-Hyperactivity Disorder
• Intermittent Explosive Disorder
• Oppositional Defiant Disorder-
Conduct Disorder-
What is the number one DSM disorder we encountered in this age group
Attention deficit hyperactivity disorder
When you're trying to get a diagnosis in this age group but must you do?
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
Disruptive behavior disorders are common in
Schools
What disorder is this? period of extreme rage w/ an aggressive outburst; grossly out of proportion to the incident
Intermittent explosive disorder
What disorder is this? parent training therapy & child therapy; hostile, defiant, or negative behavior towards authority
Oppositional defiant disorder
Would this order is this? parent training therapy & child therapy- routinely violating the rights of others and lacking empathy
Conduct disorder
What do you do when a child has irritability, aggression, impulse control?
Treat the target symptoms and underlying or comorbid conditions
How do you treat the target symptoms of the irritability aggression, and impulse control?
Atypical antipsychotics and
mood stabilizers
What are the usual or underlying comorbid conditions for irritability, aggression, impulse control?
ADHD
depression
bipolar disorder
What is the atypical antipsychotic usually used in children
Low dose risperdal
Medications to treat Irritability, Aggression, Impulse Control? These will not be on the exam
• 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)
Which to medications are FDA approved for children though we try to stay away from them because of EPS?
Thorazine and Haldol
All of the other medications have the risk of developing what?
Metabolic syndrome
Which medication has been studied the most in children
Risperdal improves the ability to interact socially & control behavior better than have that reactive type of lashout explosion
What are the three types of ADHD
Hyperactive
inattentive
combined
Which type of ADHD is the impulsive type
Hyperactive
Which type of ADHD is a separate neurological base for this d/o- doesn't respond as well to stimulants?
Inattentive
Which type of ADHD doesn't respond well to stimulants?
Inattentive
ADHD is a diagnosis of what?
Exclusion which means you have looked at all other types of differential diagnoses
Treatment of ADHD is extremely _______.
Effective
What happens when you don't treat ADHD?
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
What is the percentage of children if untreated or ADHD that will continue on through adulthood?
40%
In what age group is this diagnosis usually found ADHD?
They can show up in preschool
In infants and toddlers with ADHD who happens?
You have a hard time trying to calm them down or to soothe them
What is a symptom of ADHD?
Hyperactivity
What does ADHD look like? 3
Poor concentration
disorganized
forgetful
ADHD must have an early?
Must have an early onset
There was a study done about moms who drank during pregnancy when do the signs and symptoms of ADHD come out and why?
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
Does ADHD run in families?
Yes, it is highly genetic
What happens to children of ADHD if it is not treated?
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
What are some of the differential diagnoses for ADHD if the child has restlessness and inattention?
Rule out bipolar disorder in the prodromal phase, anxiety, social anxiety disorder, PTSD, child abuse, depression- situational stress or otherwise, boredom
ADHD stimulants have instantaneous what?
Effects
ADHD stimulants
5
Dexmethyphenidate (Focalin)-

Methylphenidate (Ritalin, Concerta, Metadate)

Dextroamphetamine (Dexedrine)

Mixed preparation: dextroamphetamine amphetamine

Lisdexamphetamine: Vyvanse
ADHD stimulants
Dexmethyphenidate (Focalin)-
when does this peak
In one hour
ADHD stimulants
Dexmethyphenidate (Focalin)-
it has a half-life of
Two hours
ADHD stimulants
Dexmethyphenidate (Focalin)- what age groups can use this
Kids six and up
ADHD
• Stimulants
Where the XR products? And they last up to how many hours?
Methylphenidate (Ritalin, Concerta, Metadate) eight hours
ADHD
• Stimulants
how long does Ritalin last
Eight hours
ADHD
• Stimulants
how long this concerta last
12 hours
ADHD
• Stimulants
what is the mixed preparation
dextroamphetamine amphetamine (Adderall)
ADHD
• Stimulants
that are all can be taken by kids ages what
3 to 5
>6 5 mg
5y/o 2.5g
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)
Stimulants treat what kind of symptoms?
All core symptoms of the disorder
stimulants are regulated by who?
DEA
Stimulants are controlled substances what class are they
Scheduled to which means they cannot be called in, it must be renewed every month and picked up in person
Stimulants have a rapid onset of action which is?
30 minutes to one hour; lasts anywhere from 8 to 12 hours with the XR products
Where the FDA indications for stimulants? 4
ADHD- inattentive and hyperactive

impulsive types

narcolepsy

refractory depression
What are the side effects of stimulants? 7
• Decreased appetite; Weight loss
• Height retardation (2-3 inches shorter)
• Insomnia, nervousness, restlessness
• Dizziness or lightheadedness is common
• Headaches
• Nausea
• Dry mouth