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52 Cards in this Set
- Front
- Back
how is ADHD characterized?
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neurobehavioral disorder with inattention, hyperactivity, and impulsivity
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how do the symptoms of ADHD present
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cause great impairment in affected patients
present before age 7 manifest in multipel settings like school/home cause significant impairment |
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how many % of kids have ADHD?
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75-80%
60% have sx and impairments as adults |
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what is 314.01 combined type of ADHD
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6 sx of inattention and 6 sx of hyperactivity-impulsivity for 6 months
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what is 314.00 predominantly inattentive type
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at least 6 sx of inattention but fewer than 6 sx of hyperactivity-impulsivity for 6 months
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what is 314. 01 predominantly hyperactive-impulsive type
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at least 6 sx of hyperactivity-impulsitivyt but fewer than 6 sx of inattention for 6 motnhs
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name the criteria for inattentive type of ADHD. 6 or more manifestations of:
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difficulty sustaining attention
fails to finish tasks loses things forgetful easily distrated avoids tasks requiring sustained attnetion seems to not listen proposed DSM5 4 ore more if >16 yo |
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what are the sx of inattention in kids? adults?
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kids- difficulty sustaining attention
easily distracted and forgetful doesn't follow through can't organize loses things doesn't listen adults- difficulty sustaining attention easily distracted poor concentration manages time poorly mispalces thigns difficulty finding things |
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what are the criteria for hypyeractive impulsive type
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impulsivity- blurts out answers before question is finished, difficulty wasting time, interrupts or intrudes on others
hyperactivity- fidgets, unable to stay seated, inappropriate running/climbing, difficulty engaging in leisurely activities quietly , talks excessively |
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symptom cluster for impulsivity in kids and adults?
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kid- blurts out answers, can't wait his turn, intrudes/interrupts
adults- drives too fast, impulsively changes, irritable or quick to get angry |
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sx cluster for hyperactivity in kids? adults?
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kids- squirms, fidgets, runs, climbs, can't play/work quietly, on the go
adults- inner restlessness, fidgets when seated, self selects active jobs, talks excessively |
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what are the impacts of untreated ADHD on adults
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interpersonal problems
deficits in occupational functioning academic underachievement increased accident rates |
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how does adhd affect MVA
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pts with ADHD tend to have more severe accidents than controls
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what are some difficulties in making accurate ADHD dx?
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testing objective but not specific
dx dependent on social and educational circumstances sx overlapw tih other psych illnesses subjectivity of diagnostic criteria |
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bipolar disorder vs ADHD?
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more likely in bipolar disorder : gradiosity, elevated mood, daredevil acts, uninhibited people seeking, silliness/laughing
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what is the path behind ADHD
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related to difference in functioning in prefrontal cortex, basal ganglia
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how does catecholimingeric CNS pathways affect ADHD
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NE and DA are modulators of attention and psychomotor activity
disruption causes cognitive, behavioral, and learning related changes paralleling that in ADHD |
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what levels of dopamine are a/w ADHD
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it has been shown that increased release of dopamine with stimulation occurs in adults with ADHD
thought that ADHD has low baseline dopaminergic tone |
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why are neuroimaging techniques not valid tools for ADHD diagnosis
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lacks specificity and sensitivity
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is ADHD familial?
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90% concordance in monozygotic twins
heritability of 0.75 a/w dopamine transporter gene DAT-1 and D4 receptor gene DRD4 thyroid receptor-beta gene |
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how do you do an ADHD eval/assessment
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standard h&p
screening neuro exam hx from parents/caregivers inattention, hyperactivity, impulsivity, age of onset, multiple settings, duration of sx, degree of functional impairment info from school. classroom behavior, learning and attendance, examples of school work, teacher eval, report card |
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what kind of associated conditions of ADHD do you assess for
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impaired vision/hearing
learning/speech/language disorders seizures, tics, migraines medical illnesses, malnutrition sleepdisorders medication/lead toxicity/pica anxiety, realistic fears, depression |
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identify target behaviors and colelct previous treatment data
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target behavior --> response
medication --> dosage, duration, SE, adverse events |
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what should you check in periodic follow up visits of ADHD pts?
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target behavior outcome
academic progress adverse effects of meds response to meds does not validate a dx of ADHD |
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what are some non pharmacologic treatments you can use
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coaching- problem solving skills
cognitive/behavioral - correct negative belief systems conflict resolution/anger management/interpersonal skills behavioral interventions- reinforcement with rewards priviledges time out, access to positive reinforcement removed contingent on performance of unwanted/problem behavior response cost token economy system decrease workload to match ability coordinate between school and home, set time limits for work completions |
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what are the stimulant treatments for ADHD
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similar to dopamine and NE structurally
inhibits DA and NE transporter proteins, inhibits MAO d-enantiomers of methylphenidate and amphetamine are MC |
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amphetamines and methylphenidate have what characteristics
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safe medically
good tolerability robust response equal response rates |
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what do stimulants improve (sx wise)
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inattention
impulsivity hyperactiivty noncompliance impulsive aggression social interaction academic productivity and accuracy |
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what are some SE of stimulants
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insomnia
HA stomach ache irritability decreased appetite |
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what are CI and cautions for stimulants?
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CI in cardiac abnormalities
be careful if you have HTN, glaucoma, tics, bipolar disorder, aggression, suicidality, seizure disorder, psychosis |
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what can you do to alleviate insomnia with stimulants
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avoid evening meds
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what can you do to alleviate stomach ache/headache
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decrease dose, switch to another stimulant or agent
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if you have irritability with stimulants what can you do
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decrease dose
try longer acting agent assess for other disorders |
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what can you do if you have growth suppression with stimulants
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weight- give meds with meals, snacks, consider drug holidays
height- deficits found in prepuberty children, catch up gaines in height even with continued stimulant treatment. no direct studies have proven much |
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what should you do if you have tics
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switch stimulant
decrease dose adjust treatment of tics try nonstimulant meds |
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what are teh D-enantiomer stimulants
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methylphenidate: focalin
amphetamine: dexedrine |
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what are the racemic compounds
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MPD: ritalin, metadate
amphd: adderall amphetamine aspartate, amphetamine sulfate, dextroamphetamine saccharate, dextroamphetaine sulfate |
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which drugs are FDA approved for adults
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atomoxetine (strattera)
dexmethylphenidate XR - focaline mixed amphetamine salts XR- adderall xr methylphenidate HCL (concerta) lisdexamphetamine (vyvanse) |
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what meds are NOT approved for adults
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short acting mixed amphetamine salts - adderall
short acting methylphenidate - methylin, ritalin, focalin dextroamphetamine - dexedrine, dexdrine, methylphenidate transdermal system nonstimulants- gaunfacine extended release clonidine |
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what is IR methylphenidate
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takes effect 30 min after admin
peaks 1.5-2 hours after ingestion benefit gonea fter 4 hours generally t.id dosing no more than 60 mg / day |
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SR stimulants
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gelatin capsule with 2 types of spherical beads
one with solid methylphenidate HCL the other with polymer coating acting as a rate controlling membrane biphasic peak effect lasts 9 hours metadate peaks at 1.5 and 6 hrs ritalin LA peaks at 1.5 and 4.5 hrs focalin peaks at 1-4 hours and 4-7 hrs |
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how does concerta work
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osmotic release oral system
outer coating of IR methylphenidate over insoluble shell that water permeates at a controlled rate as water goes in, internal compartments are forced out at a controlled rate may have a smoother effect peak at 6.7 and effective for 12 hours |
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this is a gelatin capsule with 2 types of spherical beads one with dextroamphetamine (solid) or mixed amphetamien salts, the other with polymer coating that acts as a rate controlling membrane
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SR stimulant: amphetamine
dexedrine spansule (dextroamphetamine) peaks at 8 hours typically effective for 9 adderal XR mixed amphetamine salts - peak effect at 5-6 hours effective fr 9-12 |
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this is converted in blood to l-lysin and d-amphetamine
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lisdexamfetamine
dosage 10-70 mg/day peak plasma 4.5-6 horus after oral ingetsion may have less potential for abuse and drug tampering |
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what are some non stimulant meds for ADHD
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atomoxetine
modafinil TCA's bupropion alpha adrenergic agents |
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describe atomoxetine
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nonstimulant
NE reuptake inhibitor significant increase of dopamine noted in prefrontal cortex dosed q.d peak [ ] x1-2 hours after dosing suicide warning |
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name some antidepressants
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imipramine and deipramine (TCA's)
block reuptake of noreepinephrine serious potential cardiac effects bupropioni (wellbutrin) more favoral risk to benefit ratio than TCA's long duration of action, potential benefit on mood and anxiety |
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name the 2 alpha adrenergic agents
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clonidine
guanfacine binds alpha adrenergic receptors micmics noradrenergic neurotransmission can lead to sedation or diminished neurotransmission efficacy and safety not well studied |
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you with ADHD have a 2-3 greater risk of substance use disorder. it is earlier with what activity and what dz
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earlier with cigarette smoking
risk is higher with bipolar disorder |
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adults with ADHD have a prolonged course of SUD. what drug is mc abused
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marijuana
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T or F, SSRI can effectively treat depression and anxiety and ADHD
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false. can't treat adhd
stimulants on the other hand can treat adhd but not anxiety and mood disorders |
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what should you consider for depression and anxiety
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buspirone and benzodiazepines
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