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23 Cards in this Set
- Front
- Back
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How long should you trial a stimulant before confering treatment failure?
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3 months
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What are the 2 formulations of dextroamphetamine?
What are their durations? How are they dosed? |
Adderall IR (3-5 hours) Bid-Tid
Adderall XR (8-12 hours) QAM |
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What are the 7 formulations of methylphenidate?
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Ritalin
Ritalin XR Ritalin LA Metadate ER Metadate CD Concerta Daytrana patch |
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What are their respective durations of action and dosing?
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3-5 hours Bid-Tid
3-8 hours Bid - Tid 8-12 hours (QD) 3-8 hours Bid-Tid 8-12 hours QAM 8-12 hours QAM 8-12 hours QAM |
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If you fail one stimulant class, can other class have efficacy?
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Yes
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What are the common side effects of ADHD treatment?
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Insomnia
Headaches Appetite suppression Increased HR Tic disorder |
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What is Strattera?
When is it used? |
Atomoxetine (SNRI)
First line if patient has a contraindication to stimulant therapy or unable to tolerate side effects. Not a controlled substance. Less abused 24 hour duration of action ***Takes 4 weeks to see adequate benefit*** |
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What are the side effects of Strattera?
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Hepatotoxicity, Sedation
Black Box warning: Suicidal Ideation Must monitor LFTs |
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Name another non-stimulant agent.
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Bupropion (Blocks reuptake of Dopamine and Norepi)
2nd line agent Not FDA approved for ADHD Only modest efficacy in decreasing. Doesnt work well in hyperactive individuals. CI: Seizure disorders, Head Trauma, Bulemia |
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3rd line agents
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TCA's - block reuptake of serotonin and norepi
Not FDA approved Shown to be just as effective as stimulants, but side effects are substantial |
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Adjunctive treatment
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Alpha Agonists - Clonidine, Guanfacine
Can be alternative to stimulants in patients at risk for abusing stimulants. MOA: Prevent norepi from being released FDA approved for ADHD Hypotension, Sedation |
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What would happen if you took off a clonidine patch abruptly?
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Rebound Hypertension - Must taper dose
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ADHD can cause insomnia. What could you do for a patient who is experiencing ADHD related-insomnia?
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Ambien - Studies looking at these patients with ADHD insomnia. Worsened insomnia!
Do not use this. You could use Clonidine or Guanfacine at bedtime. Melatonin - Works well in patient with ADHD. |
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What are the criteria for a tic disorder?
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1) Vocal/motor tic > 1 year
2) Younger than 18 yo at diagnosis 3) Tics occur many times per day nearly every single day 4) You can have tic free periods but they don't last longer than 3 months |
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What are the tourette treatment options?
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Alpha-2 agonists - Less side effects (Clonidine is most commonly prescribed, but is about as effective as Risperidone)
D-2 Antagonists (Risperidone) - Have a high rate of efficacy |
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Clonidine - Greater sedation
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Guanfacine - Greater HA, Agitation
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Don't need to know doses
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Don't need to know scales, but there are scales that evaluate symptom severity.
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What do you want to assess in a patient every time you see them?
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Weight
Height Blood Pressure Heart Rate Sleeping Patterns |
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How long before bedtime do you want the last dose of a stimulant to be?
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6 hours for an IR formulation
Remember to counsel on sprinkling long acting formulations in apple sauce and to not chew it. If it is less than 6 hours (IR) or 10 hours (ER) product, skip the dose and take it the next morning |
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Lifestyle modifications with ADHD on stimulant therapy.
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Limit or eliminate caffeine intake
Avoid using cold medications such as pseudo-ephedrine Avoid diet pills |
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Side effects to tell physician about?
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HA
Abdominal pain Difficulty sleeping Loss of appetite Weight loss |
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Current data suggests that growth delay will eventually catch up. What can you do to increase appetite?
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Increase activity
Take medication after they eat Big snacks in the evening |
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How can you assess therapy other than rating scales?
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Drug Holiday's will show you if the medication is effective
Long-term cardiovascular risks (Baseline ECG (if there is a family history of cardiac abnormalities), BP, HR) |
