64 - ADHD

Question 1

• higher rate if diagnosed on a ___ degree relative
• etiology is ___ (environment, genetics, physiological)

Answer 1

• first
• multifactorial

Question 2

• ___ of children with ADHD will have the diagnosis in adulthood
• increased risk of ___ use and anti-social personality disorder is ADHD is left untreated

Answer 2

• 1/3
• substance

Question 3

diagnostic criteria

for each symptom domain, must have at least __ symptoms present
- >17 yo at least 5 symptoms for with of 2 specifiers
- several inattentive or hyperactive symptoms must be present prior to age ___ years
- several inattentive or hyperactive impulsive symptoms are present in ___ or more settings

Answer 3

6
12
2

Question 4

Inattentention

__ or more of the following symptoms persistening for at least __ months

Answer 4

6
6

Question 5

hyperactivity and impulsivity

__ or more of the following symptoms persistening for at least __ months

Answer 5

6
6

Question 6

stimulants (2) based

Answer 6

amphetamines
methylphenidate

Question 7

non-stimulants

Answer 7

Question 8

MOA ADHD Treatment options

stimulants
- inhibition of ___ and ___ , inhibition of ___
- increased amount of DA and NE in synapse
- inhiibition of ___ oxidase (amphetamines are more potent)
- amphetamines - ability to enter the presynaptic terminal and cause ___ of neurotransmitters

Answer 8

• DAT, NET, reuptake
• monoamine
• release

Question 9

v

guanfacine and clonidine
- selective ___ agonist
- theorized that use in ADHD is related to binding of receptors in the ___ cortex

Answer 9

• a2A
• pre-frontal

Question 10

MOA ADHD Treatment options

atomoxetine and viloxazine
- ___ inhibition ___ reuptake

Answer 10

selective, NE

Question 11

stimulant dosing

• dose response effects seen in a short period of time
• calculating a dose in pediatric patients based on mg/kg not found to be helpful, not linked to height or weight
• IR preferred for patients weighing < ___ kg due to limitied low dose availability of long acting stimulants
• avoid giving dose too late in the day
• late afternoon symptoms may require __ acting formulation
• dont use 2 different stimulants (can use 2 diff dosage forms of the same stimulant)

Answer 11

• 16
• long

Question 12

special considerations

Mydayis (age ___ - ___ )

Daytrana (methylpenidate) - apply ___

Vyvanse (lisdexamfetamine)
- ___ that is converted to dextroamphetamine

Jornay PM
- take dose in the evening between ___ - ___

Answer 12

13-17
patch
prodrug
6:30-9:30

Question 13

stimulant adverse effects

Question 14

alpha 2 agonists

guanfacine is a ___ substrate

alonidine

Answer 14

3A4

must be tapered if d/c to avoid rebound HTN

Question 15

atomoxetine

___ substrate
___ based

Answer 15

2D6
weight

Question 16

voloxazine (Qelbree)

capsules - swallow whole/applesauce
___ / ___ substrate; strong ___ inhibitor

Answer 16

2D6/UGT, 1A2

Question 17

atomoxetine and viloxazine

increased ___ and ___
increase ___ thinking

Answer 17

HR
BP
suicidal

Question 18

clonidine and guanfacine

• decreased __ and ___ , orthostasis
• somnolence
• dizziness
• rebound ___ is abrupt d/c

Answer 18

HR, BP
HTN

Question 19

bupropion

not FDA approved for ADHD
not as effective
___ inhibitor
CI in seizure disorders and eating disorders

Answer 19

2D6

Question 20

TCA

• less effective than methylphenidate
• cardiac concerns - sudden cardiac death in children, lethal overdose

Question 21

mood stabilizers/atypical antipsychotics may be useful if thereis comorbid bipolar disorder, conduct disorder

should npt use as monotherapy

Question 22

first line

preschool
- 1st ___

elementary/middle
- 1st ___
- 2nd ___ , ___ or ___

adjunctive treatment
- only ___ and ___ have evidence as adjuncts to simulants

Answer 22

methylphenidate
stimulants
atomoxetine, guanfacine, clonidine
guanfacine, clonidine

Question 23

NICE: ADHD guidelines for adults

1) methylphenidate or ___
2) ___ if unable to tolerate lisdexamfetamin
3) ___ - if not symptom response to above

Answer 23

1) lisdex
2) dextro
3) atomoxetine