ADHD

Question 1

common neurodevelopmental disorder in children, chronic illness

Answer 1

ADHD

Question 2

characteristics of ADHD

Answer 2

inattention, hyperactivity, impulsivity, difficulty focusing, easily distracted, trouble staying still, unable to control impulse behavior

Question 3

primary treatment of ADHD and how they work

Answer 3

stimulants - inc DA and NE

Question 4

first line to manage ADHD in age >= 6

Answer 4

stimulants (take in AM)

MPH, lisdexamfetamine, dext/amp

Question 5

DSM5 diagnosis for inattention

Answer 5

> = 6 symptoms of inattention (up to age 16, then 5 sx) present for at least 6 months

Question 6

DSM5 diagnosis of hyperactivity/impulsivity

Answer 6

> = 6 symptoms of hyperactivity/impulsivity (up to age 16, then 5 sx) present for at least 6 months

Question 7

conditions that must be met for ADHD diagnosis

Answer 7

several symptoms present before age 12
symptoms in >=2 settings (home, school)

Question 8

natural product option to help sleep

Answer 8

melatonin

Question 9

preferred stimulant formulation in children

Answer 9

long acting

Question 10

patient-friendly formulation options

Answer 10

capsules to open (LA caps, vyvanse)
chewable tabs (vyvanse)
ODTs
patches (Daytrana)
suspension

Question 11

second line for ADHD if stimulants fail or if concern for abuse/diversion

Answer 11

non-stimulants

atomoxetine, viloxazine

Question 12

add on (or alone)/second line options for treatment? to sleep?

Answer 12

guanfacine ER, clonidine ER

sleep - clonidine IR, diphenhydramine, melatonin

Question 13

all stimulants are what control class

Answer 13

CII

Question 14

BBW for stimulants

Answer 14

high potential for abuse and dependence

Question 15

contraindication to stimulants

Answer 15

14 days of MAOI- hypertensive crisis

Question 16

warnings with stimulants

Answer 16

drug diversion
inc HR & BP - serious CV AEs in children/adults
priapism
new/exacerbation of psychosis
loss of appetite- can affect child growth
serotonin syndorme
seizure

Question 17

block reuptake of NE and DA

titrated every 7 days, do not need to be tapered

Answer 17

stimulants

Question 18

brand name IR methylphenidate

Answer 18

Ritalin

Question 19

starting dose of MPH IR (Ritalin)

Answer 19

5mg BID

Question 20

brand name of methylphenidate ER OROS delivery

Answer 20

Concerta

Question 21

starting dose of MPH OROS ER (Concerta)

Answer 21

18-36 mg QAM

Question 22

brand name of methylphenidate ER capsule

Answer 22

Ritalin LA

Question 23

when is Jornay PM (ER MPH cap) taken

Answer 23

QPM

Question 24

brand name of methylphenidate patch

Answer 24

Daytrana

Question 25

how and when is MPH patch (Daytrana) applied

Answer 25

QAM - 2 hrs before desired effect hip, alternate sides remove after 9 hours

Question 26

AEs of MPH

Answer 26

insomnia, dec appetite/weight, HA, irritability

Question 27

monitoring of MPH

Answer 27

ECG prior, BP, HR height & weight

Question 28

key points of MPH OROS (Concerta)

Answer 28

outer coat dissolves quick for quick action, the rest is released slowly ghost tab in stool dec abuse potential

Question 29

active isomer is methylphenidate

Answer 29

dexmethylphenidate

Question 30

brand name of IR and ER dextro/amph

Answer 30

Adderall (XR)

Question 31

brand name lisdexamfetamine

Answer 31

Vyvanse

Question 32

dosage forms of Vyvanse

Answer 32

capsule, chewable tab

Question 33

VYvanse, is a prodrug, so key point is

Answer 33

low abuse potential if injected/snorted, fast effect (rush) is muted

Question 34

2 SNRIs used

Answer 34

atomoxetine viloxazine

Question 35

brand name of atomoxetine

Answer 35

Strattera

Question 36

BBW for SNRI options

Answer 36

suicidal ideation

Question 37

contraindication of SNRIs

Answer 37

MAOI last 14 days

Question 38

AEs of SNRI options

Answer 38

dec appetite, insomnia, somnolence, dry mouth, inc BP or HR

Question 39

can atomoxetine capsule be opened

Answer 39

NO - ocular irritant

Question 40

2 central acting alpha 2 agonists

Answer 40

clonidine ER, guanfacine ER

Question 41

brand name clonidine ER

Answer 41

Kapvay

Question 42

brand name guanfacine ER

Answer 42

Intuniv

Question 43

when to take clonidine ER

Answer 43

QHS

Question 44

when can guanfacine ER be taken

Answer 44

daily anytime

Question 45

warnings of alpha agonists

Answer 45

dose-dependent CV effects sedation, drowsiness do not d/c abruptly

Question 46

AEs of alpha agonists

Answer 46

dry mouth, somnolence, fatigue, dizziness, constipation, dec HR, hypotension

Question 47

how to discontinue alpha agonists

Answer 47

taper