Psych > ADHD > Flashcards

ADHD Flashcards

(59 cards)

Study These Flashcards
1
Q

What is ADHD?

A
  • manifests in childhood w/ sxs of hyperactivity, impulsivity, and/or inattention
  • sxs affect cognitive, academic, behavioral, emotional and social fxning
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Prevalence of ADHD?

A 
- in school aged kids: 8-10%
one of the most common disorders of childhood
- male to female ratio:
4:1 for predom. hyperactive
2:1 for predom inattentive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What other psych disorders is ADHD frequently assoc with?

A
  • oppositional defiant disorder
  • conduct disorder
  • depression
  • anxiety disorder
  • learning disabilities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Neuropathogenesis of ADHD?

A
  • fxnl brain imaging reveals decreased activation in areas of basal ganglion and anterior frontal lobe
  • major neurotransmitters involved in ADHD are dopamine and NE
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fxn of dopamine?

A
  • most of dopamine sensitive neurons are located in the frontal lobe
  • dopamine system is assoc with:
    reward, attention, short term memory tasks, planning and motivation
  • dopamine limits and selects sensory information arriving from the thalamus to the forebrain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fxn of the frontal lobe?

A
  • ability to project future consequences resulting from current actions
  • choice b/t good and bad actions (or better and best)
  • override and suppression of socially unacceptable responses
  • the determination of similarities and differences b/t things or events
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How does ADHD affect the fxn of the brain?

A
  • decreased activation in the areas of the basal ganglion and anterior frontal lobe
  • increase in dopamine transporter activity thus clearing dopamine from the synapse too quickly
  • the dopamine imbalance allows an inappropriate increase in NE activity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

The mechanism of ADHD tx wtih methylphenidate?

A
  • increases extracellular dopamine in the brain
  • changes the areas of fxn in the frontal lobe
  • in pts w/o ADHD mehylphenidate doesn’t have same effect on frontal lobe fxn
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the DSM V criteria for ADHD?

A
  • need 6 or more sxs of inattention or hyperactivity/impulsivity, 5 or more for age 17 and older
  • sxs inappropriate for any given age
  • negatively impacts social and academic or occupational activities
  • sxs developed prior to age 12
  • sxs present in 2 or more settings
  • sxs present for at least 6 months
  • sxs are not better explained by other psychiatric disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the inattentive sxs for ADHD?

A
  • failure to give close attention to detail
  • difficulty sustaining attention in task
  • failure to listen when spoken to directly
  • failure to follow directions
  • difficulty organizing tasks and activities
  • reluctance to engaage in tasks that reqr sustained mental effort
  • loses things necessary for tasks or activities
  • easy distractibility
  • forgetfulness in daily activities
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the impulsive-hyperactive sxs of ADHD?

A
  • fidgetiness w/ hands and feet or squirms in seat
  • difficulty remaining seated in class
  • excessive running or climbing in inappropriate situations
  • diff. in engaging in quiet activities
  • is often on the go or acts as if driven by a motor
  • often talks excessively
  • excessive talking and blurting out answers b/f questions have been completed
  • difficulty awaiting turns (while waiting in line)
  • interrupting and intruding on others
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Medical eval of pt with suspected ADHD?

A
  • parents and teacher need to fill out a form such as the Vanderbilt form
  • refer for vision and hearing tests
  • complete Hx, ROS, and PE to rule out other causes and psychiatric illnesses
  • if hx suggests may consider the following testing:
    blood lead level
    TSH
    sleep study
    neuro consult if concern for seizures or other neuro disorder
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

dx and tx of ADHD in adults?

A
  • dx should be made by mental health professional
  • sxs often continue into adulthood and can have significant effects on social and occupational fxning
  • same meds used for adults as for kids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What methods of tx are used in ADHD?

A
  • stimulants (ritalin, adderall, and concerta) are the TOC
  • behavioral therapy tx: hasn’t been show to reduce sxs in absence of concurrent stimulant rx (in conjuction with rx - shown to be helpful)
  • other alt. such as cognitive tx, dietary modification, and mutlivitamins haven’t been shown to be effective in controlled studies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the criteria for initiation of pharm therapy for ADHD?

A
  • complete dx assessment that confirms ADHD
  • 6 or older
  • parental consent
  • school is cooperative (if dosing during school hours)
  • no previous sensitivity to the chosen med
  • normal HR and BP
  • no hx of seizure disorder (if so refer to neuro to tx ADHD too)
  • doesn’t have tourette syndrome, autism spectrum disorder, or substance abuse among household members
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Before starting stimulant therapy what should be done?

A
  • comprehensive medical eval - no hx of seizure disorder, tourettes, autism spectrum
  • EKG (rule out arrhythmia)
  • document pretx ht, wt, BP, HR
  • document presence of any of the following sxs prior to tx: general appetite, sleep pattern, HAs, and abdominal pain
  • assess for substance use or abuse: need tx b/f starting ADHD meds
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should be included in the pt’s pretx education?

A
  • tell pt that meds are beign prescribed to help with self control and ability to focus
  • benefits and potential risks:
    emphasize uncertainty about causal assoc b/t serious CV risks to include sudden unexpected death and stimulants for kids with cardiac sxs or positive family hx of heart disease
  • other potential risks: anorexia, insomnia, tics, priapism with methylphenidate or atomoxetine
  • the f/u protocol that is expected
    -pt specific tx goals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

TOC in ADHD?

A
  • depends on what pt and parents agree on
  • stimulants are first line agent:
    methylphenidate (ritalin)
    dextroamphetamine (adderall)
  • atomoxetine (strattera) is an alt. (non-stimulant) - use if hx of substance abuse in family
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What are general considerations that may affect med choice in ADHD?

A
  • daily duration of coverage needed - completion of homework or driving after school?
  • ability of child to swallow pills or capsules
  • time of day when target sxs occur
  • desire to avoid admin at school
  • coexisting tic disorder (avoid stimulants)
  • coexisting emotional or behavioral condition
  • potential adverse effects
  • hx of substance abuse in pt or household member (avoid stimulants)
  • expense (short acting are least expensive)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What are the pros of pharm therapy for ADHD?

A
  • stimulants have long record of safety and efficacy
  • at least 80% of school age kids and adolescents will respond to stimulant med
  • improves:
    core sxs of ADHD
    parent child interactions
    aggressive behavior
    academic productivity and accuracy
    improved self-esteem
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What are the cons of pharm therapy for ADHD?

A
  • insufficient data to judge affect on long term academic performance
  • ADHD sxs tend to improve over time regardless of tx modality
  • doesn’t significantly affect:
    learning problems
    reduced social skills
    oppositional behavior
    emotional problems
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

How do you choose b/t stimulants?

A
  • providers preference and comfort level

- pt and parent preference: after discussion of meds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Tx preschool kids?

A
  • this age group needs referral to behavioral health specialist
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What are the drug classes used in tx of ADHD?

Study These Flashcards
A
  1. stimulants (schedule II controlled substance):
    first line therapy
    methylphenidate
    amphetamines: detroamphetamine and detroamphetamine-amphetamine
  2. atomoxetine
  3. alpha-2-adrenergic agonists (refer for these)
  4. Antidepressants: TCAs, bupropion
25
What are the short acting stimulants - methylphenidate?
methylphenidate: ritalin and methylin are short acting formulations - tablet, chewable tab or liquid - time to onset of action ranges from 20-60 min - duration of action: 3-5 hrs - half life is 2-3 hrs
26
What are the long acting stimulants -methylphenidate?
single pulse: metadate ER, methylin ER and ritalin SR onset of action 20-60 min, duration: 8 hrs - sustained release capsules: focalin XR (dexmethylphenidate) , metadate CD, ritalin LA: - onset of action 20-60 min, duration: 9 hrs except for focalin XR duration is 12 hrs - contain a mix of immediate release and enteric coated delayed release beads - approximates BID dosing of short acting - osmotic release: concerta - immediate release on outside then uses osmotic pump to slowly release med - approximates TID dosing of short acting formula, onset of action 20-60 min, duration of action 12 hrs - oral suspension: quillivan XR: onset of action: 60 min, duration: 12 hrs - transdermal: daytrana - onset of action 60 min, duration 12 hrs, effects last 3 hrs post removal of the patch
27
Short acting stimulants - amphetamines?
- detroamphetamine: dexedrine, dextrostat, procenta (oral) - onset: 20 min, duration 4-6 hrs - amphetamine - dextroamphetamine: adderall, Onset: 20 min, duration: 4-6 hrs
28
What are long acting stimulants - amphetamines?
- lisdexamfetamine (vyvanase): prodrug of dextroamphetamine, pharm. activated after oral ingestion, designed to discourage drug misuse, onset: 1 hr, duration: 10-12 hrs - dextroamphetamine SR (dexedrine spansule): combo of immediate and continuous release meds, onset: 20 minutes, duration: 6-8 hrs - amphetamine-dextroamphetamine (adderall XR): combo of immediate and continuous release meds, onset: 20 min, duration: 8-10 hrs this is most commonly rx, well tolerated
29
What is first line therapy in ADHD tx?
- methylphenidate, dexmethylphenidate, and amphetamines are equally effective - have similar side effect profiles - short acting agents: initial rx in kids younger than 6, or can be used to determine optimal dosing b/f switching to longer acting agent - longer acting prep: may be used initially in ages over 6, starting at lowest dose and titrating up
30
Nonstimulant meds used fo ADHD tx?
- second line: atomoxetine (strattera) - third line: alpha-2-adrenergic agonists - clonidine (catapres), guanfacine (tenex) - antidepressants: imipramine (tofranil), desipramine (norpramin) - bupropion (wellbutrin)
31
How long may it take b/f effects of strattera are noted?
- 1-2 wks * pop. in younger kids since it is a non-stimulant - dosing by wt (older than 6)
32
How do you monitor the response to therapy and assess for SEs?
- assess weekly during titration stage (can last 1-3 months) - monitored behavior through parent and teacher feedback - after titration stage pts seen monthly to monitor wt, HR, BP until stable dose w/o new SEs - optimal dose is where there are favorable outcomes with minimal side effects - ?s to ask: when does side effect occur in relation to admin? Is effect related to coexisting disorder or enviro stressor? - mild adverse effects may resolve w/ time or adjusting any of the following: dose time of administration formulation of med
33
What side effects should you eval for at every visit?
- decreased appetite - poor growth - dizziness - insomnia/nightmares - mood lability - rebound - tics - psychosis - diversion and misuse
34
How do you manage a pt with the side effect of decreased appetite?
- give med at or after meal - encourage child to eat nutrient dense foods (no empty calories) - offer food that child likes for noon meal
35
How do you manage SE: poor growth?
- drug holidays may be beneficial
36
How do you manage SE: dizziness?
- monitor BP and pulse (make sure you took a good hx - any arrhythmias?) - ensure adequate fluid intake - if assoc with peak effect, try longer acting prep
37
How do you manage insomnia or nightmares as SE of meds?
- establish a bedtime routine - good sleep hygiene habits - omit or reduce the last dose of the day - if using long acting preparation consider short acting
38
How do you manage mood lability as SE of meds?
- sxs that may occur as med wears off can be averted by using longer acting formulation or increasing from BID to TID if short acting: sadness irritability increased activity - sometimes mood changes can occur at peak concentration - try reducing dose or switching to longer acting
39
How do you manage rebound sxs from meds?
- this may improve by stepping dose down at end of the day
40
How do you manage tics as SE of meds?
- conduct a drug trial at different doses included no med to be sure that they are related to meds
41
How do you manage psychosis as SE of meds?
- Psychosis: suicidality, hallucinations, increased aggression - verify dose is approp and med is admin as prescribed: if so d/c stimulant (can be done abruptly) - refer to mental health specialist
42
Diversion and misuse of stimulants - educating pts?
- have to monitor sxs and prescribe refills - to look for evidence of misuse or diversion - long acting stimulants have less potential for abuse - keep track of rx dates - open discussion with pt
43
What are reasons for tx failure?
- lack of adherence to med regimen - possibility of med diversion - are tx goals and expectations realistic? - is there a comorbid psych dx? - can try another stimulant med - if fail mult stimulants or intolerable side effects then trial atomoxetine or an alpha-2 adrenergic
44
What are drug holidays?
- d/c of stimulant med on weekends or during summer - decide on a case by case basis - not an option for atomoxetine or alpha-2-adrenergic agonists becuase of extended half life
45
Maintenance of drug therapy?
- once on a stable dose: follow up in office should be 3-6 months - continue to monitor ht, wt, BP, and HR
46
How should you terminate ADHD meds?
- may abruptly d/c stimulants or atomoxetine | - alpha-2-adrenergic agonists and TCAs should taper off over several weeks
47
MOA of ritalin (methylphenidate)?
- short and long acting available - acts on dopamine and NE to block reuptake - 70% of pts experience significant benefit (shortest acting: ritalin and methylin longest acting: concerta, quillivan XR, daytrana)
48
SEs of ritalin?
- anxiety - wt loss - psych sxs: psychosis, aggression, hallucinations - heart problems in at risk people - easy bruising - high potentiatl for addiction and abuse - schedule II drug
49
Use of adderral (amphetamine-dextroamphetamine) -Pros? Downside? SEs?
- high potential for abuse (II) - may lead to drug dependence - extremely popular - may be slightly more effective than ritalin - SEs: anxiety, wt loss, psychosis, hallucinations, aggression - ** heart problems in at risk people (sudden death)
50
Use of dexedrine? super dangerous SE?
- previously used for OTC diet pill - among most effective tx for ADHD - schedule II - sudden death in people that have heart problems or cardiac defects
51
What SEs are concerning with dexedrine?
- heart related problems including: sudden death in people that have heart problems or defects, sudden death, stroke and heart attack in adults. increased BP and HR - psych probs: new or worse behavior and thought problems, new or worse behavior - kids and teens: seeing things or hearing things believing things that aren't true, new manic sxs
52
MOA of Lisdexamphetamine (vyvanase)?
- converted to dextroamphetamine after oral ingestion - no generic - less addictive but still schedule II - amphetmaines cause release of catecholamines (primarily dopamine and NE) from their storage sites in presynaptic nerve terminals - a less significant mechanism may include their ability to block the reuptake of catecholamines by competitive inhibition
53
Use of atomoxetine (strattera)? MOA? BBW? Most common SEs?
- initially only approved non stimulant tx until Intuniv - works on NE - initially tested for depression but didn't do much - BBW: increased risk of suicidal behavior under 25 YOs - may not be as effective as stimulant meds - expensive - most common SEs: dry mouth, insomnia, nausea, decreased appetite, constipation, decreased libido, ED, urinary hesitancy, dizziness, and sweating 1-2 wks to notice effects - other SEs: chest pain, SOB, irregular heart beat, unusual thoughts or behavior, aggression, hallucinations, nausea, abdominal pain, loss of appetite, jaundice
54
Why should atomoxetine (strattera) be used with some caution?
- risk of suicidal ideation in kids and adolescents - weigh risks vs benefits - should be monitored closely for suicidal thinking and behavior - families and caregivers should be advised of need for close observation and communication with provider
55
Pros and cons of ADHD tx?
- ritalin: temporary effects - sleep not interrupted, inexpensive, effects and safety have been studied for decades, may cause jitters after snorting - adderall XR: most popular study drug, very similar to vyvanse but comparatively more addictive, inexpensive generics available, increases dopamine levels in the brain, can impact sleep patterns - vyvanse: expensive, no generics, some insurance plans don't cover vyvanse. Smoother absorption than adderall and less addictive, can suppress appetite drastically - focalin XR: expensive, no generics available. SEs include loss of appetite, jitters and headache
56
What is extended release guanfacine (intuniv)?
- alpha-2-adrenergic agoinst (antiHTN) - approved for tx of ADHD - SEs: fast or slow HR pounding heartbeat, chest tightness numbness or tingling high rate of fainting depression BP problems (low) - caution with kidney or liver disease
57
Use of bupropion (wellbutrin)?
- alt tx for ADHD, other uses - Major depressive disorder cessation - MOA: inhibits reuptake of dopamine - mildly stimulating so good for pts with fatigue, hypersomnia, or poor concentration - no sexual side effects or wt gain - SEs: anxiety, insomnia, lowers seizure threshold, avoid in bulemia
58
When should you not use stimulants in ADHD pts?
- hx of substance abuse - structural heart defects - arryhthmia or increased CV risk profile
59
ADHD screening for parents and teachers?
Vanderbilt assessment scales
Psych
flashcards
Decks in class (20)
# Cards
Brainscape helps you reach your goals faster, through stronger study habits.
© 2026 Bold Learning Solutions. Terms and Conditions