Prevelance of ADHD?
- 3-7% of all children
- male>female 9:1
Symptoms of ADHD in children 3-5 years old?`
Symptoms of ADHD in children 6-12 years old?
incomplete hw, careless errors, struggle to follow instructions, unable to stay seated, talk non-stop, interrupts, hard to wait their turn, defiant
Symptoms of ADHD in 13-18 year old teens?
disorganized, procrastinate, inner restlessness, too many things at once, dangerous driving, defiant, poor self-esteem, anger, poor peer relationships
Symptoms of ADHD in adults?
- broken into personally and professionally
- divorce, broken relationships, fear, restlessness, risk taking, unplanned pregnancy, criminal activity, late appointments, unfinished multi-tasker
Name the comorbidities along with ADHD\
- children- oppositional defiant disorder (ODD) (50%)
- adults- anxiety disorder (47%)
- other- depression, bipolar disorder, tic disorder
How would you diagnose a patient with ADHD?
- scales- specific for age
- parent, teacher, patient
Name the 3 types of ADHD
- Predominantly inattentive (females, adolescents)
- predominalty hyperactive-impulsive- (15% in children, virtually non-existant in adults)
What is the primary method to treat ADHD?
What is the primary choice of medication to treat ADHD?
stimulants: methylphenidate, dexmethylphenidate, mixed amphetamine salts, lisdexamphetamine
Name the short-acting stimulants.
- methyphenidate (Ritalin)
- dexmethlyphenidate (Focalin)
- amphetamine (Dexadrine)
- mixed amphetamine salts (Adderall)
Frequency of methylphenidate CD (Methadate CD)?
- bid dosing
- covers 8 hours
- immediate release
- 30% released immediately then 70% delayed release
release of methylphenidate (Ritalin LA)
- covers 8 hours
- 50% of dose immediately released
- 50% released 3-4 hours later
Frequency of Focalin XR
covers 12 hours
Onset of methylphenidate (Daytrana) patch?
onset of 2 hours, coverage of 3 hours after removal of patch
Duration of Adderall XR
Duration of lisdexamphetamine (Vyvanase)?
Describe the steps in first initiating a new ADHD dose.
- ped guidlines applied to adults too
- immediate release for starting therapy
- titrate every 3 to 5 days
- go to ER form once immediate release dose is reached.
efficacy of stimulants?
- higher doses = better outcome
- 70% of adolescents and children respond
- 25-78% of adults respond
How would you treat the SE of tics with ADHD tx?
- not common <1%
- d/c if clearly worsened
- alternative tx
- anti-tic (haldol, pimozide)
What would the emergence of depression or mood lability indicate?
- toxicity or rebound
- reduce, d/c
- add antidepressant/antimanic
- rule out substance abuse
If sleep disturbances become an issue, what can you do?
- check sleep patterns, adjust time of med
- add clonidine, trazodone, mirtazepine, melatonin
What medication can increase appetite in a patient who is experiencing appetite suppression as a SE?
cyproheptadine 2 mg qid
Name a non-stimulant med
- atomoxetine (Strattera)
- efficacy usually seen after 2-6 weeks
- some patients say after 3-4 months it doesn't work anymore
Name some atomoxetine SE
- Tachycardia, arrgythnia, sudden death
If a patient is on a 2D6 inhibitor such as paroxetine and fluoxetine what needs to happen to the atomoxetine dose?
needs to be reduced
Name a stimulating anti-depressant that can be used for ADHD