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Prevelance of ADHD?
- 3-7% of all children
- male>female 9:1
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Symptoms of ADHD in children 3-5 years old?`
- inattention
- hyperactivity
- impulsivity
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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
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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
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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
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Name the comorbidities along with ADHD\
- children- oppositional defiant disorder (ODD) (50%)
- adults- anxiety disorder (47%)
- other- depression, bipolar disorder, tic disorder
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How would you diagnose a patient with ADHD?
- DSM-4
- scales- specific for age
- parent, teacher, patient
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Name the 3 types of ADHD
- Predominantly inattentive (females, adolescents)
- predominalty hyperactive-impulsive- (15% in children, virtually non-existant in adults)
- combined
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What is the primary method to treat ADHD?
medication
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What is the primary choice of medication to treat ADHD?
stimulants: methylphenidate, dexmethylphenidate, mixed amphetamine salts, lisdexamphetamine
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Name the short-acting stimulants.
- methyphenidate (Ritalin)
- dexmethlyphenidate (Focalin)
- amphetamine (Dexadrine)
- mixed amphetamine salts (Adderall)
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Frequency of methylphenidate CD (Methadate CD)?
- bid dosing
- covers 8 hours
- immediate release
- 30% released immediately then 70% delayed release
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release of methylphenidate (Ritalin LA)
- covers 8 hours
- 50% of dose immediately released
- 50% released 3-4 hours later
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Frequency of Focalin XR
covers 12 hours
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Onset of methylphenidate (Daytrana) patch?
onset of 2 hours, coverage of 3 hours after removal of patch
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Duration of Adderall XR
8 hours
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Duration of lisdexamphetamine (Vyvanase)?
12 hours
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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.
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efficacy of stimulants?
- higher doses = better outcome
- 70% of adolescents and children respond
- 25-78% of adults respond
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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)
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What would the emergence of depression or mood lability indicate?
- toxicity or rebound
- reduce, d/c
- add antidepressant/antimanic
- CBT
- rule out substance abuse
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If sleep disturbances become an issue, what can you do?
- check sleep patterns, adjust time of med
- add clonidine, trazodone, mirtazepine, melatonin
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What medication can increase appetite in a patient who is experiencing appetite suppression as a SE?
cyproheptadine 2 mg qid
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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
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Name some atomoxetine SE
- Tachycardia, arrgythnia, sudden death
- hypertentsion
- hepatotoxicity
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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
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Name a stimulating anti-depressant that can be used for ADHD
bupropion (Wellbutrin)
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