Pediatric ADHD Word Scramble
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| Question | Answer |
| What is ADHD | a family of chornic neurobehavioral disorder that interfere with and indiviudals ability to regulate activity, inhibit behavior, and attend to task in developmentally appropriate ways |
| What are the hallmary deficits of ADHD | inattentiveness/distractability, hyperactivity, impulsvity |
| What's the prevalence of ADHD | 8-10$ of children will be diagnoses, 80% will car s/s intor their teens, 60% will carry s/s into adulthood |
| What's the male:female ratio | 3:1 male to female |
| What is the pathophysiology of ADHD | no single gene, neurotransmitter, alter pathy or mechanism has been found to account for the observe parttern of dysf |
| What factors may contribute? | Environmental & psychosocial factors contribute |
| How does dopamine and norepinephrine play a role | Dopamine: reward, risk taking, impulsivity. NorE: modulates attention, arousal and mood |
| What do you do when ADHD is suspected | Thorough H&P: birth hx, risk factors, complications, vision, hearing, height, weight, diet, learning disabilities, genetics, family history |
| What environmental/psychological factors may be involved? | lead, disruptive househould, abuse, neglect |
| What are some DDX fo ADHD | Anxiety, Bipoloar disorder, conduct disorder, Developmental Delay,Depression, dyslexia, learning disability, medication side effects, ODD, Seizure disorder, Vision/hearing impairment |
| Dx Recommendation #1 | In a child 6-12 years old who presents with inattention, hyperactivity, impulsvitity, academic underachievement, or behavior problems, initiate an evaluation for ADHD |
| DX Recommendation #2 | the diagnosis of ADHD requires that a child meet the criteria listed in the DSM-IV |
| Dx Recommendation #3 | The assessment of ADHD requires evidence obtained directly from parents or caregivers regarding the core symtpoms of ADHD in various settings, age of onset, duration of symtpoms and degree of functional impairment |
| Dx Recommendation #4 | the assessment of ADHD requries evidence obtained directly from the teacher regarding core symptoms, duration, the degree of functional impairment and coexisting conditions.Review reports of mulstidisciplinary evaluation. |
| Dx Recommendation #5 | Include assessment of coexisting conditions. |
| Dx Recommendation #5 | Other diagnostic tests are not routinely indicated to establish the diagnosis of ADHD |
| What is the DSM-IV criteria for ADHD | see article on diagnosis |
| True or False? children who meet diagnostic criteria for the behavioral symptoms of ADHD but who demonstrate no functional impairment do not meet the diagnostic criteria for ADHD? | True |
| True or False? the symptoms should be present in 2 or more settings, and the behaviors must adversely affect functioning in schoold or in a social situation | True |
| RX recommendation 1 | PCP should esablish a treatment program that recognizes ADHS as a chronic condition. |
| Rx Recommendation #2 | The treating PCP parents and child in collaboration with school personall, should specify appropriate target outcomes to guide management |
| Rx Recommendation #3 | the treating clinician, parents and child in collab |
| Rx Recommendation #4 | When the selected management for a child has not met target outcomes, clinicians should evaluate the original dx, use of all appropriate treatments, adhrence to the rx plan and presence of coexisting conditions |
| Rx Recommendation #5 | Provide systematic follow-up for the child with ADHD. Monitoring should be directed to target outcomes and adverse effects, with information gathered from parents, teachers and the child |
| What are some nonpharmacological treatments for ADHD | Behavioral therapy and family therapy |
| What are the first line treaments for ADHD | Methyphenidate and Amphetamines |
| What are the appropriate mehtylphenidate drugs that can be used to treat ADHD? | Short acting (Ritalin, Methylin) Intermediate: (Ritalin SR, Metadate Er, Mythlin ER), Long Acting Acting (Cooncerta, Metadate CD, Ritalin LA) |
| What are the appropriate amphetamine drugs that can be used to treat ADHD? | short acting (Dexedrine, Dextrostat), Intermidiate acting (Adderall, Dexedring) Long acting (Aderall XR). |
| What are characteristics of Pemoline? | Not a 1st line RX, risk of liver failure, alternative Rx only after a child has failed 3 or more stimulants |
| Things to know about medical management of ADHD? | PCP must be comfortable prescribing more than 1 agent, Most children will respond well to MPH or amphetamine, no single drugs meets the needs of all children, based selection on required duration of symptom control, avoid underdosing |
| What are some contraindications for ADHD medical management | marked anxiety, tension or agitation, history of psychosis or Hypertension, Use cautiously with seizure history, do not give concerta with pre-existing severe GI narrowing |
| What are characteristics of short acting stimulants? | last an average of 3-6 hour and are ofed dosed bid or tid, often problems with breathrough s/s, most have an onset of 20-60 min and peak in 1-2 hours |
| What are characteristics of longer acting agents/ | Less potential for abuse, more consistent symptom control |
| what are some characteristics of concerta | Osmotically released, time delivery system, delivers drug with ingestion followed by continous drug delivery, helps to avoid tachyphylaxis (acute tolerance), paste like and is hard to inhale or inject, making abuse more difficult |
| True or False Concerta is not affected by food | True |
| What are some characteristics of metadate CD | Contains a mixture of imm release and ext release (30:70 ratio), greater exposure and higher concetnration in the first 6 h, efficacy does not extend into pm hours, replaces BID dosing with methylphenidate |
| True or False Absorption of metadate is affected by food in stomach | True |
| What are some characteristics of Ritalin LA | Capsule form with 50% imm release and 50% providing a second, delayed release, symptoms improve during the day but not in to the pm, replaces BID dosing with methylphindate. |
| Ture or False Absorption of Ritalin LA is affected by food | True if taken with a fatty meal there is a lag time before it is absorbed and delays reaching the 1st and 2nd peaks. |
| What are some characteristics of Adderall XR | Capsule form with imm release and then a second delayed release in 4-6 h after admin. pharmacokeinteci profile is similar to BID dosing of imm release adderall |
| What are some common side effects of stimulants | Delayed sleep onset, decreased appetite, headache, jittery and behavioral rebound, anxiety, irritability. |
| What can you do to manage the side effects of decreased appetite and decreased sleep? | Appetite: eat in AM before taking meds, offer small, frequent meals, use ritalin LA or Metadate CD so that medicine has worn off by dinner. Sleep: giver LA meds early in AM, sleep hygiene techniques |
| How can you reduce increase agitation, headaches and minimize growth issues? | Anxiety: decrease dose, HA: often resolve with a coupld of weeks, may need to reduce dose or try another stimulant, Growth: monitor growth charts, assess for genetic syndrome, dose dependent, resolve after d/c of stimulant RX |
| What are some other categories of meds used to treat ADHD? | Antidepressants: buproprion (Wellburtin), TCA, Prozac and AntiHTN: guanfacine (tenex), clonidine (Catapres) |
| Which nonstimulant medication is approved for ADHD | Atomoxetine (Strattera). a selective norE reuptake inhibitor, begin slower than recommended dose due to sedation, Rports of GI side effects |
| What are some unexpected theapeutic effects of Strattera | Improved sleep, easier to arouse in AM, decreased enuresis, improved mood |
| What are some things you should know about Stattera | Few vital sign issue, no safety data on its use with low dose stimulants, do not use with TCA or Wellbutrin |
| True or False Absorption of Strattera is not affected by food | True |
| When shoud you follow-up with an ADHD patient | Depnds on degree of dysfunction, stimulant use, complications and adherence |
Created by:
lknightly
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