Most common neurodevelopmental disorder in children, occurring almost twice as often in boys compared to girls
ADHD
ADHD is characterized by symptoms of
inattention, hyperactivity and impulsivity
What catecholamine can play a role in ADHD
defects in the dopamine pathways that regulate reward anticipation and emotion self-regulation
Primary treatment of ADHD
stimulant medication because they raise dopamine and NE levels
First-line treatment for preschool-aged children (age 4-5 years)
parent training in behavior management and/or behavioral classroom intervention
ADHD medications are considered first-line in patients
≥ 6 years old
Natural products that can help with ADHD
Fish oil (improve cognitive function) and melatonin (to help with sleep)
Long-acting formulations are preferred for children, to help
maintain more steady symptom control and avoid the need for a dose during the day at school
Brand name for atomoxetine
Strattera
What is the place of therapy for atomoxetine
can be tried when stimulants do not work well enough (after 2-3 medications)
Brand name for guanfacine ER
Intuniv
Brand name for clonidine ER
Kapvay
guanfacine ER and clonidine ER are non-stimulant medications that can be used
alone or in combination with stimulants
Which stimulant capsule contents can be mixed in water, orange juice or yogurt
Vyvanse
Adderall XR and Ritalin LA capsule contents can be sprinkled on
a small amount of applesauce
all stimulants are C-II and must be dispensed with a
MedGuide
MOA of stimulants
blocks the reuptake of NE and dopamine
Methylphenidate transdermal patch
Daytrana
Brand names for methylphenidate
Ritalin, Concerta, Quillivant, QuilliChew ER, Daytrana
Brand name for methylphenidate OROS delivery
Concerta
How does OROS delivery work
the outer coat dissolves fast to provide immediate action, and the rest is released slowly (decreases abuse potential)
How to apply Daytrana
apply 2 hours before desired effect (or as soon as the child awakens so it starts to deliver prior to school); remove after 9 hours, alternate hips daily
active isomer of methylphenidate
dexmethylphenidate
Brand name of dexmethylphenidate
Focalin
prodrug to dexmethylphenidate
serdexmethylphenidate
Brand names of dextroamphetamine/amphetamine
Adderall, Mydayis
prodrug of dextroamphetamine
lisdexamfetamine
Vyvanse formulations
capsule, chewable tablet
Brand name for methamphetamine
Desoxyn
What formulation is QuilliChew ER
chewable tablet
What formulation is Quillivant XR
oral suspension
MOA of viloxazine
selective NE reuptake inhibitor (approved in patients 6 years and older)
Brand name of viloxazine
Qelbree
Stimulants can cause
increased HR and BP, serious cardiovascular events, insomnia, psychosis, priapism, decreased appetite
atomoxetine can cause
liver damage, suicidal ideation, somnolence
What does ADHD stand for
Attention deficit hyperactivity disorder