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NSC 881 EKU

APPLIES PSYCHOPHARMACOLOGY CHILD AND ADOLESCENTS WITH NEURODEVELOPMENTAL DISORDE

QuestionAnswer
Pediatric Psychopharmacology
Developmental considerations- really assess height and weight due to possible growth effects from stimulant use
Physiological consideration dose appropriately, child dosing is typically based on size (weight and age), always start low and increase slow to minimize side effects.
ADHD Types • ADHD combined • ADHD predominately nattentive • ADHD predominately hyperactive-impulsive
Possible brain structures involved with symptoms of inattention, hyperactivity and impulsivity arise from circuits in the prefrontal cortex.
symptom of inattention comes from inefficient information processing in the dorsolateral prefrontal cortex.
symptoms of impulsivity that can be seen in other psychiatric disorders as well are mania, aggression, and violence and they appears to involve the orbitofrontal cortex.
What neuro transmitters likely to involve in the symptoms of ADHD dopamine and noradrenaline (norepinephrine) as dopamine influences behavior such as risk taking and impulsivity and norepinephrine modulates attention, arousal, and mood
Evaluation tools Connor’s and Vanderbilt. The Connors is a free tool to use, Vanderbilt has a fee attached with use but may be a part of your organizations resources.
Treatment of ADHD Stimulants and other (none stimulants)
Stimulants - MOA -increases norepinephrine and dopamine by blocking their reuptake and facilitating their release
Stimulants - Prior to treatment assess for presence of cardiac disease (history, family history, physical exam)
Stimulant use on individuals with hx of heart issue Monitor ECG, if not ECG not required
other intervention with stimulant use monitor BP regularly standing and sitting
Stimulants contraindication Contraindicated with co-morbid glaucoma
Stimulants- caution Many drug drug interactions, watch and check for these carefully
Stimulants- patient education Take with food-may delay peak action for 2-3 hours, except Vyvanse. Vyvanse can be taken with or without food with no effects
Stimulant considerations • Monitor height and weight • Avoid late in the day dosing due to possible insomnia • Sleep patterns-common to use melatonin to aid with sleep issues • Patients may experience weight loss • Mild side effects are common • High abuse potential, schedu
Drug holidays may be beneficial due due to the effect of growth and development.
Sometimes these drugs can make the kids feel worse, so be sure to asses and address that concern with the family.
Stimulant side effects - Methylphenidates have the rare side effect of priapism rare but possible side effect of leukopenia and anemia
rare but possible side effect of leukopenia and anemia from the Stimulant Methylphenidates require periodic monitoring of CBC, platelet counts
Other side effects of Stimulants • Insomnia • Headache • Tics • Nervousness • Irritability • Overstimulation • Tremor • Dizziness • Dry mouth • GI symptoms • Nausea • Constipation • Anorexia • Weight loss
DHD Pharmacological Treatments Other (non stimulants) Atomoxetine (Strattera) Buproprion (Wellbutrin IR, SR, XL) - off label ADHD wk 2 Chlorpromazine (Thorazine) - off label hyperactivity wk 4 Haloperidol (Haldol)- off label hyperactivity wk 4 Clonidine (Catapress IR) (Kapvay long acting) Guanfaci
Kapvay FDA approved for ADHD ages 6-17
Clonidine (Catapress IR) (Kapvay long acting) Off label use – motor tics, Tourette syndrome, ODD, Conduct disorder, Pervasive developmental disorders
clonidine (Catapress IR) Off label use for ADHD
Clonidine (Catapress IR) (Kapvay long acting) side effects include Side effects include dry mouth, dizziness, constipation, sedation, fatigue
Guanfacine (Intuniv long acting, Tenex IR) Used off label for ODD, conduct disorder, pervasive development disorders, motor tics, and Tourette’s syndrome
Guanfacine - Use in caution with renal, hepatic, and cardiac impaired patients
Side effects include dry mouth, dizziness, constipation, sedation, fatigue
Created by: vivchiom
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