From ANCC Review
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| For management of ADHD - Inattentiveness, Impulsivity, Hyperactivity, recommend | medication management + behavioral treatment
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| First line for ADHD | stimulants
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| stimulants do this | make more DA and or NE avilable
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| second line for ADHD | antidepressants
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| antidepressants do this | make more 5HT, DA, NE available
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| which antidepressant is used for ADHD | strattera
also buproprion, venlafaxine
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| third line for ADHD | antihypertensives - alpha 2 agonists
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| these are alpha 2 agonists | clonidine or guanfacine
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| when would an alpha 2 agonist be the first line choice | with ADHD + Tics
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| how do you know what release dosage to give a pt | tailor to individual
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| immediate release compounds last | 2-4 hours
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| older sustained release compounds last | 4 hours
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| newer sustained release offer | longer coverage
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| duration of concerta | 12 hrs
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| duration of metadate CD | 8 hr
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| duration of ritalin LA | 8-12 hr duration
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| duration of adderall XR | up to 9 hr duration
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| duration of dexedrine spansule | 6-9 hr duration
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| monitor these with stimulants | BP, weight, height, periodic CBC, platelets and liver function
may consider drug holidays during summer months to allow catch up from growth suppression.
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| educate parents to do this with stimulants | monitor height and weight
give with or right after meals to minimize appetite suppresion
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| short acting stimulants can cause this | rebound hyperactivity
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| psychostimulants can | increase motor or phonic tics or stereotypic behavior
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| before starting a stimulant, evaluate | hx of cardiac problems (LVH, syncope)
family history of sudden death
EKG before starting
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| LVH is | left ventricular hypertrophy
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| psychostimulants can improve these three things but not this | inattention, hyperactivity and impulsiveness not interpersonal relationships
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| atomoxetine (Strattera) dosage | 0.5-1.2mg/kg/day
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| strattera falls under this class | norepinephrine reuptake inhibitor
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| buproprion dosing for ADHD | SR 3-6mg/kg/day useful in comorbid depression, but may exacerbate tics
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| dosage for adolescents | follow adult pattern
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| max dose for children using buproprion | 300mg/day
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| venlafaxine xr dosing for adhd | 1-3mg/kg/day
useful in comorbid anxiety and depression
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| antihypertensives for adhd | clonidine and guanfacine
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| monitor this with antihypertensives | BP
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| antihypertensives can be effective with | ADHD plus tics, hyperactivity, impulsiveness and aggression
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| side effects of antihypertensives | sedation, headaches, depression and potentially rebound hypertension
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| clonidine dosing | 0.0003-0.1mg/kg/day
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| guanfacine dosing | 0.015-0.05 mg/kg/day
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| options for med management of aggressive behavior | antipsychotics, anticonvulsants antidepressants, lithium, benzos, propranolol
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