wk 7 draft 1.docx

Stimulants Lifespan considerations of prescribing stimulants Which ADHD medications are recommended for children? Stimulants- methylphenidate (ritlan, concerta, Daytrana), dexmethylphenidate (focalin), amphetamine (adzenys), dextroamphetamine (Adderall), & lisdexamfetamine (Vyvanase). What medic...

Stimulants Lifespan considerations of prescribing stimulants Which ADHD medications are recommended for children? Stimulants- methylphenidate (ritlan, concerta, Daytrana), dexmethylphenidate (focalin), amphetamine (adzenys), dextroamphetamine (Adderall), & lisdexamfetamine (Vyvanase). What medication is the drug of choice for adults with ADHD? Non-stimulants (NRIs) such as atomoxetine (Strattera), A2 agnonists (clonidine, guanfacine), or NE DA reuptatke inhibitiors such as bupropion (Wellbutrin). What might adults who struggle with executive functioning difficulties & disorganization also experience? Occupational stress & anxiety. Which ADHD medications should be avoided in the elderly?   ADHD Primary symptoms of ADHD are: inattention, restlessness, cognitive & emotional impulsivity, executive functioning deficits, & Self-regulation Which symptom decreases markedly with age? Hyperactivity What medication should be prescribed for those with a history of substance abuse? Non-stimulants; such as atomoxetine (Strattera), A2 agnonists (clonidine, guanfacine), or NE DA reuptatke inhibitiors such as bupropion (Wellbutrin). Which NT play a role in the symptoms & treatment of ADHD? norepinephrine & dopamine. ADHD symptoms 4 categories selective attention hyperactivity lack of sustained attention, impulsivity (dACC is associated with impulsivity) ADHD symptoms may arise from abnormalities within circuits in the prefrontal cortex (PFC), which affect executive function. ADHD symptoms become noticeable around what age and why? 6-7 y/o, possibly due to abnormalities in the prefrontal cortex circuits or errors in the synaptic pruning process. Anxiety and ADHD are regulated by which loop? Corticostriatal thalamocortical (CSTC) loop What NT are associated with inefficient information processing in the prefrontal circuits? Norepinephrine (NE) and dopamine (DA) What scheduled drug level are stimulant medications? Stimulants are schedule II controlled substances Are refills permitted for stimulants? Refills are NOT permitted What diagnostic test must be obtained prior to prescribing stimulants? Must obtain a thorough health hx first Assess for cardiac disease and, if present, obtain an EKG Blood pressure, height, and weight should be monitored regularly Assess for bipolar disorder before treatment Treatment efficacy will be noted within the first week of treatment What can cause or worsen /unmask symptoms of tics? Stimulants What is the youngest age ADHD can appear at? 3 y/o What plays an important role in the development of ADHD? Genetics Terms associated with ADHD Selective attention? lack of attention to detail, careless mistakes, not listening, losing things, diverting attention, forgetful Sustained attention? poor problem solving, difficulty completing tasks, disorganization, difficulty sustaining mental effort Impulsivity Modulated by orbitofrontal cortex: Impulsivity Symptoms of impulsivity: Excessive talking, blurting things out, not waiting one's turn, interrupting Hyperactivity Modulated by the prefrontal cortex (PFC): Hyperactivity Symptoms of hyperactivity: fidgeting, leaving one's seat, running, climbing, trouble playing quietly. Children present with hyperactivity, the hyperactive symptoms are going to decline markedly with age, becoming more subjective, & less apparent/ obvious to others. Adults are not hyperactive but do report internal restlessness & difficulty sitting still. What other medications, in combination with a stimulant, can increase anxiety?   What is the correct protocol for switching patients from one stimulant medication to another? When switching stimulants, discontinue the current medication and start the new medication at a starting dose the next day. What two forms are stimulant medications available in? Available as immediate-release or sustained-release formulations. Are short-acting or Long-acting stimulants at a higher risk for diversion? Short-acting medications are at higher risk for diversion. How should stimulant medications be monitored? Occasional urine drug screens should be obtained to verify the presence of amphetamines & the absence of other substances of abuse. Common side effects of stimulants include? restlessness, irritability, anxiety, insomnia, stomachache, headaches, tics, & worsening of aggression symptoms Is this more likely to occur with immediate or sustained-release medications? Clients may note a worsening of symptoms, or "crash" when the medication wears off, especially with immediate-release (IR) medications. When should clients take stimulant medications? Medications may cause appetite changes & subsequent weight loss. Take medication with breakfast to decrease anorexia NE & DA are associated with the symptoms of inefficient information processing in the prefrontal circuits. Rather than deficiency, both are “Out of Tune.”