PMHNP 7348.01 Final exams passed
Which of the following is true regarding psychostimulants? - ✔✔First line treatment for ADHD
Stimulants are first line treatment for ADHD in children, adolescents and adults. They are the most
studied (Dulcan).
ll of the following are changes that were made to the DSM V regarding ADHD? - ✔✔Changed age of
onset to 12
CAN have Autism and ADHD and added symptoms across the lifespan since we know ADHD does not go
away
Can have ADHD and ODD comorbid.
Also included in DSM under ADHD comorbidity- discusses that ADHD and ODD are comorbid 50% of the
time
modifiers were added so that the severity of the disorder (i.e., mild, moderate, or severe) can be
specified and the disorder can be coded as "in partial remission"
ADHD treatment is associated with a ... - ✔✔Decrease in accidental injury and medical utilization due
to accidents and trauma
Stimulants have a black box warning for: - ✔✔Drug Dependence
The U.S. Food and Drug Administration (FDA) reviewed the prescribing information on stimulants in an
effort to clarify risks and benefits. After this careful review, the only black box warning for stimulants
concerns their abuse potential" Screen for cardiac concerns.
,Which of the following is true regarding cortical brain development in children with ADHD compared to
healthy controls? - ✔✔The timing of cortical maturation is different
Peak thickness of cortex delayed (typically occurs around 7, may not happen until 10 for kids with ADHD)
Paroxetine (Paxil) and atomoxetine (Strattera) - ✔✔Paroxetine (Paxil) is an inhibitor of CYP450 2D6 and
atomoxetine (Strattera) is metabolized by CYP450 2D6, so the dose of atomoxetine should be
decreased.
Strattera as it is metabolized (get rid of d and c)by the P450 CYP 2D6, which many other psychiatric
medications are also metabolized by. Specifically if you look under epocrates for interactions you will
find "avoid combo, combo may increase atomoxetine levels, risk adverse effects" therefore you'd want
to decrease the Strattera dose (or not use the combo)
Which of the following is a risk factor for the development of Conduct Disorder - ✔✔Poor family
functioning
child maltreatment, overly harsh and abusive parenting or inconsistent parenting, neglectful parenting
Which of the following symptom is the MOST frequent reason for referral in child psychiatry clinics? - ✔
✔Disruptive behavior
"disruptive behavior disorders being the most frequent referral problem for youth, accounting for one-
third to half of all cases seen in mental health clinics" and slide 43 and 44 I mentioned this during the
lecture.
Amphetamine preparations Short-acting considerations - ✔✔Short-acting stimulants often used
as initial treatment in small
,children (<16 kg/35 lb), but have
disadvantage of b.i.d.-t.i.d.
dosing to control symptoms
throughout day
Amphetamine x3 preparations Short-acting - ✔✔Adderalla 5, 7.5, 10, 12.5, 15, 20, 30 mg tab
Dexedrine 5 mg cap
DextroStat 5, 10 mg cap
Adderall 5, 7.5, 10, 12.5, 15, 20, 30 mg tab - ✔✔Typical starting Dose
3-5 y: 2.5 mg q.d.
>6 y: 5 mg q.d.-bid
FDA Max 40 mg
Off Label Max Daily >50 kg/100lb: 60 mg
Dexedrine (dextroamphetamine) 5 mg cap - ✔✔Typical Starting Dose 3-5 y: 2.5 mg q.d.
Typical Starting Dose >6 y: 5-10 mg q.d.-b.i.d. spansule
Dextrostat (Dextroamphetamine) 5, 10 mg cap - ✔✔Typical Starting Dose >6 y: 5 mg q.d.-b.i.d
Amphetamine preparations long acting considerations - ✔✔Longer acting stimulants
offer greater convenience,
, confidentiality, and compliance
with single daily dosing but may
have greater problematic effects on
evening appetite and sleep
Adderall XR cap may be opened
and sprinkled on soft foods
Amphetamine x3 preparations long acting - ✔✔Dexedrine Spansule 5, 10, 15 mg cap
Adderall XR 5, 10, 15, 20, 25, 30 mg cap
Lisdexamfetamine (Vyvanse) 30, 50, 70 mg cap
Dexedrine Spansules (dextroamphetamine) 5, 10, 15 mg cap - ✔✔Typical Starting Dose >6 y: 5-10 mg
q.d.-b.i.d
FDA Max 40 mg
Off Label Max Daily >50 kg/100lb: 60 mg
ADDERALL (XR), amphetamine and dextroamphetamine salts 5, 10, 15, 20, 25, 30 mg cap - ✔✔Typical
Starting Dose >6 y: 10 mg q.d
FDA Max 30 mg
Off Label Max Daily >50 kg/100lb: 60 mg
