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Michelle - The world of ADHD According to S.P.A.C.E. medication presentation

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A presentation from The World of ADHD According to S.P.A.C.E. by Michelle Dorber.

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Michelle - The world of ADHD According to S.P.A.C.E. medication presentation

  1. 1. ADHD Medication what’s the point?
  2. 2. The ADHD Brain • Development of the cortex in the frontal lobe of the brain is slower • It doesn’t work as well as it should • Nerves pathways which drive the brain are linked by neurotransmitters • Noradrenaline • Dopamine • Scans show areas of reduced metabolism i.e. areas not working This Photo by Unknown Author is licensed under CC BY-ND
  3. 3. ADHD medication………. • Makes these areas work • Makes nerve pathways in the frontal lobe cortex more effective • Helps the nerve cells pass messages between themselves using neurotransmitters • Usually by increasing the amount of neurotransmitter available
  4. 4. Where do these medicines fit in? • Part of plan inc. psychological, behavioural, educational or occupational needs • Not to be started by G.P. • Prescribed by Hospital & then issued by G.P. • (Already on it from G.P. should be referred to hospital) • Health checks done by hospital CAMHS (transfer to GP when move to adult service)
  5. 5. Medications Age Appropriate? • Pre-school < 5 years • not recommended • School age • moderate ADHD • Non-drug interventions • Parent education programme • School age/Adults • severe ADHD • Medication with other interventions
  6. 6. NICE Guidance First Line- Methylphenidate Stimulant • Medikinet • Ritalin • Tranquilyn • Equasym XL • Afternoon release • Medikinet MR • Morning release • Concerta XL • Longer lasting • Delmosart • Matoride XL • Xaggitin XL • Xenidate XL 8 hours 8-12 hours 3 hours
  7. 7. Equasym
  8. 8. Second Line- Lisdexamphetamine (Elvanse) Stimulant • Prevents reuptake noradrenaline • After 6 week trial methylphenidate • Switch to dexamphetamine (Amfexa) if responding to lisdexamphetamine but need shorter effect Adults either methylphenidate or lisdexamphetamine/dexamphetamine first line
  9. 9. Third Line-Atomoxetine (Strattera) Non-stimulant • Prevents reuptake noradrenaline • (? Doesn’t work if lisdexamphetamine doesn’t) • Cannot tolerate methylphenidate or lisdexamphetamine/dexamphetamine • 6 week trial of either • Useful if tics/tourette’s, anxiety, stimulant misuse/risk of selling stimulants • Mood elevating • Gastro side-effects • Use with slower cognitive processing (not stupid!)
  10. 10. Guanfacine (Intuniv) Non-Stimulant • Needs tertiary referral for adults • Regulates noradrenaline • May reduce tics • Causes sleepiness particularly in first month • Good in combination with a stimulant
  11. 11. Clonidine • Tertiary referral for children with ADHD/ sleep disturbance/rages or tics • Better for restlessness than inattention • Good for tics • Dry mouth and hypotension
  12. 12. Others • Risperidone (Risperdal) • Aripiprazole (Abilify) • SSRIs for anxiety e.g. fluoxetine, sertraline, citalopram (ok with methyphenidate)
  13. 13. Monitoring/Side Effects • Height every 6 months (?growth can be affected by methylphenidate,lis/dexamphetamine & atomoxetine) • - dose related, e.g. methylphenidate 60mg daily for 10 years-somewhat disproved • Weight – after 3-6months, then every 6 months – methylphenidate can be appetite suppressant, improved mood on atomoxetine can cause weight gain • Heart rate & blood pressure before and after each dose change and every 3 months • ?Potential for suicidal thinking/self harm – atomoxetine (due to antidepressant action c.f sertraline etc in adolescents)- not in clinical practice • ?Liver problems (rare)- atomoxetine – should monitor liver function periodically- not in clinical practice • ?Reduction seizure threshold- guanfacine > atomoxetine
  14. 14. Melatonin 2mg m/r licensed (Circadin)/3mg unlicensed Bio- melatonin • Used to help sleep problems associated with stimulants • We produce melatonin as we go to sleep • Need to be in the dark for it to work properly • Take 30mins before bedtime • Licensed dose circadin 2mg at night • (designed for over 55year old stops waking in the night) • Maximum 10mg at night • Unlicensed Specially imported - better release • Adults –from Hospital

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