RT Book, Section A1 Dopheide, Julie A. A1 Pliszka, Steven R. A2 DiPiro, Joseph T. A2 Talbert, Robert L. A2 Yee, Gary C. A2 Matzke, Gary R. A2 Wells, Barbara G. A2 Posey, L. Michael SR Print(0) ID 1145192099 T1 Attention Deficit/Hyperactivity Disorder T2 Pharmacotherapy: A Pathophysiologic Approach, 10e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9781259587481 LK accesspharmacy.mhmedical.com/content.aspx?aid=1145192099 RD 2024/03/28 AB KEY CONCEPTS Untreated or ineffectively treated childhood attention deficit/hyperactivity disorder (ADHD) can lead to poor school performance, poor socialization, and increased risk for traffic accidents, psychiatric comorbidities, unemployment, and incarceration during adolescence and adulthood. ADHD is 40% to 90% genetic in origin, and it is associated with decreased brain volume, a delay in cortical thickening, and dysregulation of the “default mode network,” a brain system that regulates attention, prioritization of information, memory, and impulse control. Symptoms of inattention or hyperactivity and impulsivity or all three must be present during childhood and cause functional impairment in two different settings for 6 months to meet diagnostic criteria for ADHD. Prior to initiating pharmacotherapy, overall physical and mental health and psychiatric comorbidities must be assessed, and goals of treatment must be set. Preschoolers, school-age children, adolescents, and adults with ADHD all can benefit from nonpharmacologic interventions that include a healthy diet, education on ADHD, and potentially effective cognitive and behavioral treatments. The psychostimulants, methylphenidate, dexmethylphenidate, lisdexamfetamine or amphetamine salts, are the most effective pharmacologic treatment options for all ages with a rapid therapeutic effect, typically within 1 or 2 hours of an effective dose.α2-Adrenergic agonists such as extended-release preparations of guanfacine and clonidine are less effective than stimulants as monotherapy and are used as adjuncts to stimulants in youth to improve symptom control, particularly for oppositional behaviors and insomnia. When ADHD coexists with other neuropsychiatric conditions, such as anxiety disorders, major depression, autism spectrum disorder (ASD) or Tourette’s disorder, it is optimal to treat the most functionally impairing disorder first (whether it is ADHD or the co-occurring condition) and then treat the second disorder. When ADHD coexists with bipolar disorder, it is necessary to first stabilize the mood with lithium, an anticonvulsant, or an atypical antipsychotic before adding an ADHD-specific medication such as a psychostimulant. Atomoxetine is a good option to manage ADHD symptoms in adolescents and adults with substance use disorders. It has a delayed onset of effect (2-4 weeks), but it has no abuse potential.