UNDERSTANDING AND TREATING ADHD TAMMIE LEE DEMLER, PHARMD, MBA, BCPP
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1 UNDERSTANDING AND TREATING ADHD TAMMIE LEE DEMLER, PHARMD, MBA, BCPP
2 UNDERSTANDING AND TREATING ADHD ACTIVITY DESCRIPTION Pharmacists can play a pro-active role in the treatment of ADHD. Management of ADHD requires far more than patients simply seeking treatment -- it requires patients and/or caregivers to understand and adhere to the treatment regimen in the most dedicated manner. The pharmacist must understand the underlying condition, possible comorbid conditions, potential of currently available treatment options (along with their probable results and possible side effects) and work with health care providers in therapeutic selection and titration of doses to achieve maximum benefit with minimum adverse events. This program will satisfy the education need by creating a program for pharmacists that will enhance their understanding of ADHD, treatment options, counseling points, and information needed to work with both health care providers and patients/caregivers to manage ADHD and improve quality of life. TARGET AUDIENCE The target audience for this activity is pharmacists and pharmacy technicians in hospital, community, and retail pharmacy settings. LEARNING OBJECTIVES After completing this activity, the pharmacist will be able to: Review the prevalence and burdens of Attention- Deficit/Hyperactivity Disorder (ADHD). Outline Diagnostics and Statistics Manual (DSM-5) criteria for diagnosing ADHD Compare and contrast the pharmacological treatment options for ADHD, including efficacy, safety, and tolerability profiles. Identify opportunities for the pharmacist to advance patient care of ADHD through adherence and collaboration with health care providers in therapeutic selection and titration of doses to achieve maximum benefit with minimum adverse events. ACCREDITATION PHARMACY PharmCon, Inc. is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. NURSING PharmCon, Inc. is approved by the California Board of Registered Nursing (Provider Number CEP 13649) and the Florida Board of Nursing (Provider Number ). Activities approved by the CA BRN and the FL BN are accepted by most State Boards of Nursing. CE hours provided by PharmCon, Inc. meet the ANCC criteria for formally approved continuing education hours. The ACPE is listed by the AANP as an acceptable, accredited continuing education organization for applicants seeking renewal through continuing education credit. For additional information, please visit Universal Activity No.: H01-P&T Credits: 1.0 contact hour (0.1 CEU) Online Date: 9/15/2015 Offline Date: 9/16/2016 ACPE Expiration Date: 7/1/2018 ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY PharmCon After completing this activity, the pharmacy technicians will be able to: List signs and symptoms of ADHD List medications used to help treat ADHD 1
3 ABOUT THE AUTHOR Dr. Tammie Lee Demler is the Director of the ASHP accredited post Doctoral psychiatric pharmacy residency for the New York State Office of Mental Health and is the Director of pharmacy services for the Buffalo Psychiatric Center. facility within the New York State Office of Mental Health. Dr.Demler is past President of the Pharmacists Society of the State of New York and President of the Pharmacists Association of Western New York. She received her BS in pharmacy in 2002, Doctor of Pharmacy degree in 2002 and Masters of Business Administration in 2009 from the University of Buffalo. She is board certified in psychiatric pharmacy practice. Currently, Dr. Demler serves as Clinical Associate Professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, Clinical Assistant Professor at The University of Florida, St. John Fisher College and D Youville College in Buffalo, NY. She received a gubernatorial appointment to the NYS Department of Motor Vehicles Medical Advisory Board and currently collaborates on special projects with the FBI and NYS police. Having found her passion for media and community outreach, Dr. Demler has been host of WNY Tonight with Tammie Lee for the last decade, and in addition to being featured as an expert in numerous media interview she is also a contributing author for APA psychiatric news, US Pharmacist and Carlat behavioral report. She most recently was promoted to community affairs radio reporter for Cumulus Broadcast Company (97 Rock, 103 the edge, 104 WHTT). Among her most notable awards, Dr. Demler was named the New York State Senate Woman of Distinction in 2004 for her professional contributions to the people of New York State. Tammie Lee Demler, PharmD, MBA, BCPP New York State Office of Mental Health FACULTY DISCLOSURE It is the policy of PharmCon, Inc. to require the disclosure of the existence of any significant financial interest or any other relationship a faculty member or a sponsor has with the manufacturer of any commercial product(s) and/or service(s) discussed in an educational activity. Tammie Lee Demler, reports no actual or potential conflict of interest in relation to this activity. Peer review of the material in this CE activity was conducted to assess and resolve potential conflict of interest. Reviewers unanimously found that the activity is fair balanced and lacks commercial bias. Please Note: PharmCon, Inc. does not view the existence of relationships as an implication of bias or that the value of the material is decreased. The content of the activity was planned to be balanced and objective. Occasionally, authors may express opinions that represent their own viewpoint. Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information presented in this activity is not meant to serve as a guideline for patient or pharmacy management. Conclusions drawn by participants should be derived from objective analysis of scientific data presented from this monograph and other unrelated sources. 2
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15 ACTIVITY TEST YN is a 16 year old female patient who is comes to your pharmacy along with her mom to pick up some prescriptions. While waiting, YN s mom mentions she is worried about her daughter s recent symptoms of inattention and hyperactivity and wonders whether she may have ADHD. What do you advise YN s mom regarding the diagnostic symptoms of ADHD? 1. In order to determine an ADHD diagnosis, YN would need to exhibit the following: a. One symptom in one setting b. One symptom in more than one setting c. Several symptoms in at least one setting d. Several symptoms in more than one setting 2. Which of the following is true regarding YN s sex and likely diagnostic prevalence when compared to her male peers: a. She is more likely to have ADHD because she is female b. She is less likely to have ADHD because she is female c. She is no more likely to have ADHD as a female(equal chance) d. Sex plays no role in the prevalence of pediatric ADHD 3. YN s mom asks your opinion about current options for medication therapy in children. She has heard there are serious side effects, especially with stimulants. What side effects are more likely associated with stimulants when compared to non-stimulants? a. Hepatotoxicity b. Headache c. Hypotension d. Substance abuse 14
16 4. YN returns to your pharmacy a month later with a prescription for amphetamine mixed salts (Adderall immediate release tablets) twice daily and asks the best way to take this new medication. What would your recommend to YN? a. Take first dose upon awakening with milk b. Take first dose upon awakening with orange juice c. Take second dose at bedtime with a high calorie snack d. Take second dose at bedtime with cold iced tea 5. After a month of trying the amphetamine mixed salts, YN s prescriber orders methylphenidate ER capsules. YN expresses her concern about not being able to swallow capsules. What recommendation do you offer to YN at this time? a. Capsules can be opened and contents sprinkled on warm oatmeal b. Capsules can be opened and contents sprinkled on warm applesauce c. Capsules can be opened and contents sprinkled in cold cottage cheese d. Capsules can be opened and contents sprinkled in cold orange juice 6. YN s friend takes ADHD medication, but reports the friend describes seeing the tablet the next day in her stool. YN does not want to take a medication that has this side effect. What do you recommend to YN regarding her concern? a. Only Concerta brand methylphenidate carries this risk b. Only Methylin brand methylphenidate carries this risk c. Only Daytrana brand methylphenidate carries this risk d. All methylphenidate brands carry this risk 7. YN reports that her friend changed to a different brand of ADHD medication called dexmethylphenidate and wonders if that might be an option for her as well. What would you recommend to YN regarding a change to dexmethylphenidate relative to her current methylphenidate prescription? a. She would need a higher dose of dexmethylphenidate b. She would need a lower dose of dexmethylphenidate c. She would need the same dose of dexymethylphenidate d. She is not a candidate for dexmethylphenidate 15
17 8. YN asks if stimulant transdermal patches are easier to use. What do you recommend for YN regarding the administration of transdermal methylphenidate patches? a. Apply at the same spot daily so patient doesn t forget to remove old patch b. Rotate site, but limit application only to the hip area c. Rotate patches daily between trunk and upper arms d. Reapply a patch that falls off and secure with surgical tape 9. YN s mom is considering asking the prescriber for a non-stimulant product for her daughter. What concerns should she have about the non-stimulant atomoxetine? a. Renal toxicity b. Cardiac toxicity c. Suicidal ideation d. Substance abuse 10. YN has heard that ADHD can persist into adulthood and thinks she would like to initiate and continue a medication that she knows has the best chance of working for her when she is older. What medication has the best efficacy data for older adults? a. Methylphenidate (Concerta) b. Atomoxetine (Strattera) c. Guanfacine (Intuniv) d. Clonidine (Kapvay) Please submit your final responses on freece.com. Thank you. 16
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