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All right we've talked about the behavior adjustment we've talked about
how to make these changes at the
its but let's also faces by themselves they're not
enough only a third of ADHD children respond enough to those changes
to not need medication and even many of those would still benefit from their
medication
but two-thirds and in my experience it as many as eighty percent
are going to have to go on medication at some point in life
maybe it's not this month maybe it'll be in six months maybe a two-year
just depends on how compassionate and cooperative the caregivers happened to
be
and of course how severe the ADHD happens to be as well
but at some point these medications will be needed for most children
so I want parents to know them and to know about them now if you're looking
for a very good book the single best book for parents and psychiatric drugs
is by doctor timothy willens
straight talk about psychiatric medication for children
you can get it at the ATT warehouse you can get it through Guilford publications
that deal for dot com
willens wiil E and yes
it is a parent's book I'm psychopharmacology straight
talk about psychiatric medication for children
so quickly let's go over what's out there
right first of all parents need to know we have stimulants there are only two
now
we have had them since 1936 for the amphetamines and 1957 from Ethel Kennedy
they've been around a long
time which means we know a lot about them we know how safe and effective they
are
these are the best study drugs used in pediatrics and psychiatry
so parity to understand that we got a lot of information out there
on the safety and effectiveness up these agents but they're still
is only to stimulants the news in the last seven or eight years
has been in the delivery systems because the problem with the immediate release
medications is the only lasted three or four hours
so they had to be given two to three times a day so you had to take him at
school
and they're created all kinds of problems so companies went back and
reengineer delivery systems to try to keep the drugs in the body for longer
periods of time on a single dose
and they came up with four ingenious delivery systems called the 5 P's which
I will tell you about
in just a moment let's also understand that last year was published biggest
study ever done
a stimulant safety for preschool children with ADHD in a show that the
drugs are effective
and are safe down to age to so the fact that we are seeing some of these drugs
instituted younger in life than previously is nothing to worry about
it looks okay the preschoolers don't respond quite
as well but apart from that there are no new side effects and there's certainly
nothing life-threatening
about using the other new agent we have out there
is at a mock city district hero approved in 2003 in the US in about a year later
here in Canada
shittier is not a stimulant it has not been a beautiful drug
haha and it is nearly as effective though not quite
as effective as the stimulus but for some children with particular
are ADHD comorbidities like text anxiety
tourette's OCD insomnia and so forth atomoxetine can be a good
alternative drug because it doesn't worsen those comorbid conditions
now you should also be aware that this August the US will have a new drug
on the market for ADHD it will be quanta seen XR
want racine XR will be called Intuniv
this is not a stimulant decision antihypertensive drug
it has been used for years with ADHD children especially if they have
tourette's syndrome
or bipolar disorder or very explosive behavior because the antihypertensive
drug
appears to help lower emotional
impulsive behavior in the individual but Shire has now been able to manufacture a
long-acting version of guanfacine or previously called 10x
unit will be marketed under the quanta seen label
I expect you guys will probably see a year or two after we get it
now let's go back to the 5 P's these are the new delivery systems
the first P is the pellet system Sydney the pill system
my apologies the pills are the original forms of the drug
ritalin and dexedrine are in their original pill form
and last about three to five hours so what's new
they put him in a pump this is concerta concerta is a miniature
hydraulic pump so that when you swallow this there is powdered ritalin on the
outside of this little capsule
and it goes to work immediately and then on one end at this capsule barely
visible to you
is a laser Hill drilled hole at the end of the capsule
inside the capsule is a methylphenidate sludge in two doses
a light does at the beginning double the dose in the afternoon
when you swallow this water is gonna come into this upper chamber and a
continuous rate and it's gonna push down on this from like a tuba toothpaste
gonna squeeze liquid really now for about 10 to 12 hours
that is really neat and then the pill is excreted
in the the child so excrement so you've got a drug that can last
around 10 hours some kids it's only eight others get as much as 12 but about
eight to 10 is about right that is a really need
system the next system is the time-release
colored system so we've got the pill the pump
and now the pellet the time release pellets are what adderall xr involves
focalin on LA Arthur XR Ritalin LA they're all time release pellets
and want to see necks are going to be the same way so you have different
pellets
up medication in this case amphetamine third coated with different time release
coatings
some dissolve right away some in an hour to 34
up to eight to 10 hours so is there any difference between the pellet system
and the pump not really over the day
but on the time of day there is the palate system
it's better if the problems are greatest in the morning the pump system is
greater
better if the problems are toward the afternoon or late in the day
but other than that across the day the copper about eight to 10 hours
excuse me want to get rid of that okay
well done the next p I don't know if you have this up here in Canada
this is the patch okay this is Datron a
this is methylphenidate in a skin patch wear it on the buttocks
wear it on your shoulder on your hip wear it all day long that it absorbed
through the skin
no taken pills this is a very hard road to abuse because you can't snort
the patch in
but there's a problem about 15 18 percent of patients develop a skin rash
to this and can tolerate it and it's due to the drug
but 80 84 percent of people can tolerate the skin patch
so it's pretty good as an alternative a by the way I
I meant to mention under the pellet system one of its advantages as a child
can swallow a pill and you don't have the patch available
you can open the capsule and sprinkle the palate on food
like on yogurt or applesauce doesn't change the delivery
at all I'm so at another advantage of that
finally last august we have the first drug of its kind ever produced
this is vyvanse to former them fed a mean called a pro drug
hence the last key what is a pro driver approach rock is where you take
a chemical in this case amphetamine and you lock it up
okay this is the amphetamine right here and you lock it up
with another chemical so it can't work
now this drug will only work after you split of in this case
the lies in you swallow vyvanse
there's a chemical in your body that will split of the lysing
and now the amphetamine can go to work this is the first known abuse about
lunch at a mean ever invented
because it only works in the stomach and after crosses through the intestine
into the bloodstream and that's where the
chemical is the enzyme that splits of the lighting
and now it goes to work so we have a non a beautiful amphetamine on the market in
the US
I don't know if your vyvanse yet probably coming this year I believe
okay so just be aware that it's down there
vyvanse is a little better than adderall xr which is the other drug made by the
same company and its replacing it in the US
yes vyvanse last to hours longer
than the other drugs do this is about a twelve
our truck it also has a softer on certain and a softer or
offset unlike adderal so it's pretty good drug