ADHD IS COLOR BLIND - UNDERSTANDING AND ELIMINATING TREATMENT DISPARITIES IN MINORITIES JULIE DOPHEIDE, PHARM.D. ADHD IS COLOR BLIND - UNDERSTANDING AND ELIMINATING TREATMENT DISPARITIES IN MINORITIES ACTIVITY DESCRIPTION ACCREDITATION ADHD, like most other medical conditions is color blind. ADHD doesn't discriminate between white, black, male, female, etc. But we as health care professionals, including pharmacists, can be barriers to improving the diagnosis and treatment of our patients. By better understanding cultural differences and biases, then developing culturally relevant management strategies; pharmacists can help minimize treatment gaps and ensure that treatment of ADHD is color blind. This activity will satisfy the education need by creating a program for pharmacists that will enhance their understanding of ADHD, identify the cultural differences that may limit diagnosis, pharmacotherapy, counseling points, and information needed to work with all the patients to manage ADHD and improve quality of life. 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 503515). 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 http://www.nursecredentialing.org/RenewalRequirements.aspx TARGET AUDIENCE The target audience for this activity is pharmacists, nurses and pharmacy technicians in hospital, community, and retail pharmacy settings. Universal Activity No.: 0798-0000-13-H01-P&T Credits: 1.25 contact hour (0.125 CEU) LEARNING OBJECTIVES After completing this activity, the pharmacist and nurse will be able to:  Describe the cultural differences that may limit   Release Date: December 18, 2013 Expiration Date: December 18, 2016 diagnosis and barriers to care facing minorities with ADHD Review the pharmacological approaches to the management of ADHD (pharmacologic profiles, efficacy, side effects, & adverse events) Outline the effective guideline based, culturally relevant counseling techniques that nurses can use with patients and caregivers in daily practice to eliminate disparities in treatment and maximize quality of life for all patients ACTIVITY TYPE Knowledge-Based Home Study Webcast FINANCIAL SUPPORT BY Shire Pharmaceuticals After completing this activity, the pharmacy technician will be able to:   List signs and symptoms of ADHD Recognize that cultural differences in patients and when to refer a patient to a pharmacist 1 ABOUT THE AUTHOR Dr. Dopheide is a Professor of Clinical Pharmacy, Psychiatry and the Behavioral Sciences, at the University of Southern California in Los Angeles. She received her Pharm.D. from the University of Nebraska and completed a residency in psychiatric pharmacy practice at the University of Southern California. Dr. Dopheide is a board certified psychiatric pharmacist and provides clinical service for adults and children with psychiatric illness at Los Angeles County + USC Medical Center. She supervises the psychiatric pharmacy resident in the provision of comprehensive medication management at the Center for Community Health (CCH) located in downtown Los Angeles. She is actively involved in teaching pharmacy students, medical students allied health and psychiatry residents in both the classroom and clinical settings. Dr. Dopheide has over 40 publications in peer-reviewed journals, textbooks and educational publications. She is a nationally recognized expert in psychiatric pharmacy, particularly child/adolescent psychopharmacology, sleep medicine and depression. Dr. Dopheide is the current president of the College of Psychiatric and Neurologic Pharmacists (CPNP) and is active in the American Society of Hospital Pharmacists (ASHP), American Pharmacists Association and the National Alliance for the Mentally Ill (NAMI). Julie Dopheide, Pharm.D. Professor, University of Southern California 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. Julie Dopheide 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 3 4 5 6 7 8 9 10 11 12 13 ACTIVITY TEST Brett Cole is a 12 year old boy in the sixth grade who has been taking methylphenidate OROS since the age of 8 for ADHD-combined type and oppositional defiant disorder. He is getting A’s and B’s in school and he has taken up basketball and he plays the violin. Brett’s parents are pleased with their son’s accomplishments but they are concerned that as he gets older, he may be at risk for substance use and abuse. They are particularly concerned given the family history of alcohol abuse. They have questions about Brett’s substance abuse risk and wonder if they should consider a trial of atomoxetine before high school. 1. According to available research on substance abuse and ADHD, which of the following factors is most likely to increase the risk of substance abuse for Brett? A. A diagnosis of ADHD. B. lisdexamphetamine C. Comorbid Autistic spectrum disorder. D. Family alcohol abuse. 2. Brett’s parents ask if the stimulant that Brett takes has a higher abuse potential than other stimulants. Which ADHD medication has the greatest potential for abuse? A. methylphenidate OROS B. lisdexamphetamine C. mixed amphetamine salts D. atomoxetine 3. Jason has been taking 15mg per day of mixed amphetamine salts for 4 weeks now and his attention is better with improved behavior in the classroom. He is able to raise his hand before speaking; he is less aggressive, calmer and his grades have improved. Unfortunately, significant symptoms remain as Jason is still impulsive, unable to wait his turn in line and he has trouble completing homework assignments. He reports persistent insomnia and poor appetite as well. Select the most appropriate drug therapy intervention. A. Increase mixed amphetamine salts to 40mg in the morning. B. Add guanfacine extended release 1mg and titrate to response. C. Switch to atomoxetine 10 mg twice daily and titrate to response. D. Switch to immediate release mixed amphetamine salts 20mg bid. 4. A 4 year-old is frequently sent home from preschool for hyperactivity and impulsivity. The child should be evaluated for a deficiency in which substance that could contribute to ADHD symptoms? A. Ferritin B. Cyanocobalamin C. Folate D. Omega-3 fatty acids 14 5. When an ADHD diagnosis is confirmed in a 4-year-old patient, first-line treatment recommended by the American Academy of Pediatrics is: A. Methylphenidate extended-release preparations B. Parent training and behavioral modification C. Meditation, yoga, and physical therapy D. Clonidine or guanfacine extended release 6. Potential advantages of α-adrenergic agonists over stimulants for ADHD include: A. More rapid onset of therapeutic effect B. Greater efficacy for aggression and impulsivity C. Less insomnia, anorexia, and growth effects D. Effective for children, teens, and adults 7. When asked about the risk of sudden unexplained death when stimulant medications are given for ADHD, the best response is: A. Careful screening for patient and family history of cardiac disease is recommended because those with underlying disease are at risk. B. The risk of sudden unexplained death is significant only for those taking stimulants combined with other illicit drugs. C. Administering stimulant combined with either extended release guanfacine or clonidine is cardioprotective. D. Methylphenidate formulations pose less of a risk of adverse cardiac events compared with amphetamine formulations. 8. Which of the following is true regarding methylphenidate extended release suspension? A. It should be started at 10mg in the morning B. Its duration of effect is 6 to eight hours C. It is stable for 4 months after reconstitution D. It has less stomach upset than OROS methylphenidate 9. According to a study by Morgan et. Al. that assesses ADHD diagnosis and treatment rates from kindergarten to the eighth grade; children of which ethnicity is least likely to be diagnosed and treated for ADHD? A. Pacific Islander B. Hispanic C. Caucasian D. African American 10. Which of the following is accurate regarding the worldwide prevalence of ADHD? A. Prevalence rates are similar when consistent diagnostic criteria and methodology are used B. Rates of ADHD are higher in South America compared to North America and Europe C. Most epidemiological studies have been conducted in Asia and the Middle East. D. Both B and C are correct Please submit your final responses on freeCE.com. Thank you. 15