GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha)




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ANEXO N° 5



CONTRAINDICACIONES AL USO DE ESTIMULANTES 2



  • Sensibilidad previa a estimulantes




  • Glaucoma




  • Enfermedad cardiovascular sintomática




  • Hipertiroidismo




  • Hipertensión arterial




  • Abuso previo de estimulantes a menos que estén siendo tratados en un programa con controles periódicos




  • Si un miembro de la casa tiene una historia de abuso de estimulantes deben tomarse las medidas necesarias para resguardar el uso




  • Uso concomitante con inhibidores de la MAO




  • Psicosis




  • Epilepsia no bien controlada con anticonvulsivos


ANEXO N° 6



a.- REACCIONES ADVERSAS A TRATAMIENTO3


SEVERAS

(Requiere reducción de la dosis o discontinuación)
MODERADAS

(Puede requerir disminución de la dosis y no se puede aumentar)
LEVES

(mantenerse expectante)

Anorexia severa
Anorexia moderada
Anorexia leve

Insomnio severo (+ 1,5 horas)
Insomnio moderado (1 a 1,5 horas)
Insomnio leve (- 1 hora)

Tics nuevos, marcados o severos
Tics nuevos pasajeros

Tics pasajeros, menores que no causan problemas

Cefalea severa
Cefalea moderada
Cefalea leve

Calambres intolerables
Calambres moderados
Calambres leves

Alergia en piel severa
Alergia en piel moderada

Alergia en piel leve

Ansiedad severa
Ansiedad moderada
Ansiedad leve

Irritabilidad severa que lleva a la agresión
Irritabilidad moderada
Irritabilidad leve

Depresión severa no pre-existente
Depresión moderada no pre-existente
Depresión leve

Alucinaciones

Alucinaciones cuestionables



Psicosis







b.- EFECTOS COLATERALES4


EFECTOS COLATERALES
OPCIONES DE MANEJO

Anorexia, nauseas, pérdida de peso
Monitorear cuidadosamente, dar medicación con las comidas, dar suplemento calórico

Problemas con el crecimiento
Si es significativo (raro en el largo plazo) o causa ansiedad parental, intentar períodos libres de fármaco

Vértigos y cefalea
Monitorear cuidadosamente (chequear la presión arterial), asegurarse que la medicación sea tomada con las comidas y fomentar la ingesta de líquidos

Movimientos involuntarios, tics y Síndrome de Tourette
Reducir la medicación, si persisten considerar alternativa farmacológica

Pérdida de espontaneidad, disforia, agitación
Reducir o discontinuar la medicación (discontinuar si se sospecha trastorno del pensamiento o psicosis, raramente se producen)

Irritabilidad, rebote conductual
Monitorear cuidadosamente, reducir o dar una dosis más en la tarde, descartar Comorbilidad con trastornos disociales

Problemas con el sueño
Monitorear cuidadosamente, reducir o eliminar dosis de las tardes


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1 Adaptado de Hechtman, L.: Assessment and Diagnosis of Attention- Deficit / Hyperactivity Disorder. Child and Adolescent Psychiatric Clinics of North America Vol 9 (3), 481-498, 2000 )


2 Greenhill, L. L. et al.: Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry, 41(2 Suppl): 26S-49S, 2002

3 Greenhill, L. L. et al.: Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry, 41(2 Suppl): 26S-49S, 2002,

4 Attention Deficit and Hyperkinetic Disorders in Children and Young People. A National Clinical Guideline. Scottish Intercollegiate Guidelines Network, 2001



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GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconLas niñas con el trastorno de déficit de atención con hiperactividad...

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconTrastorno por déficit de atención con hiperactividad

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconEl Trastorno por Déficit de atención con Hiperactividad (tdah)

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconConsenso de expertos del área de la salud sobre el llamado "trastorno...

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconEl Trastorno por Déficit de Atención con Hiperactividad (tdah) afecta...

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) icon¿Acaso su hijo (a) tiene el trastorno por déficit de atención?

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconEl tema del Trastorno por Déficit de Atención con Hiperactividad...

GUÍa clínica atención Integral de Niñas/ Niños y Adolescentes con Trastorno Hipercinético/Trastorno de la Atención (tha) iconGuia n modelo de atención integral y humanizada en salud



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