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) icon¿Acaso su hijo (a) tiene el trastorno por déficit de atención?

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