A child has been taking SD methylphenidate (Ritalin), 10 mg at ...

[Wadzanai]

A child has been taking SD methylphenidate (Ritalin), 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school.
 
  The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?
  a. Ask the prescriber whether this child could be given methylphenidate (Concerta).
  b. Contact the prescriber to suggest using a nonstimulant medication.
  c. Reinforce the need to take all doses as prescribed.
  d. Suggest drug holidays for the child on weekends.

Question 2

A child will begin taking methylphenidate (Ritalin) for attention-deficit/hyperactivity disorder. Important baseline information about this patient will include:
 
  a. results of an electrocardiogram (ECG).
  b. family history of psychosis.
  c. height and weight.
  d. renal function.

[dominiqueenicolee]

Answer to Question 1

ANS: A
This child is showing slight improvement with the medication but has trouble taking the noon dose; therefore, a once daily formulation would increase compliance and improve effects. There is no indication to use a nonstimulant medication, because the child's appetite is normal. If 3 times/day dosing were the only option available, reinforcing the need to take all doses would be necessary; however, some children avoid taking medication at school because of the stigma attached to being different from their peers. The use of drug holidays is controversial; this approach is used when growth suppression is a problem.

Answer to Question 2

ANS: C
Side effects of methylphenidate include a reduced appetite, and children taking these drugs should be monitored for growth suppression. Baseline height and weight measurements help with this ongoing assessment. The value of an ECG for children has not been proven, except when known heart disease is a factor. Excessive use of stimulants can produce a state of psychosis but is not related to the family history. Renal function tests are not indicated.

[Wadzanai]

Excellent

[jordangronback]

Gracias!