ADHD is a neuropsychiatric illness that affects about 5% of school-aged children (Rosenthal & Burcham, 2018). ADHD symptoms include inattention, hyperactivity, and impulsivity (Rosenthal & Burcham, 2018). Children with ADHD may have difficulties waiting their turn, switching activities fast, calling out excessively, and completing tasks (Rosenthal & Burcham, 2018). There are subtypes of ADHD, including inattentive types, hyperactive types, and a combination of the two (Rosenthal & Burcham, 2018). NURS 6521 Week 8 Discussion ADHD Paper
In our chosen case study, Katie is an 8-year-old girl who suffers from an inattentive type of ADHD. According to information provided by her teacher, Katie is inattentive, easily distracted, forgets learned information, and is poor in basic school subjects. From the description, hyperactivity is not an issue for Katie, and she is a pleasant child to be around. Katie’s biggest challenges arise during school hours, when a longer attention span is necessary. She has a good relationship and good interactions with her parents and in her home life. NURS 6521 Week 8 Discussion ADHD Paper
Knowing these things, I chose to start Katie on an initial dose of Ritalin chewable tablets 10 mg orally each morning. I chose Ritalin, because this dose is short acting and the duration is 3-5 hours. This dose and medication would provide Katie with the needed effects during school hours only. This medication would increase attention span, increase goal-oriented behavior, and decrease impulsiveness and distractibility.
Katie returns to the clinic in 4 weeks and her parents have a good report from the teacher. Her teacher reports that symptoms are much better in the morning, but that the effects wear off by afternoon. This suggests that Katie needs a higher dose, or a medication that lasts longer. Katie did report that her heart “felt funny” and upon further exam it was noted that her pulse was 130. The report from Katie’s teacher suggests that the stimulant medications are the right course of treatment for her, but that Ritalin at this dose is not quite the right medication.
Because we have an undesirable, and potentially dangerous side effect of a rapid heart rate, we will switch Katie to Adderall XR 15 mg orally daily. This will allow us to see if a longer acting medication is more helpful for Katie, and also to see if a different medication will have different, and potentially less dangerous side effects for her. Adderall XR is an amphetamine that is also classified as a Central Nervous System Stimulant (Rosenthal & Burcham, 2018). Data does not suggest better efficacy of one stimulant over another, and it is recommended to try another stimulant, should one be ineffective, before moving to a second line agent (Rosenthal & Burcham, 2018).
Adderall XR is usually started at 10mg orally daily. For our third decision point, we will decrease Katie’s dose of Adderall XR to 10 mg PO daily, which is a more appropriate starting point. We saw beneficial effects with Katie on a stimulant and keeping her on a stimulant is desirable. By decreasing Katie’s dose, we should begin to see a decrease in side effects and keep the benefits that were seen with this medication (Adderall XR, 2020).
There are many benefits to using stimulant medications for the treatment of ADHD. Typically, children with ADHD who take stimulant medications will benefit from an increased attention span, increase goal-oriented behavior, decreased impulsiveness, distractibility and hyperactivity. With these benefits comes some less desirable side effects of cardiac nature, insomnia and growth suppression (Rosenthal & Burcham, 2018). When prescribing medications for ADHD, it is important to always start with the lowest starting dose appropriate for age and weight in order to maximize benefits and minimize the risk for side effects. It is safer to begin and work up to a higher dose if needed. NURS 6521 Week 8 Discussion ADHD Paper
NURS 6521 Week 8 Discussion ADHD Paper References:
- Adderall XR (Amphetamine, Dextroamphetamine Mixed Salts): Uses, Dosage, Side Effects, Interactions, Warning. (2020, May 26). Retrieved July 21, 2020, from https://www.rxlist.com/adderall-xr-capsules-drug.htm
- IBM Micromedex (2020). Methylphenidate (Oral Route) Side Effects. Retrieved July 21, 2020, from https://www.mayoclinic.org/drugs-supplements/methylphenidate-oral-route/side-effects/drg-20068297?p=1
- Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier.
Module 6 Week 8 Discussion Reply #2
Thank you for a great discussion, I really enjoyed reading it. I did not realize that there were different types of ADHD. As you discussed there is inattentive ADHD and hyperactivity/impulsivity ADHD (Team ADHD, 2020). Inattentive is characterized by daily activity forgetfulness, easily distracted, losing things needed for tasks, avoiding mental effort tasks, difficulty with deadlines, managing time, and organization, failure to follow through on tasks, poor listening skills, lacks attention to detail, and making careless mistakes (Team ADHD, 2020). NURS 6521 Week 8 Discussion ADHD Paper
Hyperactivity/impulsivity ADHD is characterized by intrudes or interrupts others, does not like to wait their turn, talking excessively, constantly on the go, does not like quiet, excessive movement, restless, does not like to remain seated, squirms, taps hands, or fidgets. To be diagnosed with either of these or mixed, there must be more than two of these symptoms found in two settings or more (such as home, school, public) (Team ADHD, 2020). NURS 6521 Week 8 Discussion ADHD Paper
Stimulants are the first-line treatment and are usually tolerated well (Griffin & Harari, 2019). There is a risk of psychosis when taking stimulants such as amphetamine (Griffin & Harari, 2019). This could be due to the fact that amphetamine causes the release of more dopamine which could contribute to psychosis that is stimulant-induced (Griffin & Harari, 2019). NURS 6521 Week 8 Discussion ADHD Paper
In addition, amphetamines can have cardiovascular effects including increased heart rate, increased AV conduction, and increased force of contraction (Rosenthal & Burchum, 2018). As you discussed Adderall XR may be a good option for this patient. This medication lasts 10-12 hours and is taken once daily (Rosenthal & Burchum, 2018). The usual maintenance dose is 20 mg in the morning (Rosenthal & Burchum, 2018). NURS 6521 Week 8 Discussion ADHD Paper
- Griffin, M., & Harari, E. (2019). Research sheds light on two types of treatment for ADHD. Psychiatric Times, 36(7), 23–25. https://go-gale-com.ezp.waldenulibrary.org/ps/i.do?p=EAIM&u=minn4020&id=GALE%7CA596317842&v=2.1&it=r&sid=ebsco
- Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for nurse practitioners and physician assistants. Elsevier.
- Team ADHD. (2020). Complex ADHD: ADHD diagnosis. Retrieved July 22, 2020, from https://www.team-adhd.com/complex-adhd/diagnosis-adhd/