The case study I chose this week was the young patient, Katie, who presents with symptoms of attention deficit hyperactivity disorder (ADHD), predominantly inattentive presentation. Her teacher describes her symptoms as inattentive, easily distracted, forgets things she already learned, and is poor in spelling, reading, and arithmetic. ADHD is the most common neurodevelopmental disorder diagnosed in childhood and is characterized by chronic symptoms of inattention, impulsivity, and/or hyperactivity leading to functional impairment in multiple settings (Danielson, Bitsko, Ghandour, Holbrook, Kogan & Blumberg, 2018).
The first decision I made in Katie’s plan of care was prescribing Ritalin chewable tablets 10mg orally in the morning. Katie and her parents returned to the clinic four weeks later stating that the medication did improve her symptoms in the morning and overall academic performance, but by the afternoon Katie became easily distracted again. She also was tachycardic from the medication. My next decision was to discontinue the Ritalin and prescribe Adderall XR 15mg orally daily. The extended release helped maintain her attention throughout the day, but Katie still was tachycardic. At this point, my next decision was simply to reduce the dose to 10mg. Unfortunately, tachycardia is a main side effect from Adderall, but Katie’s could have been worse because she was started at a higher dose. It is important to initially start at 10mg and increase to 5-10mg once the patient is tolerating the medication well.
The administration of the associated pharmacotherapeutics I recommended may impact the patient’s pathophysiology in different ways. For example, the drugs Ritalin and Adderall are both stimulants causing a possible increased heart rate, which is the main side effect this patient presented with. This is why it is important to start the patient on a low dose and gradually increase the dose as needed. In addition, these drugs may also impact the patient’s sleep and cause eating problems, which has commonly been reported but can be managed by making adjustments to the medication regimen or daily routines (Hennissen, Bakker, Banaschewski, Carucci, Coghill, Danckaerts, Buitelaar, 2017). However, these types of drugs are highly effective in the treatment of ADHD by improving attention and focus causing the impulsiveness and hyperactivity to decline because the child is now able to concentrate on the specific task (Rosenthal & Burchum, 2021).
Danielson, M. L., Bitsko, R. H., Ghandour, R. M., Holbrook, J. R., Kogan, M. D., & Blumberg, S. J.(2018). Prevalence of Parent-Reported ADHD Diagnosis and Associated Treatment Among U.S. Children and Adolescents, 2016. Journal of clinical child and adolescentpsychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(2), 199–212. https://doi.org/10.1080/15374416.2017.1417860
Hennissen, L., Bakker, M. J., Banaschewski, T., Carucci, S., Coghill, D., Danckaerts, M., . . .
Buitelaar, J. K. (2017). Cardiovascular Effects of Stimulant and Non-Stimulant Medication
for Children and Adolescents with ADHD: A Systematic Review and Meta-Analysis of
Trials of Methylphenidate, Amphetamines and Atomoxetine. CNS Drugs,31(3), 199-215.
Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice
nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier.