pharm week 8 discussion post
Attention-deficet/hyperactivity disorder is a neuropsychiatric disorder affecting 5-11% of children with boys being two to three times more likely to diagnosed (Rosenthal DNP ACNP, Laura & Burchum DNSc APRN BC, Jacqueline, 2020). A diagnosed with ADHD can be made if the symptoms began before the age of seven and have to have been exhibited for at least six months (Rosenthal DNP ACNP, Laura & Burchum DNSc APRN BC, Jacqueline, 2020). There is thought to be a genetic component to ADHD to which I fully agree as my son has ADHD and while I do not have a formal diagnoses of it I have most definitely diagnosed my self and my father. Children typically respond to the medication based on the mechanism of action meaning that it will either cause a release or blockage of norepinephrine, dopamine, and serotonin.
In the scenario we were told that it is an eight-year-old girl whose parents were told by her teacher that she felt that she might have ADHD and now the parents have sought out professional help in determining if she does and if so what the corse of treatment would be. We are then asked to choose what medication we feel she should be started on (wellbutrin, intuniv, or ritalin) and I feel she should be started on Ritalin 10mg in the am. During her next follow up it is noted that the teacher feels that her attention has improved for the first part of the day however by the afternoon she is back to being unable to concentrate. It was also noted during the appointment that her pulse was elevated. At this point I felt that it was necessary to change her medication to Ritalin LA and to monitor her heart rate as it is a side effect of taking a stimulant. At her next follow up it was noted that she has been able to remain attentive during the entire school day and that her heart rate has returned to a normal rate. From this point I feel it would be acceptable to continue with the current regimen.
Ritalin or methylphenidate works by increasing the release of norepinephrine and dopamine while also preventing the reuptake of the same neurotransmitters. A study was conducted regarding how to properly dose Ritalin and what they noted was that it should be started at 5mg not the 10mg that the scenario suggested and should be given twice a day with increased increments of 5-10mg based on the effectiveness of the medication(Childress et al., 2016). This same study also concluded that children tend to do better and are more compliant with the extended release Ritalin because they do not require a second dose while at school (Childress et al., 2016). It should also be noted that the goal of any medication should be to be on the lowest possible dose while achieving the desired affect. There are times when adding a second medication to the treatment can enhance the affect of Ritalin on in particular is memantine (namenda) a medication that is typically used to treat Alzheimer. What one study found is that memantine is able to improve the symptoms associated with ADHD without adding any adverse side effects (Riahi et al., 2020).
ADHD is a condition that can be treated in a multitude of ways with multiple differed medication options and combinations that can be tailored to fit the needs of each individual patients. It is important to make sure that the child is not only on the correct medication but also that they are taking the lowest possible dose. Educating the family regarding dietary restrictions and when the medication should be given is also extremely important.