Pharmacology for Psychological Disorders
Attention deficit hyperactivity disorder (ADHD) is a condition that can arise in infancy with unique signs such as hyperactivity, impulsivity, and/or lack of attention (Krull, 2019). Once detected`, these signs also affect the cognitive, physical, academic, emotional and social capacities of the infant (Krull, 2019). The first step in my decision to complete the interactive media was to start Ritalin (methylphenidate) chewable 10 mg tablets orally in the morning. According to Iacobucci (2018), methylphenidate is the recommended treatment option for children with ADHD because it has been found to be the most effective and best. Pharmacology for Psychological Disorders
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Methylphenidate has been seen to enhance the effects of ADHD by decreasing the impulsivity frequently found with these infants (Iacobucci, 2018). This allows them to concentrate and hence to improve their overall behavior. Ritalin is a stimulant that influences the dopaminergic and noradrenergic processes, resulting in the production of catecholamines from central nervous system storage sites (Krull, 2019). Short-acting methylphenidate, including ritalin or methylene, is available as a pill, chewable tablets or liquid (Krull, 2019). The initial impact of this stimulant may vary from 15 to 50minutes (Krull. 2019). The length of operation is between three and five hours and the half-life is between two and four hours (Krull, 2019). Stimulants are used for the treatment of ADHD since the 1930s (Krull, 2019). Rarely severe adverse results have been associated to pediatric patients with stimulants, and possible hazards with stimulants can be addressed with patients and families before selecting a treatment plan. Known negative impacts of methylphenidate include physiological effects, such as increased pulse rate and high blood pressure (Rosenthal & Burchum, 2018).Pharmacology for Psychological Disorders
Wellbutrin (bupropion) XL 150 mg oral daily is not recommended for this infant with ADHD. Wellbutrin, an antidepressant, is regulated by the Food and Drug Administration (FDA) for depression and to help avoid smoking (Cafasso, 2019). Seldom has ADHD been used as an off-label alternative, but protection and efficacy in infants have not been shown (Cafasso, 2019). The other alternative was Intuniv extended-release 1 mg orally at bedtime which is a non-central nervous system stimulant recommended for the treatment of ADHD in children but not as a first option (Rosenthal & Burchum, 2018). The warning to be considered with Intuniv is that it can induce hypotension and other adverse effects such as anesthesia, somnolence and exhaustion (Rosenthal & Burchum, 2018).
The decision to choose Ritalin, after four weeks, proved to be successful when Katie’s teacher observed changes, mainly in the mornings with symptoms that resumed in the afternoon, such as “daydreaming” and “staring off into space.” The patient and family had a main worry for Katie, who reported that her “heart felt funny” and her HR was around 130 bpm. With this 4-week test in mind, the second decision I chose was to change Ritalin to a long-acting oral dosage of 20 mg daily in the morning. This sustained the changes observed in her academic results and, with the training of the LA, continued for Katie’s entire school day. In addition, this settled “funny” heart feelings with a HR of 92 ranking, which is the standard average for Katie’s generation. This is what brings me to the third decision in which I chose to retain the current dosage of Ritalin and to re – examine it in the next four weeks.
The administering of pharmac`otherapeutics, Ritalin LA, has had a positive effect on the pathophysiology of ADHD for Katie. The changes made to the preferred prescription were based on the adverse impact of elevated heart rate on people and the lack of drug effects later in the day. The possible impact for Katie with daily tolerance to use can improve, requiring change. Appetite reduction can also occur and weight control is recommended when taking this drug. Stimulation of her heart and cardiovascular symptoms secondary to the activation of norepinephrine (NE) from sympathetic neurons should be regarded. It is also vital to inform the family that the chance of sudden cardiac arrest is very rare, and this argument is backed by studies that indicates that there is no indication that screening for cardiac disease with ECG before beginning a stimulant would be helpful (Rosenthal & Burchum, 2018).
In particular, an ECG assessment will be necessary as the patient experiences symptoms. For example, Katie experienced a smaller rise in heart rate, no established background, and her recovery plan identified new symptoms with an immediate adjustment to her medication. The ECG was not expected at this time. According to Krull (2019), accounts of accidental deaths of children undergoing stimulant treatment have raised questions that stimulants raise the risk of cardiovascular (CV) negative impacts, such as sudden unexpected deaths (SUDs). Krull (2019) indicated that a significant number of cohort trials have found that stimulant treatment would not raise the risk of severe CV adverse effects in infants without heart disease. Pharmacology for Psychological Disorders
Regular monitoring of infants prescribed ADHD stimulant treatment must include any improvements in heart rate or blood pressure, and also CV symptoms over the course of care (Krull, 2019). And if the patient’s experience or physical examination is indicative of heart failure, additional assessment, including ECG and/or consulting with a pediatric cardiologist, will be provided as part of the care plan.
References
Cafasso, J. (2019). From Antidepressant to ADHD Medication? About Wellbutrin for ADHD. Retrieved from https://www.healthline.com/health/wellbutrin-for-adhd.
Iacobucci, G. (2019). ADHD: methylphenidate should be first-line drug treatment in children, review confirms. BMJ-BRITISH MEDICAL JOURNAL, 362. https://doi-org.ezp.waldenulibrary.org/10.1136/bmj.k3430
Krull, K.R. (2019). Attention deficit hyperactivity disorder in children and adolescents: Clinical features and diagnosis. Retrieved from https://www.uptodate.com/contents/attention-deficit-hyperactivity-disorder-in-children-and-adolescents-clinical-features-and-diagnosis
Rosenthal, L. D., & Burchum, J. R. (2018). Lehne’s pharmacotherapeutics for advanced practice providers. St. Louis, MO: Elsevier. Pharmacology for Psychological Disorders