Attention Deficit Hyperactivity Disorder Discussion

Disorder/Scenario

The disorder I chose to discuss is ADHD. ADHD or Attention Deficit Hyperactivity Disorder is a disorder that is common among children that are characterized by the child displaying impulse behaviors, and inability to concentrate, an inability to remain inactive, talkative, and a difficult time displaying patience (CDC, 2020). The patient discussed in the scenario is an 8-year-old girl who has been referred by her teacher based on the results of the Conners’ Teacher Rating Scale-Revised. The CTRS-R has been shown to have varying results when provided to potential students on a wide-scale (Charach, Chen, Hogg-Johnson, & Schachar, 2009). Per the teacher’s report, the patient cannot focus on class, easily distracted, is only knowledgeable about subjects that concern her, and is rarely able to answer questions concerning what has been recently discussed. Her grades are now beginning to show a reflection of her inability to stay on task and retain information. The patient and her parents are resistant to the idea that she has ADHD because she lacks the symptoms that hyperactivity usually portrays. When evaluated the patient is shown to have met developmental milestones and has a happy positive home environment. During the evaluation, the patient does admit that she sometimes has a hard time staying on task. From the information above I based her medication regime below around her symptoms.

Decisions

The goal of my decision-making was to establish a medication regimen that best fits the patient’s needs. For my first pharmacological therapeutic decision, I chose to begin to start with the medication Intuiv extended-release 1 mg orally at bedtime (Laureate Education, 2019). The patient’s parents reported that the medication made the patient to drowsy to complete daily tasks. My second decision was to discontinue the Intuiv and to begin Focalin (dexmethylphenidate) XR 10 mg orally Daily (Laureate Education, 2019). The patient’s parents reported that there has been a compelling improvement seen at school, but the patient has had a decrease in appetite. For my final decision, I choose to not change the patient’s current medication regimen and reassess her status at the next visit (Laureate Education, 2019). The reasoning for decision making is discussed below.

Pharmacotherapeutics/ Pathophysiology and Treatment Plan

For decision one, I chose to use a second line of defense, Guanfacine, for ADHD because the patient shows a high level of inattention without hyperactivity. Guanfacine is an a2 adrenergic agonist which are effective as a second line of defense by lowering symptoms of hyperactivity, but not as effective as an first line of defense medications such as methylphenidate, amphetamine, and dexmethylphenidate (Rosenthal, & Burchum, 2021). The medication I chose made the patient too tired to function I was hoping to avoid prescribing a stimulant if possible but, in this case, it is required. My second decision was to replace the Intuiv with dexmethylphenidate. When patients are treated with stimulates for ADHD their reactions vary, if one stimulant does not work another should be used in its place before stepping the patient down to the second line agents to achieve desired results (Rosenthal, & Burchum, 2021). After the patient returned or a follow-up her symptoms improved, she was able to focus but has a decreased appetite. For my final decision, I choose to keep her on her same medication dosage and regimen because her appetite may improve, and if not I’d rather find an alternative or prescribe her something than to increase her appetite than to keep changing her stimulate dosage. Attention Deficit Hyperactivity Disorder Discussion

References

CDC, (2020). Attention-Deficit/Hyperactivity Disorder (ADHD). Retrieved from https://www.cdc.gov/ncbddd/adhd/facts.html

Charach, A., Chen, S., Hogg-Johnson, S., & Schachar, R. J. (2009). Using the Conners’ Teacher Rating Scale—Revised in School Children Referred for Assessment. The Canadian Journal of Psychiatry, 54(4), 232–241. https://doi.org/10.1177/070674370905400404

Laureate Education, (2019). Attention deficit hyperactivity disorder [Interactive media file]. Baltimore, MD: Author. Attention Deficit Hyperactivity Disorder Discussion

Rosenthal, L. D., & Burchum, J. R. (2021). Lehne’s pharmacotherapeutics for advanced practice nurses and physician assistants (2nd ed.) St. Louis, MO: Elsevier. Attention Deficit Hyperactivity Disorder Discussion

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Attention Deficit Hyperactivity Disorder Discussion