Briefly explain and summarize the case for this Assignment. Be sure to include the specific patient factors that may impact your decision-making when prescribing medication for this patient.
Attention Deficit Hyperactivity Disorder Case Study
The patient, Katie, is a Caucasian female aged eight years. Her parents bring her for psychiatric review. According to her parents, Katie’s teacher implied that their daughter may have attention deficit hyperactivity disorder (ADHD). As such, their primary care provider referred them to a psychiatric-mental health nurse practitioner. Katie’s teacher completed Conner’s Teacher Rating Scale-Revised. This is a questionnaire completed by a child’s teacher. It is an essential component of the workup in the diagnosis of ADHD.
According to the teacher’s evaluation, Katie has a short attention span, is forgetful and distracted, and performs dismally in spelling tests, reading, and mathematics. She has a short attention span and is known to focus on only the things that interest her. According to the teacher, she lacks enthusiasm for schoolwork and is easily sidetracked. Katie is known for starting tasks but never finishing them, not always doing as she is told, and not completing her assignments. According to Katie, she fails to understand the cause of the alarm. She reports that school is okay and that she enjoys art and recess. According to her, other subjects do not intrigue her. She admits to having a short attention span. Additionally, she denies abuse, bullying, suicidal ideations, hallucinations, delusions, or paranoia.
In this context, relevant patient factors that affect the prescription decision-making process include the patient’s age, medical history, and absence of comorbidities. The patient is aged eight years. Children have poorly developed metabolic pathways (Aldin Sharifnia et al., 2018). Therefore, this necessitates accurate dose calculation and appropriate drug selection. In the context of medical history, the patient has never received treatment for ADHD. In addition, she is not on any other medication. This eliminates the likelihood of polypharmacy or drug interactions (Peugh et al., 2020). Furthermore, the patient lacks any comorbidity that may lead to contraindications of specific treatment options.
Decision 1
The first decision is to begin Ritalin (methylphenidate) chewable tablets of 10 mg orally in the morning. My decision was guided by the guidelines of the American Academy of Pediatrics for the management of ADHD. According to these guidelines, FDA-approved medications should be prescribed for ADHD in children aged above six years (Wolraich et al., 2019). Methylphenidate is the first-line FDA-approved treatment of choice for managing children with ADHD aged six years and above (Wolraich et al., 2019). Methylphenidate is ideal for Katie because she is aged eight years. Additionally, there is no known hypersensitivity to methylphenidate that could contraindicate its use.
Medical history reveals that the patient is not on medications such as monoamine oxidase inhibitors that would warrant contraindication. Additionally, the patient lacks comorbidities such as hypertension, tachycardia, or other cardiovascular problems that may contraindicate the use of methylphenidate (Wilens et al., 2022). Examination revealed that the patient is appropriately developed for her age. As such, the need to use methylphenidate (a stimulant) with caution is eliminated. The risk of abuse is minimal because the patient is under the custody of her parents. Therefore, the patient is an ideal candidate for a low dose of methylphenidate.
The other options are initiating Ritalin LA 20 mg orally daily in the morning and maintaining this dose (20mg) for four more weeks. I did not select these options because they are initiated at a higher dose. This is undesirable because higher doses are associated with a higher risk of adverse effects (Storebø et al., 2018). By selecting Ritalin (methylphenidate) chewable tablets 10 mg orally in the morning, I was hoping to evaluate the toxicity profile of the drug. This includes hypersensitivity reactions, adverse events, and response to treatment (Storebø et al., 2018). Ethical considerations can impact my interactions with the patient and her family. For example, autonomy requires involving the patient’s parents in clinical decision-making (McDermott-Levy et al., 2018).
Decision 2
The second decision is to change the medication to Ritalin LA 20 mg orally daily in the morning. I selected this option after reviewing the patient. Four weeks after initiating 10 mg of Ritalin every morning, follow-up indicates that the patient’s symptoms have improved in the morning. However, the symptom recurs in the afternoon. This finding reveals that the immediate-release formulation of Ritalin 10 mg does not provide a sustained therapeutic effect to last the whole day. This necessitates the selection of an extended-release formulation (Wol