A child has been taking SD methylphenidate (Ritalin), 10 mg at 0800 and 1200 and 5 mg at 1600, for 2 months. The parents tell the nurse that the child sometimes misses the noon dose while at school
The child's appetite is normal. The teacher has reported a slight improvement in hyperactivity and impulsivity. What will the nurse do?
a. Ask the prescriber whether this child could be given methylphenidate (Concerta).
b. Contact the prescriber to suggest using a nonstimulant medication.
c. Reinforce the need to take all doses as prescribed.
d. Suggest drug holidays for the child on weekends.
ANS: A
This child is showing slight improvement with the medication but has trouble taking the noon dose; therefore, a once daily formulation would increase compliance and improve effects. There is no indication to use a nonstimulant medication, because the child's appetite is normal. If 3 times/day dosing were the only option available, reinforcing the need to take all doses would be necessary; however, some children avoid taking medication at school because of the stigma attached to being different from their peers. The use of drug holidays is controversial; this approach is used when growth suppression is a problem.
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