Comprehensive exams for Mental Health Q 183
Nurse Irish is aware that Ritalin is the drug of choice for a child with ADHD. The side effects of the following may be noted by the nurse:
A. Increased attention span and concentration.
B. Increase in appetite.
C. Sleepiness and lethargy.
D. Bradycardia and diarrhea.
Correct Answer: A. Increased attention span and concentration
The medication has a paradoxical effect that decreases hyperactivity and impulsivity among children with ADHD. Methylphenidate is FDA-approved for the treatment of attention deficit hyperactivity disorder (ADHD) in children and adults and as a second-line treatment for narcolepsy in adults. Children with a diagnosis of ADHD should be at least six years of age or older before being started on this medication. The treatment of both ADHD and narcolepsy have significantly better outcomes when used concurrently with nonpharmacologic therapies (i.e., social skills training in ADHD or sleep hygiene measures in narcolepsy).
Option B: Patients are more prone to become easily agitated, irritable, or depressed and go through mood swings/lability). While many of the common side effects can be relieved by adjusting the dosage or avoidance of an afternoon or evening dose, some require treatment emergently to prevent complications. While it rarely occurs, priapism is a medical emergency that requires immediate attention.
Option C: Insomnia and nervousness are the most commonly reported adverse effects in patients on methylphenidate. Other frequent side effects mainly involve the CNS (dizziness, headache, tics, restlessness/akathisia), gastrointestinal (nausea/vomiting, dry mouth, decreased appetite, weight loss, abdominal pain), and cardiovascular systems (tachycardia, and palpitations).
Option D: Side effects of Ritalin include anorexia, insomnia, diarrhea, and irritability. It is important to note that there have been reported cases of sudden death in both children and adults with a pre-existing structural cardiac abnormality. Stroke and myocardial infarction also have been observed in adults. Due to the risk of such fatal side effects, it is advisable to avoid methylphenidate in patients with a structural cardiac abnormality, cardiomyopathy, or arrhythmias.