Go to this website: https://cdn-media.waldenu.edu/2dett4d/Walden/NURS/6630/DT/week_09/index.html
Follow these steps:
Decision Point One- Click\”Begin Intuniv ER 1mg\”
Decision Point Two- Click \”Discontinue Intuniv and begin Focalin XR 10mg\”
Decision Point Three- Click \”Maintain current dose of Focalin\”
Assignment Paper-
The Assignment: 5 pages
Examine Case Study: You will be asked to make three decisions concerning the medication to prescribe to this patient. Be sure to consider factors that might impact the patient’s pharmacokinetic and pharmacodynamic processes.
-Page 1: Introduction
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.
– Page 2: Decision #1
Which decision did you select?
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
-Page 3: Decision #2
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
-Page 4: Decision #3
Why did you select this decision? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
Why did you not select the other two options provided in the exercise? Be specific and support your response with clinically relevant and patient-specific resources, including the primary literature.
What were you hoping to achieve by making this decision? Support your response with evidence and references to the Learning Resources (including the primary literature).
Explain how ethical considerations may impact your treatment plan and communication with patients. Be specific and provide examples.
-Page 5: Conclusion
Summarize your recommendations on the treatment options you selected for this patient. Be sure to justify your recommendations and support your response with clinically relevant and patient-specific resources, including the primary literature.
Treating Patients with ADHD
Name
Institution
Date
Treating Patients with ADHD
Introduction
The case study presents an 8-year-old Caucasian patient who is accompanied by her parents to the office. The parents suggest that Katie could be having attention. According to the Conner’s Teacher Rating Scale-Revised, the patient is inattentive, forgets things she learned easily, and is poor in spelling, arithmetic, and reading. She also noted that her attention span is short, lacks interest in her schoolwork, and is easily distracted.
The patient’s mental exam indicates that the patient is well developed for her age. She has a clear, coherent, and logical speech. The patient is oriented to place, time and event. She is also dressed for the weather and time of the year. She has no tics, gestures, or noteworthy mannerisms. She has a euthymic mood. She denies delusions, paranoia, or hallucinations. Her insight and judgment are age-appropriate. The patient denies suicidal ideations. Based on the fact the patient is a minor of eight years, it would be paramount to choose medications with minimal side effects and at the same time adopt a multi-faceted approach involving a team of interdisciplinary professionals as well as patients.
Decision Point 1- Begin Intuniv ER 1 mg
The first decision is to begin Intuniv ER 1 mg. Intuniv (Guanfacine) extended-release is a non-stimulant, a selective a2A-adrenergic receptor agonist that the Federal Drug Agency has approved for the management of ADHD symptoms among children aged between 6 and 17 years (Newcorn et al., 2020). The recommended starting dosage is 1 mg once daily. The medicine, which is a non-stimulant, is preferred as compared to stimulants, which are unsuitable for this age group. Some of the side effects of Intuniv include sedation, somnolence, irritability, decreased appetite, nausea, and constipation.
The other two choices were not appropriate for the management of the patient’s medication based on their pharmacological profiles. Wellbutrin (bupropion) is an atypical anti-depressant, which is prescribed for the management of major depression as well as smoking cessation. The drug is however prescribed for the management of ADHD symptoms. The drug has been associated with worsening comorbid sleep, anxiety, and mood disorders (Ng, 2017). Similarly, the drug has been linked to misuse and diversion. The drug also however promotes suicide ideations and thoughts of hurting oneself among patients. The second drug is Ritalin, which is a stimulant. The medication is a federally controlled substance since it can result in dependence or misuse. The medication has been linked with heart problems such as increased blood pressure, heartbeat, and even risk for stroke. Besides the heart-related problems, patients might also experience mental problems such as negative thought processes, aggression, and even psychotic symptoms like hearing voices. The two medications, therefore, have less tolerable properties, which increases a patient’s risk of negative health outcomes.
The choice of Intuniv ER 1 mg as a first-line treatment for the management of the patient’s ADHD symptoms was likely to improve the patient’s behavior. Despite the drug having sedative side effects, they are tolerable as compared to those of the other two medications.
The ethical considerations that should be looked at include the patient’s age and overall wellbeing. Minors are more vulnerable to drug adverse events, which communicates the need for clinicians to prescribe medicines with safe pharmacological profiles. It is important to note that nurses are held accountable for their nursing actions and care.
Decision Point 2 -Discontinue Intuniv and begin Focalin (dexmethylphenidate) XR 10 mg Orally Daily
After four weeks of being under Intuniv 1 mg daily, the patient returns to the clinic. Her teacher reports that she sees no change in her classroom behavior. Katie’s parents note that she has become more impossible in the morning especially when it comes to waking up. More so, for the first few hours of the day, Katie seems sluggish than she was. Intuniv has been associated with somnolence and sedation among the patients, which justifies the patient’s sluggish nature during the first few morning hours and trouble waking up in the morning. Based on the patient’s non-improvement of ADHD symptoms, there was a need to change the medication.
Decision point 2 was to discontinue Intuniv and begin Focalin (dexmethylphenidate) XR 10 mg orally daily. Focalin XR is a first-line agent that is used for the management of ADHD symptoms. Focalin is a central nervous system stimulant that works by increasing attention as well as decreasing impulsiveness and hyperactivity among patients with ADHD (Pheils & Ehret, 2021).
The other two choices available include increasing Intuniv to 2 mg orally at bedtime and discontinuing Intuniv and beginning Dexedrine (dextroamphetamine) 5 mg orally daily. Intuniv at higher doses is likely to result in an increase in the sedative symptoms, which would not be a good option as the patient would continue being sluggish in the early hours and having trouble waking up. Dexedrine is an Amphetamine, which has a high risk for addiction and abuse. More so, the medication has less tolerable side effects such as circulation issues, loss of appetite, fever, tremors, chest pain, and an increase in blood pressure (Cutler et al., 2022). The two medications therefore would not be safe for the 8-year-old based on their pharmacological profiles.
The ethical consideration at this decision point would concern patient safety, especially considering that the patient is a minor. Clinicians have an ethical responsibility to remove conditions that are likely to cause harm to the patient. The change of medication was based on the drug’s side effects of somnolence, which negatively affected her daily routine.
Decision Point 3- Maintain the Current Dose of Focalin XR
After four weeks, the patient returns to the clinic. Her parents confirmed that after speaking with her teacher, she noted that she has noticed that Katie’s symptoms have improved and her academic performance is much better too. The parents are however concerned that Katie’s appetite has continued to worsen which is a big concern to them even though their daughter was not such a big eater.
Based on the patient’s progress, the third decision was to maintain the current dose of Focalin XR. Focalin XR is a first-line agent that has been proven to be effective in the management of ADHD symptoms. Based on the patient’s reaction, the 10 mg dosage has more pronounced side effects as compared to a starting dose of 5 mg. However, since the patient was put on an initial dose of 10 mg daily, the most logical course of action would be to continue with the same dose until the patient’s next visit after four weeks. The patient’s parents note that her appetite has drastically reduced which communicates the need for more assessment and monitoring. In case, the patient’s appetite improves, the dosage should be retained. On the other hand, if the appetite issue worsens, the dosage should be reduced to mg orally daily.
The other two choices would not be appropriate for the patient. Increasing the dosage of Focalin from 10 mg to 20 mg would not be safe since it will worsen the side effects. More so, based on the patient’s progress report, the medicine has a good efficacy at the dose of 10 mg. It is vital to acknowledge that patients require to be put on low doses of stimulants. Tyson et al. (2020) assert that individualized dosing of medications should be able to curb risks and poor outcomes among patients. The second choice of discontinuing Focalin XR and beginning Strattera (atomoxetine) 10 mg orally daily would not be appropriate since healthcare professionals should not change medication based on an incidence of common side effects on a patient. The patient should first be monitored and re-assessed during the next visit after four weeks.
Ethical consideration at this point would be beneficence, which states that clinicians should do good and the right thing for the patients they are caring for. The choice to continue the medication when closely monitoring the patient demonstrates the clinician’s goodwill as well accountability.
Conclusion
Based on the patient’s case study, she was put on two medications after the first drug did not produce the desired effects. An initial dose of Intuniv 1 mg was not effective, as the patient classroom, behavior did not change. On the contrary, she became sluggish during the morning hours. The second drug that she was put on was Focalin 10 mg, which resulted in improvements though with some side effects that could be monitored and assessed after 4 weeks. The choice of medication for patients should be based on its safety profile and evidence of its effectiveness in managing a particular health condition.
References
Cutler, A. J., Suzuki, K., Starling, B., Balakrishnan, K., Komaroff, M., Castelli, M., … & Childress, A. C. (2022). Efficacy and Safety of Dextroamphetamine Transdermal System for the Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: Results from a Pivotal Phase 2 Study. Journal of Child and Adolescent Psychopharmacology.
Newcorn, J. H., Huss, M., Connor, D. F., Hervás, A., Werner-Kiechle, T., & Robertson, B. (2020). Efficacy of guanfacine extended release in children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder. Journal of Developmental & Behavioral Pediatrics, 41(7), 565-570.
Ng, Q. X. (2017). A systematic review of the use of bupropion for attention-deficit/hyperactivity disorder in children and adolescents. Journal of child and adolescent psychopharmacology, 27(2), 112-116.
Pheils, J., & Ehret, M. J. (2021). Update on methylphenidate and dexmethylphenidate formulations for children with attention-deficit/hyperactivity disorder. American Journal of Health-System Pharmacy, 78(10), 840-849.
Tyson, R. J., Park, C. C., Powell, J. R., Patterson, J. H., Weiner, D., Watkins, P. B., & Gonzalez, D. (2020). Precision dosing priority criteria: drug, disease, and patient population variables. Frontiers in Pharmacology, 11, 420.