A nurse is teaching the parents of an 8-year-old child newly… | MyMerci
Medical EmergenciesPA
Question
A nurse is teaching the parents of an 8-year-old child newly prescribed methylphenidate immediate-release for ADHD. Which instruction is most important?
1Discontinue the medication during school vacations to prevent dependence.
2Increase the dose if the child seems hyperactive on weekends.
3Administer the second dose in the early afternoon, before 4:00 pm, to avoid insomnia.✓ Correct answer
4Give both doses with a high-fat meal to slow absorption.
Explanation
Correct (2): Methylphenidate is a CNS stimulant; late-afternoon or evening doses cause insomnia. Standard practice is morning and early-afternoon dosing (often before noon and again before 2-4 pm for IR). (1) Food does not significantly affect IR formulation; the issue is dose timing, not absorption. (3) Parents must not titrate the dose; growth, appetite, BP, and HR are monitored by the prescriber. (4) Routine drug holidays are no longer standard — decisions should be individualized with the prescriber, not parent-initiated.
In-depth explanation
Memory Tip Stimulants = "STIMulate appetite DOWN, sleep DOWN." Monitor weight, height, BP, HR every visit. Clinical Practice Guide Plot growth curves; persistent weight loss or BP elevation triggers dose review.
Clinical scenario
Scenario 8-year-old boy newly diagnosed with ADHD prescribed methylphenidate IR 5 mg PO BID (morning and noon). Parents receiving initial teaching at outpatient pediatric clinic.
Key concepts
CNS stimulant — Drug class that increases dopamine and norepinephrine in the prefrontal cortex; first-line pharmacologic treatment for ADHD.
ADHD pharmacologic monitoring — Routine tracking of weight, height percentile, blood pressure, heart rate, sleep, and appetite in children on stimulant therapy.
Drug holiday — Planned medication-free period; historically used with stimulants but no longer routinely recommended — decided individually with the prescriber.