DRUGS USED FOR CHILDREN with

ADHD
MEDICATION

NURSING
IMPLICATIONS

SIDE EFFECTS

PATIENT TEACHING

Ritalin
(Methylphenidate)
Ther. class: central
nervous system
stimulants
Action: increased
attention span in
ADHD

-monitor BP, pulse, &

respiration before
administering &
periodically during
therapy
-monitor closely for
behavior change
-pedi: monitor
growth, both height,
& weight, in children
on long-term
therapy
-assess children for
attention span,
impulse control, &
interactions with
others - therapy may
be interrupted at
intervals to
determine whether
symptoms are
sufficient to continue
therapy
-has high
dependence & abuse
potential - tolerance
to abuse of
medication occurs
rapidly - do not
increase dose

-hyperactivity
-insomnia
-restlessness
-tremor
-behavioral
disturbances
-dizziness
-hallucinations
-headache
-irritability
-mania
-thought disorder
-blurred vision
-SUDDEN DEATH
-hypertension
-palpitations
-tachycardia
-hypotension
-anorexia
-constipation
-cramps
-diarrhea
-metallic taste
-nausea
-vomiting
-contact
sensitization
(erythema, edema,
papules, vesciles)
(transdermal),
erythema, rashes
-growth suppression
-weight loss (may
occur with prolonged
use
-fever
-hypersensitivity
reactions
-physical
dependence
-psychological
dependence
-tolerancne

-take the last dose

before 6pm to
minimize the risk of
insomnia
-abrupt cessation of
high doses may
cause extreme
fatigue & mental
depression
-check weight 2 to 3
times weekly &
report weight loss to
health care
professional
-avoid driving or
activities requiring
alertness until
response to
medication is known
-avoid using
caffeine-containing
beverages along
with this therapy
-notify health care
professional if
nervousness,
insomnia,
palpitations,
vomiting, skin rash,
or fever occurs
-notify health care
professional of
behavioral changes
-routine follow-up
exams are important
to monitor progress
-take immediate &
sustained release
tablets on an empty
stomach (30 to 45
min before a meal)
-take chewable
tablet with at least 8
oz (240mL) of water

MEDICATION

NURSING
IMPLICATIONS

SIDE EFFECTS

PATIENT TEACHING

Concerta
(Methylphenidate HCL)
-sustained release
Ther. class: central
nervous system
stimulants
Action: increased
attention span in
ADHD

-monitor BP, pulse, &

respiration before
administering &
periodically during
therapy
-monitor closely for
behavior change
-pedi: monitor
growth, both height,
& weight, in children
on long-term
therapy
-assess children for
attention span,
impulse control, &
interactions with
others - therapy may
be interrupted at
intervals to
determine whether
symptoms are
sufficient to continue
therapy
-has high
dependence & abuse
potential - tolerance
to abuse of
medication occurs
rapidly - do not
increase dose
-check CBC,
differential, &
platelet counts with
long-term use

-hyperactivity
-insomnia
-restlessness
-tremor
-behavioral
disturbances
-dizziness
-hallucinations
-headache
-irritability
-mania
-thought disorder
-blurred vision
-SUDDEN DEATH
-hypertension
-palpitations
-tachycardia
-hypotension
-anorexia
-constipation
-cramps
-diarrhea
-metallic taste
-nausea
-vomiting
-contact
sensitization
(erythema, edema,
papules, vesciles)
(transdermal),
erythema, rashes
-growth suppression
-weight loss (may
occur with prolonged
use
-fever
-hypersensitivity
reactions
-physical
dependence
-psychological
dependence
-tolerancne
-thrombocytopenia
-thrombocytopenic
purpura
-leukopenia
-anemia

-take the last dose

before 6pm to
minimize the risk of
insomnia
-abrupt cessation of
high doses may
cause extreme
fatigue & mental
depression
-check weight 2 to 3
times weekly &
report weight loss to
health care
professional
-avoid driving or
activities requiring
alertness until
response to
medication is known
-avoid using
caffeine-containing
beverages along
with this therapy
-notify health care
professional if
nervousness,
insomnia,
palpitations,
vomiting, skin rash,
or fever occurs
-notify health care
professional of
behavioral changes
-routine follow-up
exams are important
to monitor progress
-take immediate &
sustained release
tablets on an empty
stomach (30 to 45
min before a meal)
-take chewable
tablet with at least 8
oz (240mL) of water
-Concerta may be
administered w/o
food but must be
taken w/water, milk,
or juice

MEDICATION

NURSING
IMPLICATIONS

SIDE EFFECTS

PATIENT TEACHING

Adderal
(Amphetamine)
Ther. class: central
nervous system
stimulants
Action: increased
attention span in
ADHD

-monitor BP, pulse, &

respiration before &
periodically during
therapy
-monitor closely for
behavior change
-has high
dependence & abuse
potential - tolerance
to medication occurs
rapidly - do not
increase dose
-monitor weight
biweekly & inform
physician of
significant loss
-pedi: monitor height
periodically - inform
physician of growth
inhibition
-assess child's
attention span,
impulse control, &
interactions with
others

-hyperactivity
-insomnia
-restlessness
-tremor
-behavioral
disturbances
-dizziness
-irritability
-thought disorder
-SUDDEN DEATH
-palpitations
-tachycardia
-hypertension
-hypotension
-anorexia
-constipation
-cramps
-diarrhea
-dry mouth
-metallic taste
-nausea
-vomiting
-growth inhibition
(with long term use
in children

-take the last dose

6hrs before bedtime
to avoid sleep
disturbances
-with extended
release capsule,
avoid afternoon
doses to prevent
insomnia
-do not share
medication
-limit caffeine intake
-may impair
judgement - use
caution when driving
or during other
activities requiring
alertness
-children should be
given a drug-free
holiday each year to
reassess symptoms
& treatment
-doses will change
as children age due
to pharmacokinetic
changes such as
slower hepatic
metabolism
-pedi: provide high
calorie meals when
drug levels are
low(breakfast or
bedtime) if reduced
appetite & weight

MEDICATION

NURSING
IMPLICATIONS

SIDE EFFECTS

PATIENT TEACHING

Dexedrine
(Dextroamphetamine)
Ther. class: central
nervous system
stimulants
Pharm. class:
amphetamines
Action: increased
attention span in
ADHD

-monitor BP, pulse, &

respiration before
administering &
periodically during
therapy
-has high
dependence & abuse
potential
-tolerance to med
occurs rapidly - do
not increase dose
-monitor closely for
behavior change
-monitor weight
biweekly & inform
health care
professional of
significant loss
-pedi: monitor height
periodically - report
growth inhibition
-assess child's
attention span,
impulse control, &
interactions with
others

-hyperactivity
-insomnia
-restlessness
-tremor
-behavioral
disturbances
-depression
-dizziness
-hallucinations
-headache
-irritability
-mania
-thought disorder
-SUDDEN DEATH
-palpitations
-tachycardia
-arrhythmias
-hypertension
-anorexia
-constipation
-cramps
-diarrhea
-dry mouth
-metallic taste
-nausea
-vomiting
-physical
dependence
-psychological
dependence

-take 6hrs before

bedtime to avoid
sleep disturbances
-abrupt cessation of
high doses may
cause extreme
fatigue & mental
depression
-avoid sharing drug
-avoid the intake of
large amounts of
caffeine
-may impair
judgement - use
caution when driving
or during other
activities requiring
alertness
-notify health care
professional if
nervousness,
restlessness,
insomnia, dizziness,
anorexia, or dry
mouth becomes
severe
-pedi: provide high
calorie meals when
drug levels are low
(breakfast and/or
bedtime) if reduced
appetite & weight
loss are a problem

MEDICATION

NURSING
IMPLICATIONS

SIDE EFFECTS

PATIENT TEACHING

Strattera
(Atomoxetine)
Ther. class: agents for
attention deficit
disorder
Pharm. class: selective
norepinephrine
reuptake inhibitors
Action: increased
attention span

-assess attention
span, impulse
control, &
interactions with
others
-monitor BP & pulse
periodically during
therapy
-monitor growth,
body height, &
weight in children
-assess for signs of
liver injury (pruritis,
dark urine, jaundice,
RUQ tenderness,
unexplained "flu-like
symptoms" during
therapy
-do not restart drug
in patients
w/jaundice or
laboratory evidence
of liver injury
-monitor closely for
notable changes in
behavior that could
indicate the
emergence or
worsening of suicidal
thoughts or behavior
or depression

-SUICIDAL
THOUGHTS
-dizziness
-fatigue
-mood swings
-behavioral
disturbances
-hallucinations
-mania
-thought disorder
-hypertension
-orthostatic
hypotension
-syncope
-tachycardia
-dyspepsia
-severe liver injury
(rare)
-nausea
-vomiting
-decreased appetite
-weight/growth loss
-ALLERGIC
REACTIONS
INCLUDING
ANGIONEUROTIC
EDEMA &
ANAPHYLAXIS

-notify health care

professional if
thoughts about
suicide or dying,
attempts to commit
suicide, new or
worse anxiety,
feeling very agitated
or restless, panic
attacks, trouble
sleeping, new or
worse irritability,
acting aggressive,
being angry or
violent, acting on
dangerous impulses,
an extreme increase
in activity & talking,
other unusual
changes in behavior
or mood occur
-avoid driving or
other activities
requiring alertness
until response to
medication is known
-take without regard
to food
-doses may be
discontinued without
tapering