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INTRODUCTION

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dexmethylphenidate (deks-meth-il-fen-i-date)

Focalin, Focalin XR

Classification

Therapeutic: central nervous system stimulants

Pharmacologic: amphetamines

Schedule II

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Indications
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Adjunctive treatment of attention deficit hyperactivity disorder (ADHD).

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Action
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Produces CNS and respiratory stimulation with weak sympathomimetic activity. Therapeutic Effects: Increased attention span in ADHD.

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Adverse Reactions/Side Effects
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CNS: behavioral disturbances, hallucinations, insomnia, mania, nervousness, thought disorder. EENT: visual disturbances. CV: tachycardia. GI: abdominal pain, anorexia, nausea. Metab: growth suppression, weight loss (may occur with prolonged use). Neuro: twitching. Misc: fever.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Hallucinations, disordered thoughts, or other behavioral disturbances. Report these signs to the physician.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report fast heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor attentiveness and behavior in patients with ADHD. Report any changes in attention and hyperactivity, and document whether this drug appears to be producing the desired effects.

  • Assess growth rate and body weight in children receiving chronic therapy; report a substantial weight loss or delayed/stunted growth to the physician.

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Interventions
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  • Because of the risk of arrhythmias, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (see Appendix L).

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Patient/Client-related Instruction
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  • Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged fever, sleep loss, and vision disturbances.

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Pharmacokinetics
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Absorption: Readily absorbed following oral administration.

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Distribution: Unknown.

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Metabolism and Excretion: Mostly metabolized by the liver; inactive metabolites are renally excreted.

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Half-life: 2.2 hr.

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TIME/ACTION PROFILE (improvement in symptoms)

ROUTE ONSET PEAK DURATION
PO 7 days 1 mo unknown

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity; Hyperexcitable states (marked anxiety, agitation, or tension); Hyperthyroidism; Psychotic personalities, suicidal or homicidal tendencies; Glaucoma; Motor tics, family history or diagnosis of Tourette's syndrome; Concurrent use of MAO inhibitors; Should not be used to treat depression or prevent/treat normal fatigue; Psychoses (may exacerbate symptoms).

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Use Cautiously in: History of cardiovascular disease; Hyperthyroidism; Hypertension; Diabetes mellitus; Geri: Geriatric/debilitated patients; Continual use (may result in psychologic or physical dependence); Seizure disorders (may lower seizure threshold); OB: Lactation: Pedi: Pregnancy, lactation, or children <6 yr (safety not established; use in pregnancy only if clearly needed).

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Interactions
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Drug-Drug: Concurrent use with or use within 14 days following discontinuation of MAO inhibitors may result in hypertensive crisis and is contraindicated. May ↓ effects ...

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