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INTRODUCTION

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methylphenidate (meth-il-fen-i-date)

Concerta, Metadate CD, Metadate ER, Methylin, Methylin ER, PMS-Methylphenidate, Riphenidate, Ritalin, Ritalin LA, Ritalin-SR

Classification

Therapeutic: central nervous system stimulants

Pharmacologic: amphetamine derivatives

Schedule II

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Indications
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Treatment of ADHD (adjunct). Symptomatic treatment of narcolepsy. Unlabeled Use: Management of some forms of refractory depression.

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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. Increased motor activity, mental alertness, and diminished fatigue in narcoleptic patients.

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Adverse Reactions/Side Effects
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CNS: hyperactivity, insomnia, restlessness, tremor, dizziness, headache, irritability. EENT: blurred vision. CV: hypertension, palpitations, tachycardia, hypotension. GI: anorexia, constipation, cramps, diarrhea, dry mouth, metallic taste, nausea, vomiting. Derm: rashes. Neuro: akathisia, dyskinesia. Misc: fever, hypersensitivity reactions, physical dependence, psychological dependence, suppression of weight gain (children), tolerance.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for signs of excessive CNS stimulation, including hyperactivity, restlessness, tremor, or irritability. Report these signs to the physician.

  • 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.

  • Monitor alertness in patients with narcolepsy; document the frequency and duration of sleeping episodes to help document the effects of drug therapy

  • 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.

  • Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

  • Be alert for abnormal muscle tone and movements (dyskinesias), extreme restlessness (akathisia), or other signs of motor dysfunction. Report problematic movement disorders to the physician.

  • Monitor signs of hypersensitivity reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician if these reactions occur.

  • Assess body weight in children receiving chronic therapy; report decreased body weight or an inability to gain weight.

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Interventions
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  • Because of the risk of arrhythmias and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, 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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  • Advise patient or family/caregivers about the potential risk of tolerance and physical/psychologic dependence. Emphasize that addiction is more likely during prolonged, excessive, or inappropriate use of this drug.

  • Instruct patient and family/caregivers to report other troublesome side effects including severe or prolonged headache, fever, blurred vision, sleep loss, skin rash, or GI problems ...

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