Methylphenidate
Methylphenidate is a C II which means
controlled substance level 2. high likelihood of addiction
Brand name for D- methyl
FDA approved for
D- methyl is what type of inhibitor?
Focalin, Focalin XR
children 6-17 & Adults
NE & DA reuptake inhibitor
Eating with d, L-methylphenidate may delay onset of medi by
2-3 hours
When prescribing a Daytrana patch for ADHD. The PMHNP should share the following PHE:
1. apply to a clean dry intact hip
2. avoid cutting or exposure to heat (speeds up medication)
3. remove prior patch before new application
Rule of thumb when prescribing oral solutions:
Use caution
Must be confident in those administering it
concern about toxicity if TOO MUCH!!!
What 2 enantiomers are Methyl made up of?
How is it available?
D & L
D, D, L
What should the PMHNP monitoring when prescribing
D- methyl, D, L methyl?
Side effects?
EKG- at start and periodically (sudden cardiac death-check family hx)
B/P
wt- can be an appetite depressant
ht (in children) d/t growth suppression (parental height is the most significant predictor of ht)
Side effects dose related:
NE=Increased HR, HTN, Cardiac arrythmias
NE & DA insomnia, agitation, psychosis, and SUD
rare priapism
IR formulations have ___ to ____ duration
2-4
examples: Ritalin, methylin, generic methylphenidate
When providing PHE regarding Jornay PM the PMHNP knows that?
It can be taken with or without food
opened and sprinkled in applesause
****Most importantly, if an evening dose is missed RESUME NEXT EVENING
D isomer is more ________ than L isomer at which binding
sites?
Potent
NET & DAT
D- methyl/Focalin dosing
Focalin IR:2.5-10mg start with 2.5 mg BID max 10 mg BID
Focalin XR 5-40mg start 10mg daily, increase 10mg Q 7 days MAX 40 mg daily
**** PHE with BID dosing- timing for second dose to prevent insomnia
SR formulas have a ______ to ____ duration
4-6
ex. Methylin ER, Ritalin SR, Metadate and generic methylphenidate
The PMHNP is providing pt health education (PHE) about QuilliChew ER. She knows ?
It is a chewable tablet that can be taken with or without food
D enantiomer is _______ as efficacious as the mixture of D,L
Twice
D, L- methyl notable brand names
FDA approval
off label
Ritalin, Methylin,
ADHD (age depends on formulation) Narcolpesy (metadate ER, Ritalin ER, Methylin ER)
treatment resistant depression
Which formulation has an early peak and 8 hour duration of action?
SR Metadate CD
Examples of 12 formulations:
SR Concerta
Contempla
Quillivant XR
Aptensio XR
MOA for D- methyl
Increases NE & especially DA in the DLPFC.
reduces hyperactivity by increasing DA in the basal ganglia
improves attn, concentration, executive fxn, and wakefulness
MOA D, L Methylphenidate:
Increases NE & especially DA in the DLPFC
decrease hyperactivity, by increasing DA action at the basal ganglia.
***** Increased DA & NE in the medical PFC and hypothalamus
improved depression, fatigue, and sleepiness
Which formulation has an early peak , 8 hr duration with 2 pulses (immediate &4 hrs
SR Ritalin LA
When teaching a pt about taking Adhansia XR the PMHNP shares:
1. It can be given with or without food
2. can be opened and sprinkled on applesauce or yogurt
3. If not consumed within ______ mins it should be
4. If a dose is missed when should the next dose be taken?
10, discarded
resume next morning