A 7-year-old boy is brought to the office by his mother for a routine checkup. Medical history is significant for 2 upper respiratory tract infections this past year but is otherwise normal. Family history includes hypertension in his father and bipolar disorder in a maternal aunt. Physical examination is normal, but the mother says that her son's behavior has been difficult to manage over the past year. "He is always running around (even during dinner), does not listen, and keeps his room a mess. He is always bothering his younger brother, interrupting him when he talks, and taking his toys without asking. He is unable to follow a morning routine to get ready for school, and he frequently misses the bus as a result." The mother also reports difficulty at school. The boy's second-grade teacher has reported that he cannot sit still, answers questions impulsively and out of turn, and becomes irritable when she redirects him. The physician recommends a trial of methylphenidate. Which of the following side effects is the patient most likely to experience while taking this medication?

Question

A 7-year-old boy is brought to the office by his mother for a routine checkup.  Medical history is significant for 2 upper respiratory tract infections this past year but is otherwise normal.  Family history includes hypertension in his father and bipolar disorder in a maternal aunt.  Physical examination is normal, but the mother says that her son's behavior has been difficult to manage over the past year.  "He is always running around (even during dinner), does not listen, and keeps his room a mess.  He is always bothering his younger brother, interrupting him when he talks, and taking his toys without asking.  He is unable to follow a morning routine to get ready for school, and he frequently misses the bus as a result."  The mother also reports difficulty at school.  The boy's second-grade teacher has reported that he cannot sit still, answers questions impulsively and out of turn, and becomes irritable when she redirects him.  The physician recommends a trial of methylphenidate.  Which of the following side effects is the patient most likely to experience while taking this medication?

Quizplus · Accepted Answer

This patient's behavioral problems both at home and at school (hyperactivity, impulsivity, disorganization) are consistent with attention-deficit hyperactivity disorder (ADHD). The stimulant methylphenidate is a first-line treatment for school-age children with ADHD. Common side effects of methylphenidate include decreased appetite, weight loss, and insomnia. Stimulants commonly cause a mild reduction in appetite that can usually be managed by encouraging the child to eat favorite nutrient-dense foods and take the medication after meals. Weight should be monitored regularly during treatment. (Choices A and E) Jitteriness, irritability, and emotional lability have been reported on stimulants. However, agitation and mania are rare. (Choice C) Methylphenidate more commonly causes insomnia. (Choices D and G) Stimulant medications have modest cardiovascular effects, including small elevations in heart rate (3-10/min), systolic blood pressure (3-8 mm Hg), and diastolic blood pressure (2-14 mm Hg). Although heart rate and blood pressure should be monitored before and during treatment with stimulants, clinically significant increases are rare. Hypertension and tachycardia are less common than decreased appetite. (Choice F) Although nausea can occur, it is less common than decreased appetite. (Choice H) The high rate of comorbidity between tic disorders and ADHD makes it difficult to know whether the connection between stimulants and tics is causal or coincidental. The current consensus is that stimulants do not commonly cause new-onset tics, and children with tic disorders can be cautiously treated with stimulants for comorbid ADHD. Educational objective: Methylphenidate is a central nervous system stimulant that is frequently used to treat attention-deficit hyperactivity disorder. Common side effects of stimulants include decreased appetite, weight loss, and insomnia. References: Pediatric pharmacoepidemiology - safety and effectiveness of medicines for ADHD. (http://www.ncbi.nlm.nih.gov/pubmed/28984477) Psychopharmacology of attention-deficit hyperactivity disorder: effects and side effects. (http://www.ncbi.nlm.nih.gov/pubmed/26601963)

A 7-Year-Old Boy Is Brought to the Office by His