tailieunhanh - HANDBOOK OF PSYCHIATRIC DRUGS - PART 8

Chuẩn độ acclimatizes đứa trẻ đối với thuốc và xác định hoặc tốt nhất liều của mình: • Trẻ em nên được bắt đầu với liều thấp để giảm thiểu tác dụng phụ. • Psychostimulant thuốc nên được thực hiện | 184 handbook of psychiatric drugs Titration acclimatizes the child to the drug and determines his or her best dose Children should be started with low doses to minimize adverse effects. Psychostimulant medication should be taken at or just after mealtime to lessen the anorectic effects studies have shown that food may enhance drug absorption. MPH treatment can be initiated with a single 10 mg dose of long duration beaded methylphenidate at 8 00 am for 3 days then a 15 mg dose at 8 00 am for the next 3 days and finally 20 mg at 8 00 am for 3 days are given and maintained for at least 2 weeks. Preschoolers may start as low as mg of MPH at 8 00 am but build to the same total 20 mg day dose. DEX is usually started at to 5mg day and gradually increased in to 5-mg increments. The dosing instructions should be written down for the parent with dates and times specified in detail. A photocopy of the instructions should be kept in the patient s chart. The Conners Teacher Rating Scale is then repeated. Further dose adjustments up or down depend on the rating scale s scores teachers verbal reports parents comments and adverse effects experienced by the child. Stimulants with a shorter duration of action have been administered three times a day before school at lunch and at home before homework. However current practice is to start with a long-duration preparation such as Concerta or Metadate-CD. This once-daily regimen avoids the noontime dosing in school. Eventually a standard formulation may have to be combined with a sustained-release formulation at 8 00 am to ensure early- and late-morning coverage. Plasma level measurements are not helpful for adjusting the dose of MPH because their inter- and intraindividual variability in plasma level concentrations are large and doseresponse relationships vary from individual to individual. Adverse reactions to medications show the same variability and may appear unpredictably during different phases of the drug s .