Assessment

• Monitor blood pressure, pulse, and respiration before and periodically during therapy. Obtain a history (including assessment of family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further evaluation (ECG and echocardiogram), if indicated. If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly

• May produce a false sense of euphoria and well-being. Provide frequent rest periods and observe patient for rebound depression after the effects of the medication have worn off

• Monitor closely for behavior change

• Has high dependence and abuse potential. Tolerance to medication occurs rapidly; do not increase dose

• Monitor weight biweekly and inform physician of significant loss. Pedi: Monitor height periodically in children; inform physician of growth inhibition

• Assess attention span, impulse control, motor and vocal tics, and interactions with others in children with ADHDs

• Observe and document frequency of narcoleptic episodes

• May interfere with urinary steroid determinations

» May cause plasma corticosteroid concentrations; greatest in evening

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