Question 13  <br/>Karen is a 7-year-old girl who has been started

on atomoxetine 18 mg once daily for ADHD, which is just under the recommended starting dose of 0.5 mg/kg/day. After just 1 week, her parents report that she is not eating, complains of stomach pain almost every day, is having trouble sleeping, and is ―really cranky.‖ Her teacher says she never seen anything like it; that Karen is actually worse on her ADHD medication. A careful review reveals that Karen is taking her medication just as prescribed. She is not on any other prescribed, over-the-counter, or herbal medications. The PMHNP considers that:

A. These are common in the first weeks of therapy and the dose should be increased to a therapeutic regimen
B. Karen may be a poor metabolizer of CYP2D6 medications and will need a change of therapy
C. Behavioral modalities should be started as optimal management of ADHD is multimodal
D. Fluoxetine should be added to the regimen as it has demonstrated efficacy with coincident anxiety