Stimulant medications for attention-deficit hyperactivity disorder (ADHD): Nursing pharmacology

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Notes

STIMULANT MEDICATIONS USED TO TREAT ADHD
DRUG NAME
amphetamine (Adzenys, Adzenys ER-ODT, Dyanavel XR, Evekeo ODT), 
dextroamphetamine (Dexedrine, ProCentra, Zenzedi), 
lisdexamfetamine (Vyvanse), 
methylphenidate (Concerta, Ritalin, Ritalin LA, Daytrana)
CLASS
CNS stimulants
MECHANISM OF ACTION
Inhibit norepinephrine and dopamine reuptake → ↑ free concentration of norepinephrine and dopamine → ↑ focus, ↓ impulsivity
INDICATIONS
ADHD
ROUTE(S) OF ADMINISTRATION
  • All: PO
  • Methylphenidate: transdermal
SIDE EFFECTS
  • Weight loss, anorexia
  • Insomnia, irritability, headache, dizziness, seizures
  • Tachycardia, palpitations, chest pain
  • Boxed warnings:
    • Potential abuse and dependence
    • Severe cardiovascular disease (e.g., myocardial infarction, sudden death)
CONTRAINDICATIONS AND CAUTIONS
  • Arteriosclerosis, severe cardiovascular disease, moderate to severe hypertension
  • History of substance abuse, hyperthyroidism, agitation, anxiety, glaucoma
  • During / within 14 days of MAO inhibitor administration
  • Pregnancy and breastfeeding
  • Children younger than 6 years of age
  • History of seizures or myocardial infarction
  • Psychiatric conditions (e.g., anorexia nervosa, depression, bipolar disorder)
NURSING CONSIDERATIONS:
STIMULANT MEDICATIONS USED TO TREAT ADHD
ASSESSMENT AND MONITORING
  • Focused baseline assessment; height, weight, vital signs; baseline mental status, sleep patterns, and nutritional history; dietary habits; e.g., consumption of cola or other caffeinated beverages
  • Laboratory tests: CBC, liver and renal function
  • Diagnostic tests: ECG
  • Monitor: effects on heart rate, blood pressure, sleep, nutrition; social and academic functioning
CLIENT EDUCATION
  • Purpose of medication: helps to decrease symptoms of ADHD; help improve functioning in school, social interaction, and family relationships
  • Self-administration
    • Immediate-release medication twice daily after breakfast and in the early afternoon
    • Extended release medication: once daily after breakfast
    • Transdermal patch
      • Apply a new patch at the same time each day
      • Ensure skin is clean, dry, and intact
      • Alternate hips, avoid waistline area
      • Remove patch after nine hours
      • Wash their hands after handling the patch
      • Monitor the application site for redness, blister formation, edema, or other signs of irritation
    • Do not discontinue abruptly
  • Common side effects
    • Headaches, dizziness, tremors, a fast heartbeat, and palpitations
      • Contact pediatrician promptly
    • Monitor appetite and weight
      • Provide appealing, nutritious meals; avoid caffeinated beverages
    • Monitor mood; hyperactivity, impulsivity, aggressiveness; sleep patterns
      • Seek assistance for management
  • Keep medications in a safe, secure place; prevent use by others

Transcript

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Attention Deficit Hyperactivity Disorder, or ADHD for short, refers to a range of behaviors characterized by inattention, hyperactivity, and impulsivity. Now, pharmacological treatment of ADHD can involve several medication groups, the main ones being central nervous system or CNS stimulant medications.

Additional medication groups that can be used to treat ADHD include norepinephrine reuptake inhibitors, such as atomoxetine; and alpha 2 adrenergic agonists, like guanfacine.

Finally, adjuvant medications include antidepressants, such as serotonin-norepinephrine reuptake inhibitors like venlafaxine, and tricyclic antidepressants, like imipramine; as well as antipsychotics, such as risperidone.

Alright, now CNS stimulants include amphetamine, dextroamphetamine, lisdexamfetamine, and methylphenidate. All of them are taken orally, while methylphenidate can also be applied transdermally.

Once administered, these medications are absorbed into the bloodstream, and travel to the brain. Here, they work at the synaptic cleft by inhibiting the reuptake of the neurotransmitters norepinephrine and dopamine.

This results in an increased concentration of these neurotransmitters within the synaptic cleft, subsequently increasing focus and attention while decreasing impulsivity.

Sources

  1. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Focus on Nursing Pharmacology" LWW (2019)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
  5. "Lehne's Pharmacology for Nursing Care" Elsevier Health Sciences (2014)
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