Moduole 2 Drugs for ADHD and CNS Stimulants

How do amphetamines/methylphenidate work, in plain terms?

They increase the release of norepinephrine and dopamine in the brain (and some in the body) → ↑ alertness/focus, ↓ appetite

Which conditions do amphetamines treat?

ADHD (children & adults) and narcolepsy

What is the prototype amphetamine?

Amphetamine/dextroamphetamine (others: lisdexamfetamine, methamphetamine, dextroamphetamine)

What drug schedule are amphetamines?

Schedule II (high misuse potential, dependence/tolerance)

What are common amphetamine adverse effects?

Insomnia, nervousness, HTN/tachycardia/palpitations, weight loss/growth suppression (kids)

What are signs of amphetamine toxicity?

Psychosis (hallucinations/paranoia), dysrhythmias, seizures

What is amphetamine withdrawal like?

Depression, severe fatigue (after abrupt stop)

What key amphetamine nursing interventions?

Dose early in day; monitor BP/HR; monitor weight/height in kids; consider drug holidays; assess for misuse; taper to discontinue

What amphetamine administration pearls?

Available Immediate & Extended Release; do not crush/chew ER; swallow whole

What patient education for amphetamines?

Avoid caffeine; take last dose before 4 PM; report palpitations/weight loss; do not change dose without prescriber; do not stop abruptly

Who should NOT take amphetamines (contraindications)?

Allergy; moderate-severe HTN, CVD, hyperthyroidism; structural cardiac defects in children; history of misuse

What important amphetamine drug interactions?

↑ cardiac risk with other stimulants, digoxin, β-blockers, TCAs; vit C/ammonium chloride ↓ effect; NaHCO₃/acetazolamide ↑ effect; MAOI within 14 days → HTN crisis

Which conditions does methylphenidate treat?

ADHD and narcolepsy

How does methylphenidate work (MOA)?

Similar to amphetamines: ↑ NE & DA release → ↑ alertness/focus, ↓ appetite, ↑ BP/HR/RR

What drug schedule is methylphenidate?

Schedule II (misuse risk, tolerance/dependence)

What are common methylphenidate adverse effects?

Insomnia, nervousness, HTN/tachycardia/palpitations, weight loss/growth suppression; toxicity: psychosis, dysrhythmias, seizures

What methylphenidate nursing interventions?

Dose early; monitor BP/HR; track weight/height (kids); consider medication holidays; monitor for misuse; taper off

How do you administer methylphenidate safely?

Follow product; do not crush SR/ER (swallow whole); some capsules may be sprinkled; Daytrana patch AM to hip, press 30 s, rotate sites, remove after 9 h

What methylphenidate patient education?

Avoid caffeine; last dose by 4 PM; report weight loss/palpitations; use exactly as prescribed; taper rather than stop

Who should avoid methylphenidate (contraindications)?

Allergy; cardiac dysrhythmias/structural heart disease; history of psychosis/depression (may worsen); <6 y unless benefits > risks; history of misuse

What key methylphenidate interactions?

↑ cardiac risk with other stimulants/TCAs; MAOI within 14 days → HTN crisis

What do non-amphetamines like modafinil treat?

Promote wakefulness in narcolepsy, shift-work sleepiness, obstructive sleep apnea (residual sleepiness)

How does modafinil work (MOA)?

Unclear; may block NE reuptake (prolongs action)

What drug schedule is modafinil?

Schedule IV (lower misuse potential)

What are common modafinil adverse effects?

Nausea/diarrhea, headache, tachycardia/HTN; rare rash/SJS

What modafinil nursing interventions?

Give with food for GI upset; monitor BP/HR; stop & notify for any rash/blistering

How do you administer modafinil?

For narcolepsy/OSA: morning; for shift-work: 1 h before work

What modafinil patient education?

Take with food if needed; report HA/nervousness/palpitations; report rash immediately; use barrier contraception (↓ OCP effectiveness)

Who should avoid/caution modafinil?

Valvular heart disease (contra); caution CVD/HTN, hepatic/renal impairment, SUD history, mania/psychosis; avoid in pregnancy; limited data in <16 and elderly

What modafinil drug interactions matter?

↓ oral contraceptive levels (use backup); methylphenidate may ↓ modafinil absorption; ↑ warfarin & phenytoin levels; may ↑ effects of diazepam, phenytoin, propranolol, TCAs

Which adverse effects should parents report for a child on amphetamine-dextroamphetamine?

Weight loss, insomnia, hallucinations (report); orthostatic hypotension/flu-like not typical per ATI prompt