Neuro: ADHD/ADD & narcolepsy Exam 2

Modafinil

promotes wakefulness in clients who are experiencing narcolepsy, shift-work sleepiness or obstructive sleep apnea

What would be concerning if found in the client’s electronic health record? Think about the next 2 questions to answer this one because if contraindications/precautions were noted in the client’s chart that would be concerning. If the patient was having adverse drug reactions…that would be concerning. (modafinil)

-Tachycardia
-Hypertension

what are the contraindications to modafinil?

-Hx of valvular heart disease
-pregnancy

what are the precautions to modafinil?

-cardiovascular disease

-hypertension

-hepatic or renal impairment

-drug or alcohol abuse history

-mania or psychosis

-older adults or children younger than 16 years old

when is modafinil administered?

-given in the morning for narcolepsy and sleep apnea

-give 1 hr. before work for clients w/ shift-work sleepiness

what are the adverse drug reactions to modafinil?

-nausea/diarrhea

-headache

-Tachycardia/hypertension

-rash, including stevens-Johnson syndrome

-decreased effectiveness of oral contraceptives

What is Stevens-Johnson syndrome, how would you recognize it?

a serious type of skin disorder in which the epidermis separates from the dermis

Methylphenidate

used to treat ADHD/ADD & narcolepsy

what would the nurse include in the client instructions for a patient on methylphenidate related to the adverse drug reactions?

-instruct clients to avoid caffeine

-instruct clients to take the drug as early in the day as possible (last dose no later than 4pm)

-instruct client/family to report anorexia and weight loss to provider

-arrange the largest meals for times of day when appetite is greatest

-report cardiovascular symptoms

-instruct client to take only as directed and not to increase the dosage

-advise family/client regarding abuse potential

-instruct client not to stop this drug abruptly; taper dose

dextroamphetamine sulfate

(aka: Adderall) increases the release of the neurotransmitters norepinephrine and dopamine in the brain and the peripheral NS
-can be given as a mood stabilizer
-for children who have ADD/ADHD can help them focus

What assessment finding (think adverse drug reaction) would the nurse be concerned about if found in the electronic health record of patient on dextroamphetamine sulfate?

-insomnia/nervousness

-weight loss; suppressed growth in children

-hypertension, tachycardia, heart palpations

-toxicity: psychosis, dysrhythmias, seizures

-tolerance, dependence, risk for abuse

-withdrawal: occurs when drug is stopped abruptly; can also cause depression