Stimulants and sedatives

Stimulants Lecture Overview

• Introduction to stimulants:

  • Medications that provide extra energy and alertness to the brain.

  • Helps wake up the central nervous system (CNS).

• Objectives of the lecture:

  • Explore stimulants and their mechanisms.

  • Discuss specific medications within this drug class.

  • Examine ADHD and its connection to stimulant use.

  • Outline nursing considerations when caring for patients on stimulants.

Mechanism of Action of Stimulants

• Stimulants work by:

  • Increasing activity in the brain.

  • Exciting different neurons.

• Uses of stimulants:

  • Indicated primarily for:

  • Attention-Deficit/Hyperactivity Disorder (ADHD).

  • Narcolepsy (characterized by sudden sleep attacks).

• Unique characteristics:

  • Stimulants do not elevate mood; only increase alertness and concentration.

  • Not to be used for treating depression.

Attention-Deficit/Hyperactivity Disorder (ADHD)

• Definition:

  • Most common neuropsychiatric disorder in childhood.

• Prevalence:

  • Affects 5% to 11% of children; higher diagnosis in boys (2-3 times).

  • Symptoms typically manifest between ages 3-7 and may persist into adulthood.

• Response to treatment:

  • 60-70% of children respond positively to stimulants.

  • Alternative treatments include family counseling and cognitive behavioral therapy.

• Symptoms of ADHD:

  • Inattention, hyperactivity, impulsivity, difficulty with concentration and homework.

  • Symptoms must be present for at least six months in multiple settings (home, school).

Understanding ADHD in Adults

• Adult ADHD symptoms can differ:

  • Poor concentration, potential antisocial behaviors.

  • Likely to experience job loss or car accidents compared to children.

  • Could have anger outbursts, which are less common in children.

• Diagnosis for adults may come later as symptoms can be unnoticed until adulthood.

Role of Stimulants in Treatment of ADHD

• Recommended Treatment:

  • American Academy of Pediatrics suggests combined approach of medication and therapy.

• Common stimulant medications include:

  • Amphetamines (e.g., Adderall).

  • Methylphenidate (e.g., Ritalin, Concerta).

  • Note: Caffeine, although a stimulant, is not prescribed for ADHD.

• Efficacy and considerations:

  • No significant benefits of one medication over another; efficacy may vary by individual.

  • Treatment often involves trial and error.

Pharmacology of Stimulants

• Mechanism of action:

  • Increase levels of norepinephrine and dopamine, neurotransmitters associated with alertness and focus.

  • Individuals may exhibit similar concentration under pressure due to adrenaline.

  • Stimulants do not change existing poor study habits.

Risks and Considerations of Stimulant Use

• Risk for Abuse:

  • Potential for addiction due to rapid dopamine release.

  • Can produce feelings of euphoria similar to cocaine.

• Mitigating misuse:

  • Implementing "drug holidays" to lower dependency.

  • Regular scheduling for consistent blood levels in the body is important.

• Side Effects of CNS Stimulants:

  • Insomnia, restlessness, fast heart rate, dry mouth, appetite suppression, potential for weight loss.

  • Risk of dysrhythmias or sudden death in patients with pre-existing heart conditions.

• Pregnancy Considerations:

  • Methylphenidate categorized as pregnancy risk category C (potential harm).

Drug Interactions and Nursing Considerations

• Interactions with:

  • MAO inhibitors (risk of hypertensive crisis).

  • Caffeine (enhancement of stimulant effects).

  • Over-the-counter cold medications (elevated effects).

• Nursing Considerations:

  • Educate patients about taking medication whole (not crushing capsules).

  • Regular schedule adherence is crucial for efficacy and safety.

  • Monitoring of appetite and weight is important to prevent extreme weight loss.

Sedatives Overview

• Insomnia prevalence:

  • Affects approximately 10% of Americans.

  • Experience includes difficulty falling/staying asleep and waking up often.

• Nursing interventions for insomnia:

  • Promote good sleep hygiene (consistent schedule, dark room, no screens before bed).

Types of Sedative-Hypnotics

• Common categories include:

  • Benzodiazepines:

  • Used for anxiety and insomnia; examples include Diazepam, Lorazepam, and Alprazolam.

  • Mechanism: enhance GABA, leading to decreased cellular firing, thus increasing sleep time.

  • Side effects: confusion, low blood pressure, risk of abuse, and dependence.

  • Non-benzodiazepine hypnotics (Benzolike drugs):

  • Preferred for insomnia due to lower abuse potential (e.g., Zolpidem/Ambien, Zaleplon/Sonata).

• Barbiturates:

  • Older medications, nonselective CNS depressants, now less common due to safety concerns.

Non-Pharmacological and Pharmacological Recommendations

• Melatonin agonists (e.g., Rasarum) enhance melatonin actions but only address sleep onset, not maintenance.

• Orexin antagonists (e.g., Balsamra) target wakefulness, allowing for improved sleep quality.

• Other medications:

  • Chloral Hydrate for procedural sedation.

  • Niltone for short-term anxiety only.

  • Peraldehyde for hospital use; associated with severe side effects.

Patient Education

• Educate patients on:

  • Potential side effects and risks associated with each drug category.

  • Importance of adhering to prescribed dosing and times.

  • Avoiding CNS depressants (e.g., alcohol) when on sedatives.

  • Follow-up necessary for monitoring effectiveness and side effects.

• Examples of practice questions for understanding treatment effects:

  • Assessing the efficacy of sedative-hypnotics with symptoms following treatment.