STIMULANTS

DEXTROAMPHETAMINE
AMPHETAMINE  Dexedrine
 Adderall
Therapeutic Class: CNS Stimulant
Therapeutic Class: CNS Stimulant Pharmacologic Class: Amphetamine
Pharmacologic Class: Amphetamine
Mechanism of Action
Mechanism of Action Probably promotes nerve impulse transmission by releasing stored
Probably promotes nerve impulse transmission by releasing stored dopamine and dopamine and norepinephrine from nerve terminals in the brain. Main sites of activity
norepinephrine from nerve terminals in the brain. Main sites of activity appear to be the cerebral appear to be the cerebral cortex and the reticular activating system.
cortex and the reticular activating system.
Indication
Indication  Nacolepsy
 Nacolepsy  ADHD
 ADHD
Adverse Reactions
Adverse Reactions CNS: insomnia, nervousness, restlessness, tremor, dizziness, headache
CNS: insomnia, nervousness, restlessness, tremor, dizziness, headache CV: tachycardia, palpitations, arrhythmias, hypertension
CV: tachycardia, palpitations, arrhythmias, hypertension GI: constipation, diarrhea, taste perversion anorexia, dry mouth
GI: constipation, diarrhea, taste perversion anorexia, dry mouth GU: impotence
GU: impotence Metabolic: weight loss
Metabolic: weight loss Skin: urticaria
Skin: urticaria Other: increased libido
Other: increased libido
Contraindication and Caution Contraindication and Caution
 Contraindicated in patients hypersensitive to or with idiosyncratic reactions to  Contraindicated in patients hypersensitive to or with idiosyncratic reactions
sympathomimetic amines and in those with hyperthyroidism, moderate to severe to sympathomimetic amines and in those with hyperthyroidism, moderate
hypertension, symptomatic CV disease, glaucoma, advanced arteriosclerosis, or history to severe hypertension, symptomatic CV disease, glaucoma, advanced
of drug abuse. arteriosclerosis, or history of drug abuse.
 Use cautiously in agitated patients and patients with motor tics, phonics tics, or  Use cautiously in agitated patients and patients with motor tics, phonics
Tourette syndrome. Also use cautiously in patients whose underlying condition may be tics, or Tourette syndrome. Also use cautiously in patients whose
worsened by an increase in blood pressure or heart rate; patients with a psychiatric underlying condition may be worsened by an increase in blood pressure or
illness, bipolar disorder, depression, or family history of suicide; and those with a seizure heart rate; patients with a psychiatric illness, bipolar disorder, depression,
disorder. or family history of suicide; and those with a seizure disorder.
 Don’t use in children or adolescents with structural cardiac abnormalities or other  Don’t use in children or adolescents with structural cardiac abnormalities or
serious heart problems. other serious heart problems.

Nursing Consideration Nursing Consideration

 Obtain a detailed a patient history, including a family history for mental disorders, family  Obtain a detailed a patient history, including a family history for mental
history for mental disorders, family suicide, ventricular arrhythmias or sudden death. disorders, family history for mental disorders, family suicide, ventricular
 Drug shouldn’t be used to prevent fatigue. arrhythmias or sudden death.
 Drug has a high abuse potential and may cause dependence. Monitory patient closely.  Drug shouldn’t be used to prevent fatigue.
 Monitor for growth retardation in children.  Drug has a high abuse potential and may cause dependence. Monitory
 Warn patient that the misuse of amphetamine can cause serious CV adverse event, patient closely.
including sudden death.  Monitor for growth retardation in children.
 Warn patient that the misuse of amphetamine can cause serious CV
adverse event, including sudden death.
DEXMETHYLPHENIDATE HYDROCHLORIDE
 Focalin
Therapeutic Class: CNS STIMULANT
Pharmacologic Class: METHYLPHENIDATE DERIVATIVE
Mechanism of Action
Blocks presynaptic reuptake of norepinephrine and dopamine and increases their
release, increasing concentration in the synapse.
Indication
 Attention Deficit Hyperactivity Disorder (ADHD)
Common Adverse Reactions
CNS: headache, anxiety, feeling jittery
GI: anorexia, abdominal pain
Contraindication and Caution
 Contraindicated in patients hypersensitive to methylphenidate or other components.
 Contraindicated in patients with severe anxiety, tension, or agitation; glaucoma; or motor tics
or a family history or diagnosis of Tourette syndrome, or within 14 days of MAO inhibitor
therapy.
 Use cautiously in patients with a psychiatric illness, bipolar disorder, depression, or family
history of suicide; seizures, hypertension, hyperthyroidism, heart failure, recent MI, or a
history of drug or alcohol abuse.
 Use in pregnant women only if the benefits outweigh the risks; drug may delay skeletal
ossification, suppress weight gain, and impair organ development in the fetus.
 Use cautiously in breast-feeding women. It's unknown if drug appears in breast milk.
 Don't use in children or adolescents with structural cardiac abnormalities or other
Nursing Consideration
 Diagnosis of ADHD must be based on complete history and evaluation of the patient by
psychological and educational experts.
 Obtain a detailed patient history, including a family history for mental disorders, family
suicide, ventricular arrhythmias, or sudden death.
 Refer patient for psychological, educational, and social support.
 Periodically reevaluate the long-term usefulness of the drug.
 Monitor CBC and differential and platelet counts during prolonged therapy.
 Don't use for severe depression or normal fatigue states.
 Stop treatment or reduce dosage if symptoms worsen or adverse reactions occur.
 Long-term stimulant use may temporarily suppress growth. Monitor children for growth and
weight gain. If growth slows or weight gain is lower than expected, stop drug.
 Routinely monitor blood pressure and pulse.
 Monitor patient for signs of drug dependence or abuse.
 If seizures occur, stop drug.
 Stress the importance of taking the correct dose of drug at the same time every day. Report
accidental overdose immediately.
 Alert: Warn patient the misuse of amphetamines can have serious effects including sudden
death.
 Advise patients unable to swallow capsules to empty the contents of the capsule onto a
spoonful of applesauce and eat immediately.
 Alert: Tell patient not to cut, crush, or chew the contents of the extended-release beaded
capsule.
 Advise parents to monitor child for medication abuse or sharing. Also inform parents to watch
for increased aggression or hostility and to report worsening behavior.
 Advise parents to monitor child's height and weight and to tell the prescriber if they suspect
growth is slowing.
METHYLPHENIDATE HYDROCHLORIDE
 Retalin
 Concerta
Therapeutic Class: CNS STIMULANT
Pharmacologic Class: PIPERIDINE DERIVATIVE
Mechanism of Action
Releases nerve terminal stores of norepinephrine, promoting nerve impulse
transmission. At high doses, effects are mediated by dopamine.
Indication
 Attention Deficit Hyperactivity Disorder (ADHD)
Common Adverse Reactions
CNS: nervousness, headache, insomnia, seizures
CV: palpitations, tachycardia, arrhythmias
GI: nausea, abdominal pain, anorexia, decreased appetite, vomiting
Hematologic: thrombocytopenia, thrombocytopenic purpura, leukopenia
Skin: exfoliative dermatitis, erythema multiforme
Other: viral infection
Contraindication and Caution
 Contraindicated in patients hypersensitive to drug and in those with glaucoma, motor tics,
family history or diagnosis of Tourette syndrome, or history of marked anxiety, tension, or
agitation. Also contraindicated within 14 days of MAO inhibitor therapy. Avoid use in patients
with structural cardiac abnormalities.
 Because it doesn't dissolve, Concerta isn't recommended in patients with a history of
peritonitis or with severe GI narrowing (such as small bowel inflammatory disease, short-gut
syndrome caused by adhesions or decreased transit time, cystic fibrosis, chronic intestinal
pseudoobstruction, or Meckel diverticulum).
 Use cautiously in patients with a history of seizures, EEG abnormalities, or hypertension, and
in patients whose underlying medical conditions might be compromised by increases in blood
pressure or heart rate, such as those with preexisting hypertension, heart failure, recent MI, or
hyperthyroidism.
 Use cautiously in patients who are emotionally unstable or who have a history of drug
dependence or alcoholism.
Nursing Consideration
 Chewable tablets contain phenylalanine.
 Don't use drug to prevent fatigue or treat severe depression.
 Drug may trigger Tourette syndrome in children. Monitor patient, especially at start of
therapy.
 Observe patient for signs of excessive stimulation. Monitor blood pressure.
 Check CBC, differential, and platelet counts with long-term use, particularly if patient shows
signs or symptoms of hematologic toxicity (fever, sore throat, easy bruising).
 Monitor height and weight in children on long-term therapy. Drug may delay growth spurt, but
children will attain normal height when drug is stopped
 Monitor patient for tolerance or psychological dependence.
 Tell patient or caregiver to give last daily dose at least 6 hours before bedtime to prevent
insomnia and after meals to reduce appetite-suppressant effects.
 Warn patient against chewing sustained-release tablets.
 Metadate CD or Ritalin LA may be swallowed whole, or the contents of the capsule may be
sprinkled onto a small amount of cool applesauce and taken immediatel
SELECTIVE NOREPINEPHRINE REUPTAKE INHIBITOR

ATOMOXETINE HYDROCHLORIDE
 Strattera

Therapeutic Class: ADHD DRUG

Pharmacologic Class: SELECTIVE NOREPINHPRINE REUPTAKE INHIBITOR

Mechanism of Action
May be related to selective inhibition of the presynaptic norepinephrine transporter.

Indication
 Attention Deficit Hyperactivity Disorder (ADHD)

Common Adverse Reactions

CNS: headache, insomnia
GI: abdominal pain, constipation, nausea, vomiting, decreased appetite, dry mouth
Respiratory: cough
Skin: dermatitis, pruritus, increased sweating

Contraindication and Caution

 Contraindicated in patients hypersensitive to atomoxetine or to components of drug, in those
who have taken an MAO inhibitor within the past 2 weeks, and in those with angle-closure
glaucoma.
 Use cautiously in patients with hypertension, tachycardia, or CV or cerebrovascular disease,
and in pregnant or breast-feeding women.
 Safety and efficacy haven't been established in patients younger than age 6.

Nursing Consideration
 Use drug as part of a total treatment program for ADHD, including psychological, educational,
and social intervention.
 Alert: Monitor children and adolescents closely for worsening of condition, agitation,
irritability, suicidal thinking or behaviors, and unusual changes in behavior, especially the first
few months of therapy or when the dosage is increased or decreased.
 Patients taking drug for extended periods must be reevaluated periodically to determine
drug's usefulness.
 Monitor growth during treatment. If growth or weight gain is unsatisfactory, consider
interrupting therapy.
 Alert: Severe liver injury may occur and progress to liver failure. Notify prescriber of any sign of
liver injury: yellowing of the skin or the sclera of the eyes, pruritus, dark urine, upper right-
sided tenderness, or unexplained flulike syndrome.
 Monitor blood pressure and pulse at baseline, after each dose increase, and during treatment
periodically.
 Monitor for urinary hesitancy or retention and sexual dysfunction.
 Patient can stop drug without tapering off.
 Alert: Advise parents to call prescriber immediately about unusual behavior or suicidal
thoughts.
 Tell pregnant women, women planning to become pregnant, and breast-feeding women to
consult prescriber before taking atomoxetine.
 Tell patient to use caution when operating a vehicle or machinery until the effects of drug are
known.