ATTENTION DEFICIT HYPERACTIVITY  Use cautiously in patients with a history of emotional disorder, seizures, EEG

STIMULANTS abnormalities, or hypertension, and in patients whose underlying medical conditions

MEDICATION might be compromised by increases in blood pressure or heart rate, such and those
Generic Name: Methylphenidate with preexisting hypertension, heart failure, recent MI, or hyperthyroidism
Brand Name: Ritanil  Use cautiously in patients who have a history of drug dependence or alcoholism.
DRUG CLASSIFICATION Long-term abusive us can lead to tolerance and psychological dependence. Psychotic
Therapeutic Class: CNS stimulant episodes can occur. Monitor patient for severe depression during drug withdrawal
Pharmacologic Class: Piperidine derivative
INDICATION
 Attention deficit hyperactivity disorder (ADHD)
 Narcolepsy
MECHANISM OF ACTION
Releases nerve terminal stores of norepinephrine, promoting nerve impulse transmission. At
high doses, effects are mediated by dopamine
SIDE EFFECTS/ADVERSE REACTIONS
CNS: nervousness, headache, insomnia, seizures, tics, dizziness, akathisia, dyskinesia,
drowsiness, mood swings
CV: palpitations, tachycardia, arrhythmias, hypertension
EENT: pharyngitis, sinusitis
GI: nausea, abdominal pain, anorexia, decreased appetite, vomiting
Hema: thrombocytopenia, thrombocytopenic purpura, leukopenia, anemia
Meta: weight loss
Respi: cough, upper respiratory tract infection
Skin: exfoliative dermatitis, erythema multiforme, rash, urticaria, application site, irritation
Other: viral infection
NURSING RESPONSIBILITIES
 Chewable tablets contain phenylalanine
 Don’t use drug to prevent fatigue or treat 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
 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 to take chewable tablet with at least 8 oz (240mL) of water. Not using
enough water to swallow tablet may cause the tablet to swell and block the throat,
causing choking
 Caution patient to avoid activities that require alertness or good psychomotor
coordination until CNS effects of drug are known
 Warn patient with seizure disorder that drug may decrease seizure threshold. Urge him
to notify prescriber if seizure occurs
 Advise patient to avoid beverages containing caffeine while taking drug
 Tell parent to apply patch in morning immediately after opening; don’t use if pouch
seal is broken.
 Inform parent if patch comes off, a new one may be applied on a different site, but the
total wear time for that day should be 9 hours
 If the applied patch is missing, have parent ask the child when or how the patch came
off. Teach child that patch shouldn’t be shared or removed except by parent or health
care provider.
 Encourage parent to use the application chart provide with patch carton to keep track of
application and removal.
 Warn parent and patient to avoid exposing patch to direct external heat sources, such as
heating pads, electric blankets, and water beds.
 Tell parent to notify prescriber if the child develops bumps, swelling, or blistering at
the application site or is experiencing blurred vision or other serious side effects.
CONTRAINDICATIONS AND CAUSES
 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
Generic Name: Dextroamphetamine
Brand Name: Dexedrine
DRUG CLASSIFICATION
Therapeutic Class: CNS stimulant
Pharmacologic Class: Amphetamine
INDICATION
 Narcolepsy
 ADHD
MECHANISM OF ACTION
Unknown. Probably promotes nerve impulse transmission by releasing stored
dopamine and norepinephrine from nerve terminals in the brain. Main sites of
activity appear to be the cerebral cortex and the reticular activating system.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: insomnia, nervousness, restlessness, tremor, dizziness, headache, chills,
over stimulation, dysphoria, euphoria
CV: tachycardia, palpitations, arrhythmias, hypertension
GI: dry mouth, taste perversion, diarrhea, constipation, anorexia, other GI
disturbances
GU: impotence
Meta: weight loss
Skin: urticaria
Other: increased libido
NURSING RESPONSIBILITIES
 Monitor for growth and retardation in children
 Warn patient that the misuse of amphetamines can cause serious CV
adverse events, including sudden death
 Warn patient to avoid activities that require alertness, a clear visual
field, or good coordination until CNS effects of drug are known
 Tell patient he may get tired as drug effects wear off
 Ask patient to report signs and symptoms of excessive stimulation
 Inform parents that children may show increased aggression or
hostility and to report worsening of behavior
 Advise patient to consume caffeine-containing products cautiously
 Tell patient not to drink fruit juice at same time as oral solution
 Warn patient with a seizure disorder that drug may decrease seizure
threshold. Instruct him to notify prescriber if seizures occur
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to or with idiosyncratic
reactions to sympathomimetic amines and in those with
hyperthyroidism, moderate to severe hypertension, symptomatic CV
disease, glaucoma, advanced arteriosclerosis, or history of drug
abuse
 Use cautiously in agitated patients and patients with motor tics,
phonic tis, or Tourette syndrome. Also use cautiously in patients
whose underlying condition may be worsened by an increase in
blood pressure or heart rate; patient with a psychiatric illness,
bipolar disorder, depression, or family history of suicide; and those
with a seizure disorder
Generic Name: Amphetamine
Brand Name: Adderal
DRUG CLASSIFICATION
Therapeutic Class: CNS stimulant
Pharmacologic Class:
INDICATION
 ADHD
 Narcolepsy
MECHANISM OF ACTION
Causes release of norepinephrine from nerve endings.
SIDE EFFECTS/ADVERSE REACTIONS
CNS: hyperactivity, insomnia, restlessness, tremor, aggression, anger, behavioral
disturbances, dizziness, hallucinations, headache, mania, irritability, skin picking,
talkativeness, thought disorder, tics, paresthesia
CV: sudden death, palpitations, tachycardia, cardiomyopathy, hypertension, hypotension,
peripheral vasculopathy
EENT: blurred vision, mydriasis
GI: anorexia, constipation, cramps, diarrhea, dry mouth, metallic taste, nausea, vomiting.
GU: erectile dysfunction, libido changes, priapism.
Meta: growth inhibition
Musculo: rhabdomyolysis
Skin: alopecia, urticaria
Other: hypersensitivity reactions (including anaphylaxis and angioedema), psychological
dependence.
NURSING RESPONSIBILITIES
 Monitor BP, pulse, and respiration before and periodically during therapy. Obtain a
history, physical exam to assess for cardiac disease, and further evaluation if indicated.
If exertional chest pain, unexplained syncope, or other cardiac symptoms occur,
evaluate promptly.
 May produce a false sense of euphoria and well-being. Provide frequent rest periods
and observe patient for rebound depression after the effects of the medication have
worn off.
 Monitor closely for behavior change.
 Assess for risk of abuse prior to starting therapy. Monitor during therapy. Has high
dependence and abuse potential. Tolerance to medication occurs rapidly; do not
increase dose.
 Monitor weight weekly and height periodically and inform health care professional of
significant loss.
 Assess child's attention span, impulse control, and interactions with others. Therapy
may be interrupted at intervals to determine whether symptoms are sufficient to
continue therapy.
 Observe and document frequency of narcoleptic episodes
 Instruct patient to take medication once in the morning as directed. With extended
release capsule, avoid afternoon doses to prevent insomnia. Do not double doses.
Advise patient and parents to read the Medication Guide prior to starting therapy and
with each Rx refill in case of changes. Instruct patient not to alter dose without
consulting health care professional. Abrupt cessation of high doses may cause extreme
fatigue and mental depression.
 Inform patient that sharing this medication may be dangerous.
 Inform patient that the effects of drug-induced dry mouth can be minimized by rinsing
frequently with water or chewing sugarless gum or candies.
 Advise patient to limit caffeine intake.
 May impair judgment. Advise patient to use caution when driving or during other
activities requiring alertness until response to medication is known.
 Advise patient to notify health care professional of all Rx or OTC medications,
vitamins, or herbal products being taken and to consult with health care professional
before taking other medications, especially St. John's Wort.
 Inform patient that periodic holidays from the drug may be used to assess progress and
decrease dependence.
CONTRAINDICATIONS AND CAUSES
 Contraindicated in: Hypersensitivity; Hyperexcitable states including hyperthyroidism;
Psychotic personalities; Concurrent use or use within 14 days of MAO inhibitors or
MAO-like drugs (linezolid or methylene blue); Suicidal or homicidal tendencies;
Chemical dependence; Glaucoma; Structural cardiac abnormalities (may ↑ the risk of
sudden death); OB: Potentially embryotoxic.
 Use Cautiously in: Cardiovascular disease (sudden death has occurred in children with
structural cardiac abnormalities or other serious heart problems); History of substance
use disorder (misuse may result in serious cardiovascular events/sudden death);
Hypertension; Diabetes mellitus; Tourette's syndrome (may exacerbate tics); Geri:
Geriatric or debilitated patients may be more susceptible to side effects.
Generic Name: Atomoxetine
Brand Name: Strattera
DRUG CLASSIFICATION
Therapeutic Class: ADHD drug
Pharmacologic Class: SNRI
INDICATION
 Attention deficit hyperactivity disorder (ADHD)
MECHANISM OF ACTION
May be related to selective inhibition of the presynaptic norepinephrine
transporter
SIDE EFFECTS/ADVERSE REACTIONS
CNS: headache, insomnia, dizziness, somnolence, crying, irritability, mood
swings, pyrexia, fatigue, sedation, depression, tremor, early-morning awakening,
paresthesia, abnormal dreams, sleep disorder
CV: orthostatic hypotension, tachycardia, hypertension, palpitations, hot flashes
EENT: mydriasis
GI: abdominal pain, constipation, dyspepsia, nausea, vomiting, decreased
appetite, dry mouth
GU: urinary retention, urinary hesitation, ejaculatory problems, difficulty in
micturition, dysmenorrhea, erectile disturbance, impotence, delayed menses,
menstrual disorder, prostatitis
Respi: cough, upper respiratory tract infection
Skin: dermatitis, pruritus, increased sweating
Other: influenza, decreased libido
NURSING RESPONSIBILITIES
 Use drug as part of a total treatment program for ADHD,
including psychological, educational, and social intervention
 Monitor patient for the appearance or worsening of
aggressive behavior or hostility, especially when treatment is
initiated
CONTRAINDICATIONS AND CAUSES
 Contraindicated in patients hypersensitive to atomoxetine or
to components of drug, in those who have taken a 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
breastfeeding women
 Safety and efficacy haven’t been established in patients
younger than age 6