Central Nervous System Stimulants and Agents Used to Treat Attention

Deficit/Hyperactivity Disorder

And Alzheimer’s Disease

Analeptics and AnorexiantsAnaleptics

Common central nervous system stimulantCaffeine

AnorexiantsContain amphetamines

Depress the appetite

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Anorectic AgentsSome used to treat:

Attention deficit hyperactivity disorder (ADHD)

NarcolepsyWeight loss

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Anorectic AgentsAdderall, Adderall XR (amphetamine,

dextroamphetamine)Dexedrine (dextroamphetamine)Vyvanse (lisdexamfetamine)

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Anorectic AgentsNon-catacholamine sympathomimetic amines

with CNS activityThought to block reuptake of norepinephrine

and dopamine and increase release into the extraneuronal space

High-risk for clients with cardiovascular disease or pre-existing psychosis; those with bipolar disorder/ADHD may experience

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AnorexiantsDrugs that reduce appetiteUsed as short-term adjuncts to

calorie restriction for weight lossUse is controversialActs by suppressing appetite control

centers in the brain

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AnorexiantsTolerance develops rapidlyCan cause CNS and cardiovascular

stimulationSome are related to amphetamineMay lead to psychological dependenceControlled substances

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Narcolepsy and ADHDThe main symptom of narcolepsy is attacks of

sleep throughout the dayTreatment prevents this tendency and regulates

sleep patternsADHD symptoms are restlessness,

distractibility, impulsive behavior, and learning disorders

Occurs in school-age children but also affects adults

Has a paradoxical effect - calming effect - improves attention span - allows focusing of thoughts

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Central Nervous System Stimulants

Cause CNS and cardiovascular stimulation RestlessnessSleeplessnessAnxietyPalpitationsTachycardiaArrhythmiasHypertension

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Central Nervous System Stimulants

Prolonged use produces psychological dependence and tolerance

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ADHD Treatments Methylphenidate HCl (Ritalin)Pemoline (Cylert)

Both amphetamine derivativesProduce a paradoxical effect

Calming effectImproved attention span

Adverse effectsGI distress, insomnia, headache, and

depressionGrowth suppression

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Atomoxetine HCl (Strattera)Not a CNS stimulantIncreases

availability of norepinephrineImproves the thought process

Increases the attention span

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Nursing Considerations for Patients with ADHD

Do not stop drugs abruptlyAssess effectiveness of therapyEducate parents on goals of therapy

Provide information on support for patients with ADHD

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Alzheimer’s DiseaseProgressive, degenerative, and terminal disease of the brain

Leading cause of dementiaAffects more than 4 million Americans

Death usually occurs from sepsis, aspiration, pneumonia, or other chronic illness

Cause is unknown

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Alzheimer’s DiseaseThere are abnormal amounts of

plaque and tangle structures in the brain

Effects are an acceleration of the normal changes that occur with aging

There is a loss of neurons and a resultant loss of cognition and short- and long-term memory

Ronald Regan Alzheimer’s Breakthrough Act of 2004 – increased federal funding for Alzheimer’s disease research

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Alzheimer’s Disease

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Treatment for Alzheimer’s Disease

Alzheimer’s disease seriously affects memoryAcetylcholine is notably absent

Examples of drug agentsStops the action of cholinesterase inhibitorDonepezil HCl (Aricept)Rivastigmine tartrate (Exelon)

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Treatment for Alzheimer’s Disease

Improves the availability of acetylcholine

Improves memoryAdverse/side effects

Mild GI symptomsNausea, vomiting, and diarrheaAgitation during initial few weeks

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Nursing Considerations for Patients with Alzheimer’s Disease

Assess patient and caregivers for presence of depression

Assess safety strategiesAssess coping strategiesAssess patient and family’s

knowledge of disease process and medication regimen

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