And Alzheimer’s Disease Chapter 28 Central Nervous System Stimulants and Agents Used to Treat Attention Deficit/Hyperactivity Disorder And Alzheimer’s Disease

Analeptics and Anorexiants Common central nervous system stimulant Caffeine Anorexiants Contain amphetamines Depress the appetite

Anorectic Agents Some used to treat: Attention deficit hyperactivity disorder (ADHD) Narcolepsy Weight loss

Anorectic Agents Adderall, Adderall XR (amphetamine, dextroamphetamine) Dexedrine (dextroamphetamine) Vyvanse (lisdexamfetamine)

Anorectic Agents Non-catacholamine sympathomimetic amines with CNS activity Thought 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

Anorexiants Drugs that reduce appetite Used as short-term adjuncts to calorie restriction for weight loss Use is controversial Acts by suppressing appetite control centers in the brain

Anorexiants Tolerance develops rapidly Can cause CNS and cardiovascular stimulation Some are related to amphetamine May lead to psychological dependence Controlled substances

Narcolepsy and ADHD The main symptom of narcolepsy is attacks of sleep throughout the day Treatment prevents this tendency and regulates sleep patterns ADHD 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

Central Nervous System Stimulants Cause CNS and cardiovascular stimulation Restlessness Sleeplessness Anxiety Palpitations Tachycardia Arrhythmias Hypertension

Central Nervous System Stimulants Prolonged use produces psychological dependence and tolerance

ADHD Treatments Methylphenidate HCl (Ritalin) Pemoline (Cylert) Both amphetamine derivatives Produce a paradoxical effect Calming effect Improved attention span Adverse effects GI distress, insomnia, headache, and depression Growth suppression

Atomoxetine HCl (Strattera) Not a CNS stimulant Increases availability of norepinephrine Improves the thought process Increases the attention span

Nursing Considerations for Patients with ADHD Do not stop drugs abruptly Assess effectiveness of therapy Educate parents on goals of therapy Provide information on support for patients with ADHD

Alzheimer’s Disease Progressive, degenerative, and terminal disease of the brain Leading cause of dementia Affects more than 4 million Americans Death usually occurs from sepsis, aspiration, pneumonia, or other chronic illness Cause is unknown

Alzheimer’s Disease There 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

Alzheimer’s Disease

Treatment for Alzheimer’s Disease Alzheimer’s disease seriously affects memory Acetylcholine is notably absent Examples of drug agents Stops the action of cholinesterase inhibitor Donepezil HCl (Aricept) Rivastigmine tartrate (Exelon)

Treatment for Alzheimer’s Disease Improves the availability of acetylcholine Improves memory Adverse/side effects Mild GI symptoms Nausea, vomiting, and diarrhea Agitation during initial few weeks

Nursing Considerations for Patients with Alzheimer’s Disease Assess patient and caregivers for presence of depression Assess safety strategies Assess coping strategies Assess patient and family’s knowledge of disease process and medication regimen