Chapter 29 Central Nervous System Stimulants Used to Treat Attention Deficit Hyperactivity Disorder and Agents Used to Treat Alzheimer’s Disease

Analeptics and Anorexiants p665 Analeptics (CNS stimulants) Anorexiants (appetite suppressants) Anorexiants fall into the category of analeptics. They are CNS stimulants that depress appetite

Analeptics p665 Used to treat: – Attention deficit hyperactivity disorder (ADHD) – Narcolepsy – Obesity Anorexiants Must be accompanied by diet plan for weight loss to be permanent

Central Nervous System Stimulants (analeptics) p668 Cause CNS and cardiovascular stimulation – Restlessness – Insomnia – Anxiety – Palpitations – Tachycardia – Arrhythmias – Hypertension Prolonged use produces psychological dependence and tolerance

Attention Deficit Hyperactivity Disorder (ADHD) p665 Characteristics: – Inattention – Hyperactivity – Impulsivity Identified in children and adults

ADHD Treatment agents (analeptics) p666 Methylphenidate HCl (Ritalin) – Produces paradoxical effect Calming effect Improved attention span (ability to focus) – May cause psychological dependence – May increase seizures in epileptics Pemoline (Cylert) – Produces a paradoxical effect Amphetamine mixture (Adderal) – Produces a paradoxical effect

Analeptics for ADHD side effects p666 GI distress Insomnia Headache Growth suppression in children –

Atomoxetine HCl (Strattera) p666 Not a CNS stimulant Increases availability of norepinephrine – Improves the thought process – Increases the attention span Side effects in adults: dry mouth, insomnia, dizziness, nausea, constipation Side effects in children: N&V, abdominal pain, fatigue, dyspepsia.

Alzheimer’s disease p665 Loss of cognitive function and memory It is a progressive, degenerative, terminal disease of brain tissue characterized by up to 75% loss of acetylcholine Leading cause of dementia Meds only slow progress of disease Temporary effect; effective for approximately 2 years

Treatment for Alzheimer’s Disease p668 Donepezil (Aricept) Rivastigmine (Exelon) – Improves the availability of acetylcholine – Improves memory – Adverse/side effects Mild GI symptoms – Nausea, vomiting, and diarrhea Agitation during initial few weeks

Treatment for Alzheimer’s Disease p670 Memantine (Namenda) – Action: increases levels of glutamate, a chemical messenger involved in processing, storing, and retrieving information in the brain – Side effects Headache Dizziness Confusion Constipation

Alzheimer’s disease cont p671 70% Alzheimer’s pt live at home and are – cared for by family members Depression in 20% of Alzheimer’s patients Depression in as many as 50% of Alzheimer’s care givers Antidepressant meds may be appropriate for patients and their caregivers.