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

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

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

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

5. 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

6. 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

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

8. 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

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

10. Central Nervous System Stimulants
Prolonged use produces psychological dependence and tolerance

11. 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

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

13. 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

14. 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

15. 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

16. Alzheimer’s Disease

17. 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)

18. 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

19. 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