Attention Deficit Hyperactivity Disorder, or ADHD for short, refers to a range of behaviors
characterized by inattention, hyperactivity, and impulsivity.
Now, pharmacological treatment of ADHD can involve several medication groups, the main
ones being central nervous system or CNS stimulant medications.
Additional medication groups that can be used to treat ADHD include norepinephrine reuptake
inhibitors, such as atomoxetine; and alpha 2 adrenergic agonists, like guanfacine.
Finally, adjuvant medications include antidepressants, such as serotonin-norepinephrine reuptake
inhibitors like venlafaxine, and tricyclic antidepressants, like imipramine; as well
as antipsychotics, such as risperidone.
Alright, now CNS stimulants include amphetamine, dextroamphetamine, lisdexamfetamine, and methylphenidate.
All of them are taken orally, while methylphenidate can also be applied transdermally.
Once administered, these medications are absorbed into the bloodstream, and travel to the brain.
Here, they work at the synaptic cleft by inhibiting the reuptake of the neurotransmitters norepinephrine
and dopamine.
This results in an increased concentration of these neurotransmitters within the synaptic
cleft, subsequently increasing focus and attention while decreasing impulsivity.
Now, it’s important to note that CNS stimulants are highly addictive, therefore they have
a boxed warning for potential abuse and dependence.
In addition, these medications can often cause side effects like hyperactivity, irritability,
insomnia, anorexia, and weight loss.
Also, clients often develop tachycardia and palpitations, while some may present hypertension
or even arrhythmias; in fact, some of these medications have a boxed warning for serious
cardiovascular disease, such as myocardial infarction, and even sudden death.
Finally, some clients may also experience headaches, dizziness, tremors, and on rare
occasions, CNS stimulants can cause seizures.
Now, CNS stimulants are contraindicated in clients with severe arteriosclerosis, symptomatic
cardiovascular disease, and moderate to severe hypertension.
Other important contraindications include glaucoma, hyperthyroidism, and a history of
substance abuse.
In addition, these medications are contraindicated during or within 14 days of treatment with
monoamine oxidase inhibitors or MAOIs for short, which may trigger a hypertensive crisis.
Now, precautions should be taken during pregnancy and breastfeeding, as well as in children
younger than 6 years of age.
Finally, CNS stimulants should be used with caution in clients with a history of seizures
or myocardial infarction, as well as cardiovascular disease, and psychiatric conditions like anorexia
nervosa, depression, and bipolar disorder.
Okay, when a pediatric client with ADHD is prescribed a CNS stimulant like methylphenidate,
first, perform a focused baseline assessment, including height, weight, cardiac assessment
and vital signs, as well as their baseline mental status, sleep patterns, and nutritional
history, including consumption of cola or other caffeinated beverages.
Then, review their laboratory test results, including CBC, liver and renal function tests,
as well as other diagnostic tests, such as ECG.
Next, explain to your client and their caregiver how methylphenidate helps to decrease symptoms
of ADHD and help improve functioning in settings like school, social interaction, and family
relationships.
In addition, instruct them to take their immediate-release medication twice daily, once after breakfast
and once in the early afternoon to decrease the medication’s side effects on sleep.
When an extended release medication is prescribed, instruct them to take their medication once
daily after breakfast.
If a transdermal patch is prescribed, instruct them to apply a new patch at the same time
each day; remind them that they should wash their hands after handling the patch, and
that it should be applied to clean, dry, and intact skin on alternating hips, avoiding
the waistline area, and should be removed after 9 hours.
Also, remind your client and their caregiver to monitor the application site for redness,
blister formation, edema, or other signs of irritation.
Then, let them know about common side effects, such as headaches, dizziness, tremors, a fast
heartbeat, and palpitations; and advise them to contact the pediatrician promptly if these
occur.
In addition, after gaining HIPPA consent, advise the caregiver to monitor the child’s
appetite and weight, and advise them to provide appealing, nutritious meals while avoiding
caffeinated beverages.
Also, be sure to remind the caregiver to keep a close eye on their child’s mood, watching
for signs of hyperactivity, impulsivity, aggressiveness, and sleep patterns, and to seek assistance
for managing these if they occur.
If they feel the medication is no longer helping with the child’s symptoms, advise them to
notify the pediatrician and to never discontinue the medication abruptly.
Lastly, emphasize the importance of keeping the medication in a safe, secure place, in
order to prevent misuse by individuals other than the child for which it is prescribed.
Finally, during treatment with a CNS stimulant, continue to closely monitor your client’s
response to the medication, assessing effects on sleep, appetite, heart rate and blood pressure,
as well as the therapeutic effect of improved social and academic functioning.
Alright, as a quick recap…
Attention deficit hyperactivity disorder, or ADHD, is characterized by a range of behaviors
like inattention, hyperactivity, and impulsivity.
Pharmacological treatment involves medications like CNS stimulants, which inhibit the reuptake
of norepinephrine and dopamine in the brain, resulting in more of these neurotransmitters
within the synaptic cleft, ultimately increasing focus and attention while decreasing impulsivity.
Side effects can include irritability, decreased appetite, and insomnia, as well as cardiovascular
effects like hypertension or tachycardia.
When caring for a client with ADHD who is prescribed a CNS stimulant, nursing considerations
include close monitoring of sleep, appetite, heart rate, and blood pressure, as well as
for a reduction in ADHD symptoms.
Clients teaching is focused on safe self-administration, learning to recognize and manage side effects,
and secure storage of the medication.