15.1 Assess and Analyze the Impact of Nutrition on the Renal System

CNS stimulants and nonstimulants are key players in treating ADHD and narcolepsy. These meds work by tweaking brain chemicals like dopamine and norepinephrine, helping folks focus better and stay awake when needed.

While stimulants like Ritalin and Adderall are go-to options, nonstimulants offer alternatives with different mechanisms. Nurses need to know how these drugs work, their side effects, and how to guide patients through treatment for the best outcomes.

CNS Stimulants and Nonstimulants

CNS stimulants and nonstimulants for disorders

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• CNS stimulants treat attention deficit hyperactivity disorder (ADHD) by improving attention, reducing impulsivity and hyperactivity
  • Methylphenidate (Ritalin, Concerta) blocks reuptake of dopamine and norepinephrine, increasing alertness, attention, and energy
  • Amphetamines (Adderall, Dexedrine) increase release of dopamine and norepinephrine, enhancing focus, concentration, and wakefulness
• CNS stimulants also treat narcolepsy by promoting wakefulness and reducing excessive daytime sleepiness
• Nonstimulants provide an alternative treatment for ADHD and narcolepsy
  • Atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor, increases norepinephrine levels in the brain to improve attention and reduce impulsivity in ADHD
  • Modafinil (Provigil) and Armodafinil (Nuvigil) are believed to increase dopamine levels in the brain, promoting wakefulness and reducing excessive daytime sleepiness in narcolepsy

Pharmacology of ADHD and narcolepsy medications

• CNS stimulants increase levels of dopamine and norepinephrine in the brain, enhancing neurotransmission in the prefrontal cortex
• Nonstimulants have different pharmacological actions
  • Atomoxetine increases norepinephrine levels in the brain
  • Modafinil and Armodafinil increase dopamine levels in the brain
• Side effects of CNS stimulants include insomnia, decreased appetite, weight loss, headache, irritability, anxiety, increased heart rate and blood pressure
• Side effects of nonstimulants vary
  • Atomoxetine causes nausea, dry mouth, fatigue, decreased appetite
  • Modafinil and Armodafinil cause headache, nausea, anxiety, insomnia
• Potential drug interactions with CNS stimulants
  • MAO inhibitors increase risk of hypertensive crisis
  • Antidepressants increase risk of serotonin syndrome
• Potential drug interactions with nonstimulants
  • Atomoxetine increases risk of serotonin syndrome with SSRIs and SNRIs
  • Modafinil and Armodafinil decrease effectiveness of hormonal contraceptives
• These medications must cross the blood-brain barrier to exert their effects on the central nervous system

Nursing considerations for CNS medications

• Administer medications following prescribed dosage and schedule, with or without food as directed
• Monitor patient for proper medication adherence
• Assess for therapeutic response and effectiveness
  1. Look for improvement in attention, concentration, and wakefulness
  2. Observe for reduction in impulsivity and hyperactivity
• Monitor for adverse effects
  • Check vital signs, especially heart rate and blood pressure
  • Assess sleep patterns, appetite, and weight changes
  • Observe for mood changes, irritability, and anxiety
• Perform regular medication reconciliation
• Collaborate with healthcare providers for dose adjustments or medication changes as needed
• Be aware of potential off-label use of these medications for conditions not FDA-approved

Patient education for attention and sleep medications

• Explain the purpose, action, and expected outcomes of the prescribed medication
• Discuss proper dosage, administration, and storage of the medication
• Inform patients about common side effects and their management
• Emphasize the importance of reporting severe or persistent side effects to the healthcare team
• Advise on precautions, such as avoiding alcohol and operating machinery while taking these medications
• Encourage a balanced diet, regular exercise, and good sleep hygiene to support overall health
• Discuss strategies for managing stress and maintaining a consistent daily routine
• Stress the importance of regular check-ups and monitoring to assess treatment progress and make adjustments as needed
• Encourage open communication about treatment progress and any concerns the patient may have
• Provide resources for additional support, such as support groups or counseling services

Regulatory and Safety Considerations

• Many CNS stimulants are classified as controlled substances due to their potential for abuse and dependence
• Long-term use of CNS stimulants may lead to tolerance, requiring higher doses for the same effect
• Some individuals may develop physical or psychological dependence on these medications
• There is ongoing debate about the use of these medications for cognitive enhancement in healthy individuals