Pharmacologic Profile

General Use

Used in the treatment of narcolepsy and as adjunctive treatment in the management of attention deficit hyperactivity disorder (ADHD).

General Action and Information

Produce CNS stimulation by ↑ levels of neurotransmitters in the CNS. Produce CNS and respiratory stimulation, dilated pupils, ↑ motor activity and mental alertness, and a diminished sense of fatigue. In children with ADHD, these agents ↓ restlessness and ↑ attention span.

Contraindications

Hypersensitivity. Should not be used in pregnant or lactating women. Should not be used in hyperexcitable states. Avoid using in patients with psychotic personalities or suicidal/homicidal tendencies. Contraindicated in glaucoma and severe cardiovascular disease.

Precautions

Use cautiously in patients with a history of cardiovascular disease, hypertension, diabetes mellitus, or in elderly or debilitated patients. Continual use may result in psychological dependence or addiction.

Interactions

Additive sympathomimetic (adrenergic) effects. Use with MAO inhibitors can result in hypertensive crises. Alkalinizing the urine (sodium bicarbonate, acetazolamide) ↓ excretion and enhances effects of amphetamines. Acidification of the urine (ammonium chloride, large doses of ascorbic acid) ↓ effect of amphetamines. Phenothiazines may also ↓ effects. Methylphenidate may ↓ the metabolism and ↑ effects of other drugs (warfarin, anticonvulsants, tricyclic antidepressants).

Nursing Implications

Assessment

• Monitor BP, pulse, and respiration before administering and periodically during therapy.
• Monitor weight biweekly and inform health care professional of significant weight loss.
• Monitor height periodically in children; inform health care professional if growth inhibition occurs.
• May produce false sense of euphoria and well-being. Provide frequent rest periods and observe patient for rebound depression after the effects of the medication have worn off.
• Assess attention span, impulse control, and interactions with others in children. Therapy may be interrupted at intervals to determine if symptoms are sufficient to warrant continued therapy.
• Observe and document frequency of episodes.

Potential Nursing Diagnoses

• Disturbed thought process (Side Effects)
• Deficient knowledge related to disease processes and medication regimen (Patient/Family Teaching)

Implementation

Patient/Family Teaching

• Instruct patient not to alter dose without consulting health care professional. These medications have high dependence and abuse potential. Abrupt cessation with high doses may cause extreme fatigue and mental depression.
• Advise patient to avoid intake of large amounts of caffeine.
• Advise patient that many of these medications have known abuse potential. Caution patient to protect the medications from theft, and never give them to anyone other than the individual for whom it was prescribed. Store the medications out of sight and reach of children, and in a location not accessible by others.
• Medication may impair judgment. Caution patient to avoid driving or other activities requiring judgment until response to medication is known.
• Inform patient that periodic holidays from the drug may be used to assess progress and decrease dependence.

Evaluation/Desired Outcomes

• Decreased frequency of narcoleptic episodes.
• Improved attention span and social interactions.