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Medications to Treat Attention-Deficit/Hyperactivity Disorder | 마이메르시 MyMerci
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Medications to Treat Attention-Deficit/Hyperactivity Disorder

NCLEX Review Guide: ADHD Medications

Stimulant Medications

Methylphenidate (Ritalin, Concerta)

  • Mechanism of action: Blocks reuptake of dopamine and norepinephrine in the CNS, increasing focus and attention span in ADHD patients.
  • Growth suppression risk: Monitor height and weight regularly as stimulants can suppress appetite and growth in children.
  • Peak effect occurs 1-3 hours after administration, with duration varying by formulation (immediate-release vs extended-release).

Amphetamines (Adderall, Vyvanse)

  • Similar mechanism to methylphenidate but with longer duration of action and potentially more potent effects on dopamine release.
  • Cardiovascular monitoring: Assess blood pressure and heart rate before and during treatment due to sympathomimetic effects.

Key Points

  • All stimulants are Schedule II controlled substances due to abuse potential
  • Contraindicated in patients with glaucoma, severe hypertension, or history of drug abuse
  • Common side effects: decreased appetite, insomnia, headache, irritability

Non-Stimulant Medications

Atomoxetine (Strattera)

  • Selective norepinephrine reuptake inhibitor that provides 24-hour symptom control without abuse potential.
  • Takes 4-6 weeks to reach full therapeutic effect, unlike stimulants which work immediately.
  • Black box warning: Monitor for suicidal ideation, especially in children and adolescents during initial treatment.

Guanfacine (Intuniv) and Clonidine (Kapvay)

  • Alpha-2 adrenergic agonists that help with hyperactivity and impulsivity, particularly beneficial for sleep difficulties.
  • Rebound hypertension risk: Never discontinue abruptly; taper gradually to prevent dangerous blood pressure spikes.

Commonly Confused Points

StimulantsNon-Stimulants
Immediate effect (1-3 hours)Delayed effect (4-6 weeks)
High abuse potentialNo abuse potential
Growth suppression concernSuicidal ideation risk
Short-term appetite suppressionGradual onset of benefits

Memory Aid: STIMULANTS

Schedule II controlled
Takes effect immediately
Insomnia common
Monitor growth
Used first-line
Loss of appetite
Abuse potential
Norepinephrine/dopamine
Tachycardia possible
Sympathomimetic effects

Clinical Scenarios

Scenario 1:

A 10-year-old child on methylphenidate for 6 months shows decreased appetite and has lost 5 pounds. The parents are concerned about continued treatment.

Nursing Action: Recommend giving medication after meals, monitor growth charts, and suggest nutritious snacks. Consider drug holidays during summer breaks.

Scenario 2:

A teenager started on atomoxetine reports feeling "down" and having thoughts of self-harm after 2 weeks of treatment.

Priority Action: Immediately assess suicide risk and notify the prescriber. This is a black box warning side effect requiring immediate intervention.

Nursing Considerations

  1. Assessment: Obtain baseline vital signs, weight, height, and cardiovascular history before initiating therapy
  2. Monitoring: Track growth parameters, sleep patterns, appetite, and behavioral changes monthly
  3. Education: Teach families about proper timing, storage, and never sharing medications
  4. Follow-up: Schedule regular appointments to assess effectiveness and adjust dosing

Common Pitfalls

  • Don't confuse immediate-release with extended-release formulations - dosing schedules differ significantly
  • Remember that atomoxetine takes weeks to work, unlike stimulants that work immediately
  • Never stop clonidine or guanfacine abruptly due to rebound hypertension risk

Quick Check

Self-Assessment

☐ Can I identify the difference between stimulant and non-stimulant ADHD medications?

☐ Do I know the black box warning for atomoxetine?

☐ Can I explain why stimulants require growth monitoring?

☐ Do I understand the cardiovascular risks of ADHD medications?

☐ Can I teach proper medication administration and safety?

Remember: ADHD medications require careful monitoring and patient education. Your thorough assessment and teaching can make the difference in treatment success. You've got this - trust your knowledge and clinical judgment!

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