8.6 CNS Stimulants

CNS stimulants are clinically used for the treatment of attention-deficit disorders to help calm hyperkinetic children and help them focus on one activity for a longer period. The majority of CNS stimulants are controlled substances.

Methylphenidate

Methylphenidate is an example of a CNS stimulant that is often used to treat ADHD.

Mechanism of Action

Methylphenidate stimulates the brain and acts similar to amphetamines. It is thought to block the reuptake of norepinephrine and dopamine into the presynaptic neuron.

Indications for Use

Methylphenidate is used for ADHD.

Nursing Considerations Across the Lifespan

Methylphenidate is typically prescribed to clients over the age of 6. It should be avoided in clients with known structural cardiac abnormalities, cardiomyopathy, serious heart rhythm arrhythmias, or coronary artery disease. Blood pressure and heart rate should be monitored in all clients.

CNS stimulants have been associated with weight loss and slowing of growth rate in pediatric clients. It increases the risk of peripheral vasculopathy, such as Raynaud’s phenomenon, with signs and symptoms of fingers or toes feeling numb, cool, painful, and/or changing color from pale, to blue, to red.

Methylphenidate is contraindicated in clients using a monoamine oxidase inhibitor (MAOI), or use of an MAOI within the preceding 14 days. If paradoxical worsening of symptoms or other adverse reactions occur, the dosage should be reduced or, if necessary, discontinued.

Administer methylphenidate hydrochloride extended-release capsules orally once daily in the morning. Extended-release capsules should not be crushed, chewed, or divided. Monitor for signs of misuse and dependence while in therapy.

Adverse/Side Effects

Serious cardiovascular events have occurred, with sudden death reported in association with CNS-stimulant treatment in pediatric clients with structural cardiac abnormalities or other serious heart problems. Sudden death, stroke, and myocardial infarction have also been reported in adults with CNS-stimulant treatment at recommended doses. Methylphenidate may cause increased blood pressure and increased heart rate. Use of stimulants may cause psychotic or manic symptoms in clients with no prior history and may cause priapism (painful or prolonged penile erections). The most common adverse reactions (greater than 5% incidence) were headache, insomnia, upper abdominal pain, decreased appetite, and anorexia. Alcohol should be avoided because it may cause a rapid release of the drug in extended-release formulations.

Overdose

If an overdose occurs, consult with a Poison Information Center (1-800-567-8911).^[1]

Client Teaching & Education

There are several important topics to address with clients and/or parents of minor children.

Misuse and Dependence: Advise clients that methylphenidate is a controlled substance, and it can be misused and lead to dependence. Instruct clients that they should not give methylphenidate to anyone else. Advise clients to store methylphenidate in a safe, preferably locked, place to prevent misuse. Advise clients to comply with laws and regulations on drug disposal. Advise clients to dispose of remaining, unused, or expired methylphenidate through a medicine take-back program if available.

Serious Cardiovascular Risks: Advise clients that there is a serious potential cardiovascular risk, including sudden death, myocardial infarction, stroke, and hypertension. Instruct clients to contact a healthcare provider immediately if they develop symptoms such as exertional chest pain or unexplained syncope.

Blood Pressure and Heart Rate Increases: Instruct clients that methylphenidate hydrochloride extended-release capsules can cause elevations of their blood pressure and pulse rate.

Psychiatric Risks: Advise clients that methylphenidate can cause psychotic or manic symptoms, even in clients without prior history of psychotic symptoms or mania.

Priapism: Advise clients of the possibility of painful or prolonged penile erections and to seek immediate medical attention if this occurs.

Circulation Problems in Fingers and Toes: Instruct clients beginning treatment with methylphenidate about the risk of peripheral vasculopathy and associated signs and symptoms: fingers or toes may feel numb, cool, painful, and/or may change color from pale, to blue, to red. Instruct clients to report to their physician any new numbness, pain, skin color change, or sensitivity to temperature in fingers or toes or any signs of unexplained wounds appearing on fingers or toes.

Suppression of Growth: Advise parents that methylphenidate may cause slowing of growth and weight loss.

Alcohol Effect: Advise clients to avoid alcohol while taking extended-release capsules.^[2]

Now let’s take a closer look at the medication grid for methylphenidate in Table 8.6.^[3]

Table 8.6 Methylphenidate Medication Card ^[4][5][6][7]