shift is wild

Pharmacology · chapter 13 · Psychopharmacologic Drugs

CNS Stimulants and Nonstimulants

The 14 things this section of the textbook says that you are most likely to be asked about — quoted word for word, not retold. Then 6 practice questions with the reasoning.

Skip to the questions ↓

Key points

  1. Stimulants are first-line for ADHD

    Commonly used agents are CNS stimulants, which are considered the first-line treatments for ADHD. These work by increasing the brain chemicals dopamine and norepinephrine, which play essential roles in thinking and attention.

  2. Why a stimulant calms ADHD

    Although treating ADHD with a stimulant seems paradoxical, these drugs give the client the ability to maintain attention and focus on one activity for a longer period of time.

  3. Try another stimulant first

    It is valuable to know that if one stimulant is ineffective, another should be tried before considering a nonstimulant.

  4. Watch growth in children

    As with all stimulants, pediatric clients taking this medication should be monitored for evidence of hindered growth and development.

  5. Modafinil and oral contraceptives

    Clients need to be aware that this drug can decrease the effectiveness of oral contraceptives.

  6. Contraindicated conditions

    Stimulants are contraindicated in glaucoma, hyperthyroidism, and the spectrum of cardiovascular diseases because they can exacerbate these conditions.

  7. Baseline ECG before therapy

    It is now recommended to obtain a baseline electrocardiogram (ECG, EKG) before beginning this therapy.

  8. Morning dosing prevents insomnia

    To reduce the risk of insomnia, these medications should be taken in the morning or early afternoon.

  9. Tics and Tourette syndrome

    Motor and verbal tics can be intensified with the CNS stimulants, so it is essential to identify if there is a family history or personal diagnosis of Tourette syndrome.

  10. No MAOIs within 14 days

    MAOIs are contraindicated if currently taking or within 14 days of receiving the last dose because both CNS stimulants and MAOIs can drastically increase blood pressure.

  11. Guanfacine and clonidine effects

    Guanfacine and clonidine can cause sedation, severe hypotension, and bradycardia.

  12. Clonidine and bradycardia-causing drugs

    Digoxin, calcium channel blockers, and beta blockers should not be used in conjunction with clonidine because they can exacerbate bradycardia and AV block.

  13. Drug holidays for children

    Provide drug holidays to children for the purpose of determining the need for continued treatment and allow for “catch-up” growth.

  14. Weigh weekly

    Weigh self at least once a week. Be cognizant of caloric and nutrient intake to avoid excessive weight loss.

Terms to know

Narcolepsy
Narcolepsy is a chronic neurological disorder characterized by excessive daytime sleepiness and sudden periods of sleep attacks at inopportune times.
ADHD
Attention deficit hyperactivity disorder (ADHD) is the most common psychiatric or neurobehavioral disorder in children.

Practice questions

Stuck on select-all-that-apply? How to take them one option at a time.

The graded version needs JavaScript. Every question is below anyway, with the answer and why.

Every question here, with the answer

  1. A 7-year-old is about to start methylphenidate for ADHD. Which test should the nurse make sure is done before therapy begins?

    1. Pulmonary function tests
    2. Chest x-ray
    3. Serum lithium level
    4. Baseline electrocardiogram

    Answer: Baseline electrocardiogram

    Sudden cardiac arrest has occurred with CNS stimulants, mostly in children with an undocumented cardiac defect, so a baseline ECG is recommended before therapy. The other tests are not part of stimulant preparation in this section.

  2. A parent asks when to give her son his daily stimulant for ADHD. Which instruction is best?

    1. Right after dinner.
    2. In the morning or early afternoon.
    3. At bedtime so he sleeps through the night.
    4. Whenever he seems hyperactive.

    Answer: In the morning or early afternoon.

    To reduce the risk of insomnia, stimulants should be taken in the morning or early afternoon, and not after 6 p.m. or less than 6 hours before bedtime. Evening or as-needed dosing ignores this.

  3. The nurse reviews the history of a client prescribed a CNS stimulant. Which findings should the nurse report to the provider before the first dose? Select all that apply.

    1. Took an MAOI one week ago
    2. Family history of Tourette syndrome
    3. Glaucoma
    4. Hyperthyroidism
    5. Difficulty focusing on schoolwork

    Answer: Took an MAOI one week ago, Family history of Tourette syndrome, Glaucoma, Hyperthyroidism

    Stimulants are contraindicated in glaucoma and hyperthyroidism, can intensify tics in clients with personal or family history of Tourette syndrome, and are contraindicated within 14 days of an MAOI because of dangerous blood pressure increases. Difficulty focusing is the symptom being treated.

  4. A child taking clonidine for ADHD is also prescribed a beta blocker. What is the nurse's concern?

    1. There is no interaction.
    2. The beta blocker will cancel the ADHD effect.
    3. The combination causes severe hypertension.
    4. The combination can worsen bradycardia and AV block.

    Answer: The combination can worsen bradycardia and AV block.

    Digoxin, calcium channel blockers and beta blockers should not be used with clonidine because they can exacerbate bradycardia and AV block. The other options are not supported by the section.

  5. The nurse is teaching the family of a child who takes a CNS stimulant. Which instructions are correct? Select all that apply.

    1. Give the dose after 6 p.m. so it lasts through the evening.
    2. Report chest pain or fainting.
    3. Do not chew or crush extended-release forms.
    4. Weigh the child at least once a week.
    5. Share leftover tablets with a sibling who has trouble focusing.

    Answer: Report chest pain or fainting., Do not chew or crush extended-release forms., Weigh the child at least once a week.

    Extended-release forms must not be chewed or crushed, weight should be checked weekly to avoid excessive weight loss, and chest pain or fainting must be reported. The drug must not be distributed to others, and it should not be taken after 6 p.m.

  6. A school nurse asks why a child on long-term stimulant therapy is scheduled for breaks from the medication. What is the reason?

    1. To prevent the drug from being stolen.
    2. To reduce the cost of treatment.
    3. Because stimulants stop working after one month.
    4. To determine the need for continued treatment and allow catch-up growth.

    Answer: To determine the need for continued treatment and allow catch-up growth.

    Drug holidays are provided to children to determine whether continued treatment is needed and to allow catch-up growth, since stimulants can hinder growth. The other reasons are not given in the section.

Where every quote comes from

Section 13.5 CNS Stimulants and Nonstimulants of Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris, Dorie Weaver, OpenStax, 2024. Read the whole section free at openstax.org.

The textbook is licensed under CC BY-NC-SA 4.0. This page quotes it word for word and adds the headings, the order and the practice questions; references to the book's figures and stray spaces left by its formatting are removed. The page is shared under the same licence. Nothing here is sold.