CNS stimulants are used clinically to treat both attention-deficit disorders and narcolepsy. Paradoxically, these drugs calm hyperkinetic children and help them to focus on one activity for a longer period. They also redirect and excite the arousal stimuli from the RAS. The CNS stimulants that are used to treat attention-deficit disorder and narcolepsy include methylphenidate (Ritalin, Concerta, and others); dexmethylphenidate (Focalin), an isomer of methylphenidate used in lower doses than methylphenidate; dextroamphetamine (Dexedrine); modafinil (Provigil), which is not associated with many of the systemic stimulatory effects of some of the other CNS stimulants; as well as three newer drugs—armodafinil (Nuvigil), which is thought to act through dopaminergic mechanisms but it is not associated with the cardiac and systemic stimulatory effects seen with other CNS stimulants; atomoxetine (Strattera), which is a selective norepinephrine reuptake inhibitor with anticholinergic effects but without the CV and stimulatory effects, making it preferable in patients who cannot tolerate the systemic stimulatory effects; and lisdexamfetamine (Vyvanse), an amphetamine.
Site of action of the central nervous system (CNS) stimulants in the reticular activating system (RAS).
中枢神经系统刺激剂在网状激活系统的作用位点
1. Amodafinil (Nuvigil) 阿莫非尼（努维吉尔） Dose/Route 剂量/给药途径
150-250 mg/d PO as a single dose in the morning
150 – 250 mg/d PO 晨服。
Shift work sleep disorder:150 mg/d PO at 1 h before the start of shift
倒班工作睡眠障碍：150 mg/d PO，接班前1小时服用 Usual Indications 适应症
Management of patients with obstructive sleep disorders (including sleep apnea), narcolepsy, and shift work sleep disorders to improve wakefulness
适用于阻塞性睡眠障碍（包括睡眠呼吸暂停）、发作性睡病、倒班工作睡眠障碍，改善觉醒状态。
2. Atonoxetine (Strattera) 阿托西汀（择思达） Dose/Route 剂量/给药途径
Adults and children >70 kg: 40 mg/d PO, slowly increase to a target daily dose of 80 mg
成人及体重>70 kg的儿童：40 mg/d PO，逐渐增加剂量，直到达到80 mg/d目标。
Children ≤ 70 kg: 0.5 mg/kg per day, increase to a target daily dose of 1.2 mg/kg per day.
体重≤ 70 kg儿童：0.5 mg/kg/d，增加到1.2 mg/kg/d的日常目标
Hepatic impairment: decrease dose by 50%
肝受损：剂量降低50%。 Usual Indications 普通适应症
Treatment of attention-deficit/hyperactivity disorders as part of a total treatment program
注意力缺乏/多动障碍的治疗，为整个治疗计划内容的一部分。
3. Dexmethylphenidate (Focalin) 右哌甲酯（【奥】法可林(盐酸右哌甲酯缓释胶囊)） Dose/Route 剂量/给药途径
2.5-5 mg PO bid; do not exceed
2.5 – 5 mg PO bid，不得超过
10 mg PO bid 10 mg PO bid Usual Indications 普通适应症
Treatment of attention-deficit/hyperactivity disorder in patients age ≥ 6 yr
治疗≥ 6 yr患者的注意力缺陷/多动症障碍。
★Vocabulary for Today ★
methylphenidate – n. 哌甲酯
Ritalin – n. 利他林
Concerta – n. 专注达
dexmethylphenidate – n. 右哌甲酯
Focalin – n.【奥】法可林
dextroamphetamine – n. 右苯丙胺
Dexedrine – n. 硫酸右苯丙胺
modafinil – n. 莫达非尼
Provigil – n. 普维吉尔（保清醒）
armodafinil – n. 阿莫非尼
Nuvigil – n.【奥】努维吉尔
atomoxetine – n. 阿托西汀
Strattera – n. 择思达
lisdexamfetamine – n. 利右苯丙胺
Vyvanse —n. 二甲磺酸赖右苯丙胺
1. A client prescribed dextroamphetamine reports to the nurse difficulty falling asleep at night. The nurse instructs the client on how to minimize sleep disorders. Which statement by the client indicates that teaching has been effective?
A. “I’ll take the medication with a bedtime snack.”
B. “I’ll take the medication upon awaking in the morning.”
C. “I’ll take the medication two hours before going to bed.”
D. “I’ll take the medication at least 6 hours before bedtime.” 2. Methylphenidate is prescribed for a child with a diagnosis of attention deficit hyperactivity disorder (ADHD). At which time of day should the nurse instruct the mother to administer the medication?
A. Before dinner and at bedtime
B. At the noontime and evening meals
C. In the morning after breakfast and at bedtime
D. Before breakfast and before the noontime meal
1. D. “I’ll take the medication at least 6 hours before bedtime.” Rationale: Dextroamphetamine is a central nervous system (CNS) stimulant that acts by releasing norepinephrine from the nerve endings. The client should take the medication at least 6 hours before going to bed at night to prevent disturbances with sleep. Therefore, the remaining options are incorrect. 2. D. Before breakfast and before the noontime meal Rationale: Methylphenidate is a central nervous stimulant and should be taken before breakfast and before the noontime meal. It should not be taken in the afternoon or evening because the stimulating effect causes insomnia. The remaining options are incorrect.
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