A mother tells the school nurse that she is concerned over her daughter's use of an inhaler for asthmatic episodes. The daughter is taking amphetamine and dextroamphetamine (Adderall XR) for ADHD
The mother states that since beginning the Adderall, every time the daughter uses her inhaler, she gets very agitated, jittery, and anxious. Which response by the nurse is the most appropriate?
1. "Your daughter needs to see her primary care provider to have her asthmatic medication changed to another medication."
2. "Your daughter will need to discontinue her treatment for ADHD, as it is contraindicated with medications use to treat asthma."
3. "The Adderall should be discontinued during times of asthma exacerbation."
4. "Inhalers used for asthma tend to cause central nervous system stimulation, just as medications for ADHD do. Her symptoms are likely due to the additive effect of having both medications."
Correct Answer: 4
Rationale 1: There is additive CNS stimulation whenever inhalers used for asthma are used concurrently with any of the medications given for ADHD, but this effect is temporary.
Rationale 2: The effects are temporary when used together. It might be appropriate for the daughter to see the primary care provider to determine ways to control her asthma better.
Rationale 3: Amphetamines should be discontinued gradually to prevent withdrawal symptoms.
Rationale 4: Inhalers used for asthma can cause nervousness, tremors, and anxiety. The effects wear off quickly.
Global Rationale: Inhalers used for asthma can cause nervousness, tremors, and anxiety. The effects wear off quickly. There is additive CNS stimulation whenever inhalers used for asthma are used concurrently with any of the medications given for ADHD, but this effect is temporary. The effects are temporary when used together. It might be appropriate for the daughter to see the primary care provider to determine ways to control her asthma better. Amphetamines should be discontinued gradually to prevent withdrawal symptoms.
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