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Chapter 13 Central Nervous System Stimulants and Related Drugs Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Drugs that stimulate a specific area of the brain or spinal cord Sympathomimetic drugs CNS Stimulants 2Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classified according to: Chemical structural similarities or Site of therapeutic action in the central nervous system (CNS) or Major therapeutic uses (attention deficit hyperactivity disorder [ADHD], narcolepsy, obesity, migraine, and respiratory depression syndromes) Classification 3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
ADHD amphetamine (Dexedrine, Adderall) methylphenidate (Concerta, Ritalin, Metadate CD) atomoxetine (Strattera) Nonaddictive May cause suicidal thinking and behavior lisdexamfetamine (Vyvanse) Prodrug for dextroamphetamine Drugs for ADHD and Narcolepsy 4Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Drugs for ADHD and Narcolepsy (cont’d) Narcolepsy modafinil (Provigil) armodafinil (Nuvigil) 5Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Amphetamines Stimulate areas of the brain associated with mental alertness CNS effects Mood elevation or euphoria Increased mental alertness and capacity for work Decreased fatigue and drowsiness Prolonged wakefulness Mechanism of Action and Drug Effects 6Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Mechanism of Action and Drug Effects (cont’d) Respiratory effects Relaxation of bronchial smooth muscle Increased respiration Dilation of pulmonary arteries 7Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Wide range, dose-related Tend to “speed up” body systems Common adverse effects include: Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others Adverse Effects 8Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate? A.Strattera is highly addictive. B.Psychotherapy is rarely helpful in cases of ADHD. C.The patient should be monitored for possible suicidal thoughts and behavior. D.Strattera is used to treat narcolepsy as well as ADHD. 9Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Used to treat obesity Anorexiants benzphetamine (Didrex) methamphetamine (Desoxyn) phentermine (Ionamin) orlistat (Xenical) Lipase inhibitor, not a CNS stimulant Also used to treat obesity May cause fecal incontinence Anorexiants 10Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Suppress appetite control centers in the brain Increase the body’s basal metabolic rate Mobilization of adipose tissue stores Enhanced cellular glucose uptake Reduce dietary fat absorption Mechanism of Action 11Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects? A.Restrict dietary intake of fat B.Restrict dietary intake of fiber C.Increase intake of dairy products D.Avoid intake of carbonated beverages 12Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Adverse Effects Possible elevated blood pressure and heart palpitations Anxiety Agitation Dizziness Headache 13Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Antimigraine (serotonin agonists; also called triptans) almotriptan (Axert) eletriptan (Relpax) frovatriptan (Frova) naratriptan (Amerge) rizatriptan (Maxalt) sumatriptan (Imitrex) zolmitriptan (Zomig) Antimigraine Drugs 14Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Ergot alkaloids ergotamine dihydroergotamine mesylate (D.H.E. 45) (Migranal) ergotamine tartrate with caffeine (Cafergot) Antimigraine Drugs (cont’d) 15Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question Prior to administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of A.hypertension. B.allergy to penicillin. C.chronic bronchitis. D.cataracts. 16Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Mechanism of Action and Drug Effects Triptans Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms Reduce the production of inflammatory neuropeptides Ergot alkaloids Narrow or constrict blood vessels in the brain 17Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Triptans Vasocontstriction Irritation at injection site Tingling, flushing Ergot alkaloids Nausea and vomiting Cold or clammy hands and feet Muscle pain Dizziness Others Adverse Effects 18Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Used less frequently Still used for neonatal apnea Examples: doxapram (Dopram) Methylxanthines, such as aminophylline, theophylline, and caffeine Analeptics 19Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
doxapram (Dopram) Treatment of respiratory depression associated with anesthetic drugs and drugs of abuse, COPD-induced hypercapnia Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug Analeptics (cont’d) 20Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Caffeine Found in: Over-the-counter drugs Combination prescription drugs Foods and beverages Use with caution in patients with a history of: Peptic ulcer Recent myocardial infarction Dysrhythmias Analeptics (cont’d) 21Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Mechanism of Action Stimulate areas of CNS that control respiration Methylxanthines Inhibit phoshodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP) Caffeine Antagonizes adenosine receptors 22Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Adverse Effects Vagal Stimulation of gastric secretions, diarrhea, and reflex tachycardia Vasomotor Flushing, sweating Respiratory Elevated respiratory rate Musculoskeletal Muscular tension and tremors 23Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Assess for: Potential contraindications Potential interactions, including herbal therapies Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems For children, assess baseline height and weight Nursing Implications 24Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Drugs for ADHD Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia Take on an empty stomach, 30 to 45 minutes before meals Drug “holidays” may be ordered Instruct parents to keep a journal to monitor child’s response to therapy Monitor child for continued physical growth, including height and weight Nursing Implications (cont’d) 25Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Classroom Response Question A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching? A.“Take the medication with your evening meal.” B.“You will need to take this drug for at least 2 years.” C.“If you develop a dry mouth, stop taking the drug immediately.” D.“Avoid intake of caffeine.” 26Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Anorexiants Follow instructions for diet and exercise Take in the morning Avoid caffeine Fat-soluble vitamin supplementation may be needed Nursing Implications (cont’d) 27Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
SSRAs Dissolvable wafers, nasal spray, and self-injectable forms Provide specific teaching about correct administration Instruct patients to keep a journal to monitor response to therapy Nursing Implications (cont’d) 28Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Nursing Implications (cont’d) Ergot alkaloids Chest pain, confusion, slurred speech, vision changes need immediate medical attention Analeptics Pay close attention to ABCs because of patient’s diminished sensorium 29Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Monitor for therapeutic responses ADHD: decreased hyperactivity, increased attention span and concentration Anorexiant: appetite control and weight loss Narcolepsy: decrease in sleepiness Serotonin agonist: decrease in frequency, duration, and severity of migraines Monitor for adverse effects Nursing Implications (cont’d) 30Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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