1. CNS Stimulants

2. CNS Stimulants
Describe the actions, intended effects, and related nursing care for patients receiving CNS Stimulants.
Discuss the nursing process as it relates to patients receiving CNS stimulants in various care situations.

3. CNS Stimulants Drugs that stimulate a specific area of the brain
or spinal cord
Sympathomimetic drugs

4. CNS Stimulants Classification
According to:
Structural similarities or
Site of therapeutic action in the central nervous system (CNS)
Major therapeutic usages

5. CNS Stimulants Analeptics
Reversal of anesthesia-induced respiratory depression
Anorexiants
Thought to suppress the appetite control center in the brain
ADHD
Stimulate the areas in the brain responsible for mental alertness and attentiveness
Narcolepsy
Increase mental alertness
Migraine headaches
Caffeine, co-administered with other drugs, used to treat headaches

6. CNS Stimulants 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

7. CNS Stimulants ADHD Narcolepsy amphetamine (Adderall, others)
methylphenidate (Concerta, Ritalin)
atomoxetine (Strattera)
Narcolepsy
modafinil (Provigil)

8. CNS Stimulants Anorexiants sibutramine (Meridia) phentermine (Ionamin)
orlistat (Xenical)
Lipase inhibitor, not a CNS stimulant
Also used to treat obesity

9. CNS Stimulants Migraine Headaches Serotonin agonist
Dissolvable wafers, nasal spray, and self-injectable forms
Provide specific teaching about correct administration
Foods containing tyramine should be avoided
Patients should keep a journal to monitor response to therapy

10. CNS Stimulants Antimigraine (serotonin agonists) almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt)
sumatriptan (Imitrex)
zolmitriptan (Zomig)

11. CNS Stimulants Responsive Respiratory Depression Syndromes Analeptics
This use is now less frequent
Still used for neonatal apnea
doxapram (Dopram)
Methylxanthines, such as aminophylline, theophylline, and caffeine

12. CNS Stimulants Caffeine
Found in:
OTC drugs
Combination prescription drugs
Foods
Use with caution in patients with history of:
Peptic ulcer
Recent myocardial infarction
Dysrhythmias

13. CNS Stimulants Caffeine
Many uses
Neonatal apnea
Respiratory depression in adults
Enhance effects of analgesics and migraine medications
CNS stimulation (No-Doze, Vivarin)

14. CNS Stimulants Caffeine

15. CNS Stimulants Caffeine
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

16. CNS Stimulants Drugs for ADHD
Should be given at least 6 hours before bedtime to reduce problems from insomnia
May cause dry mouth; frequent oral care is needed
Take on an empty stomach, minutes before meals
Drug “holidays” may be ordered
Parents should keep a journal to note child’s response to therapy

17. CNS Stimulants Obesity - With orlistat:
Follow instructions for diet and exercise
Adverse effects may be reduced if dietary fat is limited to 30% of total intake
Take with meals that contain fat
Fat-soluble vitamin supplementation may be needed

18. CNS Stimulants Nursing Implications
Monitor for therapeutic responses
Monitor for adverse effects

19. CNS Stimulants Review
A patient with narcolepsy will begin treatment with a CNS stimulant. Which of the following adverse effects is this patient likely to encounter?
a. bradycardia
b. nervousness
c. mental clouding
d. drowsiness at night

20. CNS Stimulants Review
The parents of a 10-year old boy are concerned about the adverse effects of the medication their son is taking for ADHD. Discuss what they will need to monitor while he is taking medications for this condition.

21. CNS Stimulants Review
A patient calls the headache clinic because she is unhappy about her medication. She says, “I’ve been taking zolmitriptan (Zomig) to prevent headaches, but I am still having them.” Discuss what she needs to know about the proper use of this drug.