1. Introduction to Clinical Pharmacology Chapter 18 Central Nervous System Stimulants

2. CNS Stimulants: Action #1
Analeptics:
Used for narcolepsy
Increase depth of respirations- by stimulating chemoreceptors located in the carotid and upper aorta
Caffeine:
Cardiac, Respiratory, and CNS stimulation; dilation of coronary and peripheral blood vessels; constriction of cerebral blood vessels; skeletal muscle stimulation; diuretic

3. CNS Stimulants: Actions #2
Modafinil and armodafinil (treat narcolepsy):
Exact mechanism of action is not known, but drug is thought to bind to dopamine, thereby reducing number of episodes
Amphetamines:
Elevate blood pressure; wakefulness; increase or decrease pulse rate; produce euphoric state
Anorexiants: suppress appetite; ensure patient not taking any antidepressants

4. CNS Stimulants: Uses CNS stimulants: Treatment:
Attention deficit hyperactivity disorder; drug- induced respiratory depression; postanesthesia respiratory depression without reduction of analgesia; narcolepsy; sleep apnea; exogenous obesity; fatigue

5. CNS Stimulants: Adverse Reactions
Neuromuscular reactions:
Excessive CNS stimulation; headache; dizziness; apprehension; disorientation; hyperactivity
Other:
Nausea; vomiting; cough; dyspnea; urinary retention; tachycardia; palpitations

6. CNS Stimulants: Contraindications
CNS stimulants contraindicated:
In patients with known hypersensitivity; convulsive disorders (epilepsy); ventilation mechanism disorders such as COPD
Nurse should not administer CNS stimulants to patients with:
Cardiac problems; severe hypertension; hyperthyroidism; peptic ulcer
Amphetamines:
Contraindicated in glaucoma

7. CNS Stimulants: Precautions
Use CNS stimulants with caution in:
Respiratory illness
Renal and/or hepatic impairment
History of substance abuse
Pregnant or lactating women

8. CNS Stimulant: Interactions
Interactant drug
Effect of interaction
Anesthetics
Increased risk of cardiac arrhythmias
Theophylline
Increased risk of hyperactive behaviors
Oral contraceptives and modafinil
Decreased effectiveness of the oral contraceptive

9. Nursing Process: Assessment #1
Preadministration assessment:
Respiratory depression:
Initial assessments: blood pressure, pulse, respiratory rate
Note depth of respirations; any pattern to respiratory rate
Review recent laboratory test results

10. Nursing Process: Assessment #2
Preadministration assessment (cont.)
Attention deficit hyperactivity disorder:
Amphetamine prescribed: weigh patient and take blood pressure, pulse, and respiratory rate
Child with ADHD: observe for patterns of abnormal behavior
Record summary: document/chart client’s behavior; provides comparison/future changes

11. Nursing Process: Assessment #3
Preadministration assessment (cont.)
Obesity:
Anorexiant or amphetamine:
Used for outpatient use
Obtain and record:
Blood pressure; pulse; respiratory rate; weight—before therapy starts and at each outpatient visit

12. Nursing Process: Assessment #4
Ongoing assessment:
Respiratory depression:
After administering analeptic: monitor respiratory rate and respiration pattern until respirations return to normal
Monitor level of consciousness, blood pressure, and pulse rate at 5- to 15-minute intervals or as ordered by primary health care provider

13. Nursing Process: Assessment #5
Ongoing assessment (cont.)
Respiratory depression (cont.)
Take blood sample for arterial blood gas analysis, to determine effectiveness of analeptic
Observe adverse drug reaction; report occurrence immediately to primary health care provider

14. Nursing Process: Nursing Diagnosis and Planning
Disturbed Sleep Pattern; Ineffective Breathing Pattern; Imbalanced Nutrition
Expected outcomes:
Depend on reason for administration
Optimal response to therapy
Support patient needs: manage adverse drug reactions
Understanding: drug regimen

15. Nursing Process: Implementation #1
Promoting an optimal response to therapy:
Amphetamines: used for short-term treatment of exogenous obesity
Long-term use: causes addiction and abuse

16. Nursing Process: Implementation #2
Monitoring and managing patient needs taking amphetamines:
Disturbed sleep patterns:
CNS stimulant therapy: causes insomnia; anxiety, and confusion
Avoid coffee, tea, cola drinks
Vital signs: checked every 6 to 8 hours
Adverse reactions: amphetamine use may require discontinuation of drug

17. Nursing Process: Implementation #3
Monitoring and managing patient needs (cont.)
Ineffective breathing pattern:
Respiratory depression: requires administration of respiratory stimulant
Before administering drug: record rate, depth, character of respirations; ensure patent airway

18. Nursing Process: Implementation #4
Monitoring and managing patient needs (cont.)
Ineffective breathing pattern (cont.)
After administration: monitor respirations closely; record effects of therapy
Respiratory depression: assess patient’s level of pain

19. Nursing Process: Implementation #5
Monitoring and managing patient needs (cont.)
Ineffective breathing pattern (cont.)
Use of analeptic drugs for respiratory stimulation: enhances breathing pattern; keep record of number of times periods of sleepiness occur during the day and bring information to doctor visits
Doxapram: causes urinary retention; measure intake and output, notify primary health care provider if patient unable to void or bladder appears distended

20. Nursing Process: Implementation #6
Monitoring and managing patient needs (cont.)
Imbalanced nutrition: less than bodily requirements
Adverse reactions: use of CNS stimulants in child with ADHD decreases appetite
Long-term treatment: CNS stimulants retard growth in children

21. Nursing Process: Implementation #7
Monitoring and managing patient needs (cont.)
Imbalanced nutrition (cont.)
Monitor weight, growth patterns in children on long-term treatment with CNS drugs
Frequently check height, weight of child to monitor growth
Primary health care provider may periodically interrupt therapy to monitor effectiveness of therapy

22. Nursing Process: Implementation #8
Educating the patient and family:
Therapeutic regimen, adverse drug reactions are explained to patient and family
Emphasize need to follow recommended dosage schedule
Develop a teaching plan
Instruct the client to administer the drug early in the day, avoid caffeine and other CNS stimulants, be active during the day, and not nap during the day to aid in sleep alteration caused by the use of a CNS stimulant.

23. Nursing Process: Implementation #9
Educating the patient and family (cont.)
Additional teaching points:
Attention deficit hyperactivity disorder
Administer drug in morning 30 to 45 minutes before breakfast and before lunch
Monitor and record behavior of child
Ensure that weight and growth are monitored and recorded on routine health visits

24. Nursing Process: Implementation #10
Educating the patient and family (cont.)
Additional teaching points (cont.)
Narcolepsy:
Record number of times per day periods of sleepiness occur
Amphetamines and anorexiants:
Avoid coffee, tea, carbonated beverages containing caffeine

25. Nursing Process: Implementation #11
Educating the patient and family (cont.)
Additional teaching points (cont.)
Caffeine:
Should not be used if heart palpitations, dizziness, or lightheadedness occurs

26. Nursing Process: Evaluation #1
Child’s behavior, school performance improve
Weight loss is achieved
Respiratory depression is reversed
Fewer episodes of inappropriate sleep patterns are reported
Adverse reactions are identified, reported, and managed

27. Nursing Process: Evaluation #2
Patient complies with prescribed drug regimen
Patient and family demonstrate understanding of drug regimen
Patient verbalizes importance of complying with prescribed therapeutic regimen

28. Question #1 Is the following statement true or false?
CNS stimulants enhance neurotransmission and stimulate receptors in different parts of the brain.

29. Answer to Question #1 True
CNS stimulants enhance neurotransmission and stimulate receptors in different parts of the brain. These drugs are used for ADHD, narcolepsy, respiratory depression, and weight loss. They should not be used to treat clinical depression.

30. Question #2 Is the following statement true or false?
There is a low degree of addiction potential with CNS stimulant drugs due to depression of the brain’s pleasure centers with enhanced neurotransmission of dopamine.

31. Answer to Question #2 False
There is a high degree of addiction potential with these drugs due to stimulation of the brain’s pleasure centers with enhanced neurotransmission of dopamine.

32. Question #3 Is the following statement true or false?
When used routinely, administration of stimulants is offered in long-acting form or in the morning and at lunchtime to reduce the incidence of insomnia.

33. Answer to Question #3 True
When used routinely, administration of stimulants is offered in long-acting form or in the morning and at lunchtime to reduce the incidence of insomnia.