Transcript CNS Stim
Chapter 29 Central Nervous System (CNS) Stimulants REVIEW 2 L. Lehmkuhl, RN 2009 Central Nervous System Includes the brain and spinal cord Center of coordination and control Many drugs stimulate the CNS, but few are used therapeutically CNS Stimulants CNS Stimulates include analeptics and anorexiants Analeptics stimulate the respiratory center of the CNS and are used to treat drug induced respiratory depression and respiratory depression in pts with COPD 1 Anorexiants (aka Anorectics) contain amphetamines and therefore may be used in tx of: obesity depresses the appetite ST usage w/calorie restriction and exercise narcolepsy: day sleeping ADHD: restless, distracted, learning d/o, impulsivity Can cause insomnia and HA secondary to CNS stimulation (eg Didrex). Analeptics Act to stimulate the CNS Examples—doxapram (Dopram), caffeine, modafinil Uses – respiratory depression (COPD), relieve fatigue (caffeine) Side effects are hyperactivity, overstimulation Patient assessment includes B/P, P and R Depth and character of respirations are noted. Not used as often to stimulate respirations after surgery as mechanical ventilation more reliable Amphetamines/Anorectics Act to stimulate the CNS Examples— adderal, amphetamine, benzohetamine methamphetamine Uses-narcolepsy Adverse Reactions— elevated blood pressure, nervousness, HA, wakefulness, insomnia, increased or decreased pulse rate Uses of Amphetamines/Anorectics Obesity short term treatment Narcolepsy Attentiondeficit/hyperactivity disorder (ADHD) has calming effect improves concentration Act on the appetite center in the hypothalamus Examples— phendimetrazine, phentermine Have high abuse potential Use—obesity ADHD/Non-Anorectics ADHD are sensitive to their environments and responsive to minimal stimuli or distraction Ritalin, Cylert Both have amphetamine derivatives Adderal (anorectic) Produce a paradoxal reaction 1 Adverse Effects- GI distress, insomnia, HA, depression, growth suppression Obtain info about behavior @ home and in other settings. Ritalin may increase sz in epilecptics, may interact with anticholinergics, anticonvulsants and tricyclic antidepressants. Atomoxetine HCI (Strattera) Not a CNS stimulate Increases availability of noreprinephrine Improves thought processes Increases attention span SE’s vary in children taking (N/V,abd pain, fatigue, dyspepsia) Administration of CNS Stimulants Do not give within 14 days of MAO Inhibitor may cause hypertensive crisis and cerebral hemorrhage Administer daily mid-morning for SR products Do not administer in evening may cause insomnia Withdraw drug gradually May be increased after several weeks when larger doses are needed (drug tolerance) Nursing Alert: Amphetamines and Anorexiants Amphetamines and anorexiants have abuse potential and should not be used long-term Do not use with tricyclic antidepressants due to decrease in effectiveness of CNS stimulant Adverse Reactions of Central Nervous System Stimulates Overstimulation of the CNS Headache, dizziness Apprehension Disorientation and hyperactivity Nausea, vomiting Cough, dyspnea Urinary retention Variations in heart rate (ie, tachycardia) Administration in children Keep a record of behavior. Communicate closely with teacher to monitor childs reponse in school Provide positive reinforcemnet with appropriate behavior Gerontologic Alert Older adults more sensitive May exhibit excessive anxiety, nervousness, insomnia, and confusion Cardiovascular problems may worsen Careful monitoring is important Alzheimer Progressive, degenerative, terminal disease of brain tissue Deficit in neurotransmitters, acytecholine (most dramatically reduced 75%), norepinephrine, dopamine and seratonin.. Primarily effects memory Exact cause unknown