Transcript Chapter 19

Chapter 20
Central Nervous System Stimulants
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
CNS Stimulants
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Categories
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Amphetamines
Analeptics, caffeine
Anorexiants
Medically approved uses
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Attention deficit/hyperactivity disorder (ADHD)
Narcolepsy
Reversal of respiratory distress
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Attention Deficit/Hyperactivity
Disorder (ADHD)
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Pathophysiology
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Epidemiology
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Dysregulation of transmitters
• Serotonin, norepinephrine, dopamine
Usually occurs in children before age 7 years
More common in boys
Characteristics
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Inattentiveness, inability to concentrate,
restlessness, hyperactivity, inability to complete
tasks, impulsivity
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Narcolepsy
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Characteristics
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Recurrent attacks of drowsiness and sleep during
daytime
Unable to control sleep
Falling asleep while
• Driving
• Talking
• Eating
• Standing
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Amphetamines
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Action
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Stimulate release of norepinephrine and dopamine
Side effects/adverse reactions
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Tachycardia, palpitations, hypertension
Sleeplessness, restlessness
Irritability
Anorexia, dry mouth, weight loss, diarrhea,
constipation
Impotence
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Amphetamine-Like Drugs for ADHD
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Methylphenidate (Ritalin) and
dexmethylphenidate (Focalin)
Uses
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Increase a child’s attention span and cognitive
performance (e.g., memory, reading); decrease
impulsiveness, hyperactivity, and restlessness
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Amphetamine-Like Drugs for
Narcolepsy
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Methylphenidate (Ritalin) and modafinil
(Provigil)
Action
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Not fully understood (Provigil)
Uses
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Increases the amount of time patients with
narcolepsy feel awake
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Methylphenidate (Ritalin)
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Action
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Modulates serotonergic pathways by affecting
changes in dopamine transport
Uses: ADHD, fatigue, narcolepsy
Interactions
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Caffeine may increase effects.
Decreased effects of decongestants,
antihypertensives, barbiturates
May alter insulin effects
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Methylphenidate (Ritalin) (Cont.)
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Side effects/adverse reactions
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Tachycardia, palpitations, dizziness, hypertension
Sleeplessness, restlessness, nervousness,
tremors, irritability
Increased hyperactivity
Anorexia, dry mouth, vomiting, diarrhea, weight
loss
Thrombocytopenia
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Nursing Process: Methylphenidate
(Ritalin)
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Assessment
Nursing diagnoses
Planning
Nursing interventions
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Patient teaching
Cultural considerations
Evaluation
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Nursing Process: Methylphenidate
(Ritalin) (Cont.)
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Nursing interventions
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Give before breakfast and lunch.
Report irregular heartbeat.
Record height, weight, and growth of children.
Avoid alcohol, caffeine.
Use sugarless gum to relieve dry mouth.
Do not stop abruptly; taper off to avoid withdrawal
symptoms.
Counseling must also be used.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Anorexiants
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Benzphetamine HCl (Didrex)
Diethylpropion HCl (Tenuate)
Phentermine HCl (Suprenza)
Phentermine-topiramate (Qsymia)
Phendimetrazine (Bontril)
Lorcaserin (Belviq)
Side effects
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Nervousness, restlessness, irritability, insomnia,
heart palpitations, and hypertension
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Analeptics
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Caffeine
Theophylline
Use
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Stimulate respiration in newborns
Side effects
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Restlessness, tremors, twitching, palpitations,
insomnia
Diuresis, tinnitus, nausea, diarrhea
Psychological dependence
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Respiratory CNS Stimulants
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Doxapram (Dopram)
Uses
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Onset of action
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Respiratory depression caused by overdose, preand postanesthetic respiratory depression, and
chronic obstructive pulmonary disease (COPD)
20 to 40 seconds, peak within 2 minutes
Side effects
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Hypertension, tachycardia, trembling, convulsions
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Practice Question #1
What would indicate to the nurse that the child
taking methylphenidate requires more teaching?
A.
B.
C.
D.
The child is seen drinking a cola product.
The child checks his weight twice a week.
The child takes the drug 45 minutes before a meal.
The child takes the drug before breakfast and lunch.
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Practice Question #2
A child has been diagnosed with attention
deficit/hyperactivity disorder (ADHD). Which
drug does the nurse anticipate the health care
provider will prescribe?
A.
B.
C.
D.
Zolmitriptan (Zomig)
Doxapram HCl (Dopram)
Benzphetamine HCl (Didrex)
Methylphenidate HCl (Ritalin)
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Practice Question #3
Methylphenidate (Ritalin) should not be taken
by patients with a history of which condition?
A.
B.
C.
D.
Renal failure
Cataracts
Hypothyroidism
Coronary artery disease
Copyright © 2015, 2012, 2009, 2006, 2003, 2000, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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Practice Question #4
A patient has been ordered a transdermal patch
of methylphenidate (Ritalin). The nurse teaches
the family to leave the patch on for how long?
A.
B.
C.
D.
2 hours
9 hours
2 hours
24 hours
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Practice Question #5
When providing teaching to a group of parents
regarding attention deficit/ hyperactivity disorder
(ADHD), which information will the nurse include?
A. Children with ADHD have low intelligence.
B. Children with ADHD have an infection in their spinal
fluid.
C. EEG results are typically normal in children with
ADHD.
D. Learning disabilities are often present in the child who
has ADHD.
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