Transcript Pharmacology and the Nursing Process, 4th ed. Lilley/Harrington

Chapter 13
Central Nervous System
Stimulants and Related Drugs
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CNS Stimulants


Drugs that stimulate a specific area of the brain
or spinal cord
Sympathomimetic drugs
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Classification

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)
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Drugs for ADHD and Narcolepsy

ADHD



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amphetamine (Dexedrine, Adderall)
methylphenidate (Concerta, Ritalin, Metadate CD)
atomoxetine (Strattera)
• Nonaddictive
• May cause suicidal thinking and behavior
lisdexamfetamine (Vyvanse)
• Prodrug for dextroamphetamine
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Drugs for ADHD and Narcolepsy
(cont’d)

Narcolepsy
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
modafinil (Provigil)
armodafinil (Nuvigil)
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Mechanism of Action
and Drug Effects

Amphetamines
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
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
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Mechanism of Action
and Drug Effects (cont’d)

Respiratory effects



Relaxation of bronchial smooth muscle
Increased respiration
Dilation of pulmonary arteries
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Adverse Effects



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
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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.
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Anorexiants


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
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Mechanism of Action

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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
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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.
B.
C.
D.
Restrict dietary intake of fat
Restrict dietary intake of fiber
Increase intake of dairy products
Avoid intake of carbonated beverages
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Adverse Effects


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Possible elevated blood pressure and heart
palpitations
Anxiety
Agitation
Dizziness
Headache
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Antimigraine Drugs

Antimigraine (serotonin agonists; also called triptans)

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almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt)
sumatriptan (Imitrex)
zolmitriptan (Zomig)
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Antimigraine Drugs (cont’d)

Ergot alkaloids



ergotamine
dihydroergotamine mesylate (D.H.E. 45) (Migranal)
ergotamine tartrate with caffeine (Cafergot)
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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.
B.
C.
D.
hypertension.
allergy to penicillin.
chronic bronchitis.
cataracts.
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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
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Adverse Effects

Triptans




Vasocontstriction
Irritation at injection site
Tingling, flushing
Ergot alkaloids





Nausea and vomiting
Cold or clammy hands and feet
Muscle pain
Dizziness
Others
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Analeptics



Used less frequently
Still used for neonatal apnea
Examples:


doxapram (Dopram)
Methylxanthines, such as aminophylline, theophylline,
and caffeine
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Analeptics (cont’d)

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
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Analeptics (cont’d)

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
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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
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Adverse Effects

Vagal


Vasomotor


Flushing, sweating
Respiratory


Stimulation of gastric secretions, diarrhea, and reflex
tachycardia
Elevated respiratory rate
Musculoskeletal

Muscular tension and tremors
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Nursing Implications

Assess for:


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
Potential contraindications
Potential interactions, including herbal therapies
Conditions such as abnormal cardiac rhythms,
seizures, palpitations, liver problems
For children, assess baseline height and weight
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Nursing Implications (cont’d)
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Drugs for ADHD



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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
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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.”
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Nursing Implications (cont’d)

Anorexiants




Follow instructions for diet and exercise
Take in the morning
Avoid caffeine
Fat-soluble vitamin supplementation may be needed
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Nursing Implications (cont’d)

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
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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
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Nursing Implications (cont’d)

Monitor for therapeutic responses

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
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
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