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Chapter 13
Central Nervous System Stimulants and Related Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Drugs that stimulate a specific area of the brain or spinal cord
Sympathomimetic drugs
CNS Stimulants
2Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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)
Classification
3Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
ADHD amphetamine (Dexedrine, Adderall) methylphenidate (Concerta, Ritalin, Metadate CD) atomoxetine (Strattera)
• Nonaddictive
• May cause suicidal thinking and behavior
lisdexamfetamine (Vyvanse)• Prodrug for dextroamphetamine
Drugs for ADHD and Narcolepsy
4Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Drugs for ADHD and Narcolepsy (cont’d)
Narcolepsy modafinil (Provigil) armodafinil (Nuvigil)
5Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Amphetamines 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
Mechanism of Action and Drug Effects
6Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Mechanism of Action and Drug Effects (cont’d)
Respiratory effects Relaxation of bronchial smooth muscle Increased respiration Dilation of pulmonary arteries
7Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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
Adverse Effects
8Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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.
9Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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
Anorexiants
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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
Mechanism of Action
11Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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. Restrict dietary intake of fat
B. Restrict dietary intake of fiber
C. Increase intake of dairy products
D. Avoid intake of carbonated beverages
12Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Adverse Effects
Possible elevated blood pressure and heart palpitations
Anxiety Agitation Dizziness Headache
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Antimigraine (serotonin agonists; also called triptans) almotriptan (Axert) eletriptan (Relpax) frovatriptan (Frova) naratriptan (Amerge) rizatriptan (Maxalt) sumatriptan (Imitrex) zolmitriptan (Zomig)
Antimigraine Drugs
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Ergot alkaloids ergotamine dihydroergotamine mesylate (D.H.E. 45) (Migranal) ergotamine tartrate with caffeine (Cafergot)
Antimigraine Drugs (cont’d)
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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. hypertension.
B. allergy to penicillin.
C. chronic bronchitis.
D. cataracts.
16Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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
17Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Triptans Vasocontstriction Irritation at injection site Tingling, flushing
Ergot alkaloids Nausea and vomiting Cold or clammy hands and feet Muscle pain Dizziness Others
Adverse Effects
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Used less frequently Still used for neonatal apnea Examples:
doxapram (Dopram) Methylxanthines, such as aminophylline, theophylline,
and caffeine
Analeptics
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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
Analeptics (cont’d)
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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
Analeptics (cont’d)
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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
22Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Adverse Effects
Vagal Stimulation of gastric secretions, diarrhea, and reflex
tachycardia Vasomotor
Flushing, sweating Respiratory
Elevated respiratory rate Musculoskeletal
Muscular tension and tremors
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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
Nursing Implications
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Drugs for ADHD 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
Nursing Implications (cont’d)
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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.”
26Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Anorexiants Follow instructions for diet and exercise Take in the morning Avoid caffeine Fat-soluble vitamin supplementation may be needed
Nursing Implications (cont’d)
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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
Nursing Implications (cont’d)
28Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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
29Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
Monitor for therapeutic responses 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
Nursing Implications (cont’d)
30Copyright © 2014 by Mosby, an imprint of Elsevier Inc.
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