Describe the actions, intended effects, and related nursing care for patients receiving CNS Stimulants.

Discuss the nursing process as it relates to patients receiving CNS stimulants in various care situations.

Drugs that stimulate a specific area of the brain

or spinal cord

Sympathomimetic drugs

According to:

• Structural similaritiesor

• Site of therapeutic action in the central nervous system (CNS)

or• Major therapeutic usages

Analeptics– Reversal of anesthesia-induced respiratory

depression Anorexiants

– Thought to suppress the appetite control center in the brain

ADHD– Stimulate the areas in the brain responsible

for mental alertness and attentiveness Narcolepsy

– Increase mental alertness Migraine headaches

– Caffeine, co-administered with other drugs, used to treat headaches

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

ADHD amphetamine (Adderall, others)

methylphenidate (Concerta, Ritalin)

atomoxetine (Strattera)

Narcolepsy modafinil (Provigil)

Anorexiants

sibutramine (Meridia)

phentermine (Ionamin)

orlistat (Xenical)Lipase inhibitor, not a CNS stimulantAlso used to treat obesity

Migraine Headaches

Serotonin agonist

– Dissolvable wafers, nasal spray, and self-injectable forms

– Provide specific teaching about correct administration

– Foods containing tyramine should be avoided

– Patients should keep a journal to monitor response to therapy

Antimigraine (serotonin agonists)

almotriptan (Axert) eletriptan (Relpax) frovatriptan (Frova) naratriptan (Amerge) rizatriptan (Maxalt) sumatriptan (Imitrex) zolmitriptan (Zomig)

Responsive Respiratory Depression Syndromes:

Analeptics

This use is now less frequent Still used for neonatal apnea doxapram (Dopram) Methylxanthines, such as

aminophylline, theophylline, and caffeine

Found in:OTC drugsCombination prescription drugsFoods

Use with caution in patients with history of:Peptic ulcerRecent myocardial infarctionDysrhythmias

Many uses

Neonatal apnea

Respiratory depression in adults

Enhance effects of analgesics and migraine medications

CNS stimulation (No-Doze, Vivarin)

Assess for:

Potential contraindicationsPotential interactions, including herbal

therapiesConditions such as abnormal cardiac

rhythms, seizures, palpitations, liver problems

For children, assess baseline height and weight

Drugs for ADHD

Should be given at least 6 hours before bedtime to reduce problems from insomnia

May cause dry mouth; frequent oral care is needed

Take on an empty stomach, 30-45 minutes before meals

Drug “holidays” may be ordered

Parents should keep a journal to note child’s response to therapy

Obesity - With orlistat:

– Follow instructions for diet and exercise

– Adverse effects may be reduced if dietary fat is limited to 30% of total intake

– Take with meals that contain fat

– Fat-soluble vitamin supplementation may be needed

Monitor for therapeutic responses

Monitor for adverse effects

A patient with narcolepsy will begin treatment with a CNS stimulant. Which of the following adverse effects is this patient likely to encounter?

a. bradycardia b. nervousness c. mental clouding d. drowsiness at night

The parents of a 10-year old boy are concerned about the adverse effects of the medication their son is taking for ADHD. Discuss what they will need to monitor while he is taking medications for this condition.

A patient calls the headache clinic because she is unhappy about her medication. She says, “I’ve been taking zolmitriptan (Zomig) to prevent headaches, but I am still having them.” Discuss what she needs to know about the proper use of this drug.