309 Central Nervous System Stimulants

What does the CNS control?

control of many vegetative and conscious functions

What do CNS stimulants do?

•increased release of neurotransmitters

•decreased reuptake of neurotransmitters

•inhibition of postsynaptic

*Heightened postsynaptic response, increased arousal*

Why is stimulant given for narcolepsy?

keeps pt awake

What conditions are CNS stimulants used for?

•Narcolepsy

•ADHD

•Overweight and Obesity

•Respiratory stimulation

+bronchodilation

What is narcolepsy?

Irresistible bouts of rapid eye movement (REM) sleep during nonsleep cycles

What are hynagogic hallucinations?

•auditory, visual, or kinesthetic sensations without stimuli

•appear in the transition period between wakefulness and sleep

•can make person freeze if woken up suddenly during rem

What is Attention Deficit Hyperactivity Disorder (ADHD)?

•Chronic health issue affecting school-aged children and some adults

•Pattern of inattentiveness, hyperactivity, and impulsivity

Management is complex:

+pharmacotherapy

+behavior modification

used to help academics and to meet developmental milestones not to just calm child

What is Overweight and Obesity?

•Major health issue in the United States

•Weight regulation is multifactorial

Treatment of obesity:

•combination of different methods

+Nutrition, activity, pharmacotherapy

What conditions of obesity need to be monitored when giving stimulants?

HTN, DM, CV

Risk benefit analysis with these people to prevent MI etc

Still have to exercise and change habits

What respiratory complications are CNS stimulants used for?

Postoperative pulmonary complications

•Hypercapnia: buildup of carbon dioxide levels resulting from pulmonary compromise

Hypercapnea in preterm infants

•Immature respiratory system

Respiratory Depression

What CNS stimulants are used for respiratory depression?

Caffeine, doxapram

Increase RR to expel CO2

cocaine is...

CNS stimulant that is NOT prescribed anymore

Amphetamines

Adderall

What is the prototype drugs for Amphetamines and Related Stimulants?

Amphetamine, Methylphenidate

Indications of Amphetamine, Methylphenidate:

Narcolepsy, ADHD

Methylphenidate: old adderal for ADD

-Indicated for narcolepsy ADHD

Contraindications and precautions of Amphetamine, Methylphenidate:

•Cardiac disease, moderate-severe HTN, hyperthyroidism, and hypersensitivity

•Caution: diabetes, anxiety disorders, Tourette's syndrome, glaucoma

Adverse effects of Amphetamine, Methylphenidate:

•Sudden death, stroke, MI, decreased appetite, rebound irritability, depression, headache, and jittery feeling, blood glucose elevations, Amphetamine Psychosis

Interactions of Amphetamine, Methylphenidate:

•Multiple drug interactions – thorough interactions check!

•Other stimulants (caffeine!)

amphetamine psychosis

mix up normal brain chemistry, being paranoid all of a sudden, d-d interactions, withdrawls, psychosis will never full go away when once present

Nursing implications of Amphetamine, Methylphenidate: Assess

•VS, health status, PMH, including CV disease, glaucoma, psychiatric status (Psychosis: mania, ADHD, anxiety, agitation), medication profile

•history of substance abuse or dependence

•Children: plot height and weight on a growth chart

•For obesity, measure height, weight, BMI

•Dietary intake of caffeine or other stimulants

•Occupation, safety

Children special considerations on ADD meds:

Have to watch growth charts in kids because it can be an adverse effect for kids (weight loss)

-need to monitor if grades are getting better (hallmark)

Nursing implications of Amphetamine, Methylphenidate: Dx/plan

•Sleep and rest

•Altered nutrition

•Growth and development in children

•Socialization, school/role performance

Nursing implications of Amphetamine, Methylphenidate: Implement

•Administer with food

•Administer no fewer than 6 hours before bedtime

•TLC for obesity

•Behavior modification for ADHD

•No abrupt cessation

Nursing implications of Amphetamine, Methylphenidate: Evaluate

Therapeutic effects:

•ADHD: behavior, school performance, socialization, sleep, monitor height and weight

•Narcolepsy: decreased narcoleptic episodes, improved nocturnal sleep quality

Adverse effects:

•B/P, vison, mood, sleep, growth suppression in children, undesired weight loss, psychosis

Nursing implications of Amphetamine, Methylphenidate: Educate

•Dosage and administration

•Do not take closer than 6 hours to bedtime

•Therapeutic and adverse effects

•May take weeks for therapeutic effect (ADHD)

•D-D, D-F interactions

•Avoid caffeine and other stimulants

•No abrupt cessation

•Safe storage

•Safety

•School regulations (ADHD) – only school nurse can have meds

What is the prototype drug for Anorectic Agents?

Phentermine

•Schedule IV narcotic, structurally similar to amphetamines, lower abuse/dependence potential

Indications for Anorectic Agents:

(Phentermine)

Obesity

Contraindications and precautions of Anorectic Agents:

(Phentermine)

•Arteriosclerosis, hypertension, glaucoma, cardiac arrhythmias

•Agitation/anxiety

Adverse effects of Anorectic Agents:

(Phentermine)

dizziness, headache, dysphoria, insomnia, overstimulation, hypertension, constipation, N/V/D, dysgeusia, dry mouth, blurred vision, mydriasis, impotence, disturbed libido, urticaria

Interactions of Anorectic Agents:

(Phentermine)

SSRIs (serotonin syndrome), other CNS stimulants

Nursing Implications of Anorectic Agents: Assess

(Phentermine)

•Health status, VS, medication history, contraindication

•Height, weight, BMI

•Current dietary practices

Nursing Implications of Anorectic Agents: Dx/plan

(Phentermine)

•Altered nutrition, safety, anxiety

Nursing Implications of Anorectic Agents: Implement

(Phentermine)

•Daily administration

•No abrupt cessation

Nursing Implications of Anorectic Agents: Evaluate

(Phentermine)

•Weight and BMI

•CV and other adverse effects, mood

Nursing Implications of Anorectic Agents: Educate

(Phentermine)

•Dosing and administration

•Avoid caffeine and other stimulants

•TLC

•Safety

Other drugs to treat obesity:

•Adrenergic drugs to suppress appetite

+Similar to amphetamines

•Orlistat: inhibits absorption of fat in the gut

+Low fat diet

+Supplement fat soluble vitamins: ADEK

•SSRIs

•Incretin mimetics

+liraglutide

Analeptics

Respiratory STIMULANT

What are the prototype drugs for respiratory stimulants (Analeptics)?

Doxapram, Caffeine

Indications for Analeptics:

(Doxapram, Caffeine)

•neonatal apnea, asthma, drowsiness, and fatigue

•Post-surgical respiratory depression

Contraindications and precautions of Analeptics:

(Doxapram, Caffeine)

•Anxiety/panic disorders, insomnia

•Caution: seizure disorders, HTN, CVD, dysrhythmias

•DM, hyperthyroidism, PUD, hepatic disease

Adverse effects of Analeptics:

(Doxapram, Caffeine)

•Tremor, tachycardia, diarrhea, excitement, irritability, insomnia

•Withdrawal syndrome

Drug interactions of Analeptics:

(Doxapram, Caffeine)

•Oral contraceptives, stimulants, sympathomimetic agents, MAOIs

•Grapefruit juice

Nursing Implications of Analeptics: Assess

(Doxapram, Caffeine)

PMH, drug history, health status, respiratory rate and depth

Nursing Implications of Analeptics: Dx/plan

(Doxapram, Caffeine)

Ventilation, oxygenation, anxiety

Nursing Implications of Analeptics: Implement

(Doxapram, Caffeine)

•Administer as directed

•Monitor respiratory status

Nursing Implications of Analeptics: Evaluate

(Doxapram, Caffeine)

Rate and depth of respirations

Nursing Implications of Analeptics: Educate

(Doxapram, Caffeine)

•Avoid other stimulants, caffeine

•No abrupt cessation

•Avoid grapefruit juice

What causes migraines?

vasodilation in brain causes swelling and headache

MOA of anti migraine meds:

Vasoconstriction

•Stimulate receptors in cerebral arteries >>>> vasoconstriction

•Reduce production of inflammatory peptides

What are the anti-migraine drugs? (class and prototype)

Serotonin receptor agonist

Sumatriptan

Ergot Alkaloids

Ergotamine

Indications for anti-migraine drugs:

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

Acute migraine headache and cluster headache

Contraindications/precautions of anti-migraine drugs:

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•CVD, uncontrolled HTN, angina, Cerebrovascular disease, PVD

•Increased risk for CVD (DM, smokers, obesity)

•Caution: hepatic or renal impairment

Adverse effects of anti-migraine drugs:

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•Coronary artery vasospasm, dysrhythmias, angina, myocardial ischemia

•dizziness, cerebral vasospasm, intracranial hemorrhage, stroke, seizures

•Hypotension, hypertension, syncope, palpitations, chest pressure

•Weakness, dizziness, myalgias

Interactions of anti-migraine drugs:

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•SSRIs, MAOIs, ergots

Nursing Implications of anti-migraine drugs: Assess

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•PMH, health status, high risk conditions, hepatic and renal function

•Characteristics of the headache

•Age: > risk in postmenopausal women and men > 40

Nursing Implications of anti-migraine drugs: Dx/plan

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

Cardiac output, safety

Nursing Implications of anti-migraine drugs: Implement

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•Administer as soon as the headache begins

•Identify and eliminate trigger factors

•Monitor for s/s vasospasm

Nursing Implications of anti-migraine drugs: Evaluate

Serotonin receptor agonist: Sumatriptan

Ergot Alkaloids: Ergotamine

•Resolution of HA

•AEs