Lilley - Chapter 13 - Central Nervous System Stimulants and Related Drugs

The nurse is providing care for a neonate diagnosed with apnea of prematurity. The prescription by the health care provider is for caffeine citrate intravenously 5 mg/kg once daily. The infant's weight is 5.4 lb. What is the correct dosage to administer to the patient?

12.3 mg

5.4 lb ÷ 2.2 = 2.45 kg × 5 mg/kg = 12.27 mg.

Because doses are rounded to tenths for neonates, the answer is 12.3 mg.

A child is prescribed methylphenidate (Ritalin) to treat attention deficit hyperactivity disorder (ADHD). The parent expresses concern about using a controlled substance to treat ADHD and asks the nurse about using a noncontrolled substance. The nurse knows ADHD can be treated with which noncontrolled substance?

a. Atomoxetine (Strattera)

b. Amphetamine aspartate (Adderall)

c. Dextroamphetamine sulfate (Dexedrine)

d. Methylphenidate (Concerta)

a. Atomoxetine (Strattera)

Rationale: Atomoxetine (Strattera) is not a controlled substance because it lacks drug addictive (psychological dependence) properties, unlike amphetamines and phenidates.

A patient diagnosed with narcolepsy is prescribed a central nervous system (CNS) stimulant. Which statement best describes the action of CNS stimulants?

a. CNS stimulants increase release of and block reuptake of neurotransmitters.

b. CNS stimulants activate cyclic adenosine monophosphate.

c. CNS stimulants block or reduce the activity of inhibitory neurons.

d. CNS stimulants decrease the production of excitatory neurotransmitters.

a. CNS stimulants increase release of and block reuptake of neurotransmitters.

Rationale: CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

A nurse is educating a patient on use of caffeine. If a patient has what condition, would alert the nurse to be concerned with use of this prescribed drug?

a. Cardiac dysrhythmias

b. Constipation

c. Myelin degeneration

d. Heart block

a. Cardiac dysrhythmias

Rationale: Caffeine is a CNS stimulant. It should be used with caution in patients with a history of peptic ulcers, cardiac dysrhythmia, or recent myocardial infarction.

Which instructions would the nurse include in teaching a patient to reduce the gastrointestinal (GI) adverse effects of orlistat (Xenical)?

a. Limit dietary intake of fat.

b. Take the medication with an antacid.

c. Increase fluid and fiber in the diet.

d. Advise to take vitamin C supplement.

a. Limit dietary intake of fat.

Rationale: Orlistat is an anorexiant that works by blocking the absorption of fat from the GI tract. Restricting dietary intake of fat reduces the GI adverse effects associated with increased fat content in stool (flatulence, oily spotting, and fecal incontinence).

Ergot alkaloids exert their therapeutic effect by which action?

a. Vasoconstriction

b. Simulation of the alpha receptors

c. Vasodilation

d. Blockade of the beta2 receptors

a. Vasoconstriction

Rationale: Ergot alkaloids narrow or constrict blood vessels in the brain. They are useful in the treatment of migraine headache caused by vasodilation of vessels in the brain. Ergot alkaloids were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy.

A nurse working with patients who are diagnosed with ADHD is aware that such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified?

a. Schedule I

b. Schedule III

c. Schedule II

d. Schedule IV

c. Schedule II

Rationale: CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

A patient with narcolepsy is prescribed methylphenidate (Ritalin). Which adverse effects would the nurse include when teaching about this drug? (Select all that apply.)

a. Headache

b. Insomnia

c. Weight Loss

d. Decreased blood pressure

e. Increased appetite

a. Headache

b. Insomnia

c. Weight Loss

Rationale: The adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, GI distress, dry mouth, and worsening of or new onset of psychiatric disorders (including mania, psychoses, or aggression).

A patient with narcolepsy will begin treatment with a CNS stimulant. The nurse expects to see which adverse effect? (select all that apply)

a. Bradycardia

b. anxiety

c. increased blood pressure

d. tremors

e. drowsiness at night

b. anxiety

c. increased blood pressure

d. tremors

A patient at a weight management clinic who was give an prescription for orlistat (Xenical) calls the clinic hotline complaining of a "terrible side effect". The nurse suspects that the patient is referring to which problem?

a. nausea

b. sexual dysfunction

c. urinary incontinence

d. fecal incontinence

d. fecal incontinence

The nurse is developing a plan of care for a patient receiving an anorexiant. Which human need statement is most appropriate?

a. altered oxygenation

b. altered sexual needs

c. altered freedom from pain

d. altered food and nutrition intake

d. altered food and nutrition intake

A patient has a new prescription for sumatriptan (Imitrex). The nurse providing patient teaching on self-administration will include which information?

a. correct technique for intramuscular injections

b. take the medication before the headache worsens

c. allow at least 30 minutes between injections

d. take no more than 4 doses in a 24-hour period

b. take the medication before the headache worsens

The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy?

a. cardiovascular disease

b. chronic bronchitis

c. history of renal calculi

d. Diabetes mellitus Type 2

a. cardiovascular disease

The nurse is reviewing medication therapy with the parents of an adolescent with ADHD. Which statement is correct (select all that apply)

a. "be sure to have your child blow his nose before administering the nasal spray"

b. "this medication is used only when symptoms of ADHD are severe"

c. "the last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep"

d. "be sure to contact the physician right away if you notice expression of suicidal thoughts"

e. "we will need to check your child's height and weight periodically to monitor physical growth"

f. "if adverse effect become severe, stop the medication for 3 to 4 days"

c. "the last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep"

d. "be sure to contact the physician right away if you notice expression of suicidal thoughts"

e. "we will need to check your child's height and weight periodically to monitor physical growth"

The medication order reads "Atomoxetine (Straterra) 1.2 mg/ kg/ day in 2 divided doses". The child weighs 66 pounds. How much will be given with each dose?

18 mg per dose

A patient with narcolepsy is having problems with excessive daytime sleepiness. The nurse expects which drug to be prescribed to improve the patient's wakefulness?

a. phentermine (Ionamin)

b. almotriptan (Axert)

c. Modafinil (Provigil)

d. methylphenidate (Ritalin)

c. Modafinil (Provigil)