(2) Stimulants

stimulant Uses

• ADHD

• Narcolepsy

• Obesity — often OTC and abused

• Migraines

stimulant MOA and Effects

MOA: stimulate areas of brian assoc w/ mental alrtness; Increase effects of dopa/ and NE in CNS synapses by increasing their release and blocking their reuptake

CI: HTN and glaucoma

SEs can increase known anxiety and agitiation, “Speed up everything”

Amphetamine/Dextroamphetamine (Adderall) &

Methylphenidate (Ritalin)

FYI: Methylphenidate was 1st prescription drug indicated for Tx of ADHD

• use: elevate mood, increased energy and alertness, decreased appetite, enhanced task performance, ADHD

• admin: do not give after 4pm (insomnia); often used in children

• SE: Insomnia, decreased appetite, weight loss, growth suppression, dysrhythmia, high BP

• Toxicity includes hallucinations, palpitations, HTN and seizures (have to report these - signs of med emergency)

• NI: (pt edu BIG!)

  • monitor HR/rhythm esp in those w history of cardiac disease

  • monitor Ht and Wt and promote good nutrition in children

  • take after a meal

  • do not mix w/ caffeine

  • consult w/ provider abt “drug holidays” (kids- having them come off drug at time they’re not doing school)

  • do not stop abruptly (wean off)

  • high risk of abuse

Modafinil (Provigil)

• use: Narcolepsy, shift work sleep disorder (disruption in circadian rhythm; chronic insomnial fatigue); fatigue, ADHD

• SE: increased HR, chest pain

• less abuse potential (and lowered controlled substance) that amphetamines and methylphenidate and is scheduled IV drug

• NI:

  • caution in ppl w/ cardiac issues

  • instruct pts on timing of meds to promote healthy sleep (take 1hr prior to work shift beginning to help w/ fatigue)

Caffeine

• uses: CNS stimulation and can improve respirations in neonates w/ apnea

• use w/ caution in pts w/ history of:

  • Peptic ulcer, Recent myocardial infarction, Dysrhythmias

• admin: PO, IV (neonates)

• SE: increased HR, trouble sleeping, anxiety

• NI:

  • do not mix w/ other foods/meds that include caffeine

    • educate that caffeine is in several meds including those for migraines, PMS management, etc

  • educate on timing of the med to avoid sleep disruption

Sumatriptan (Imitrex)

FYI: the og prototype drug for Serotonin Receptor Agonist (SRA) class

• MOA: causes vasoconstriction in cerebral arteries stopping the migraines (careful w/ pts who have HTN)

• admin: Oral, SL, SQ injection, nasal sprays

• SE: vasoconstriction, irritation at injection site, tingling, flushing

• NI:

  • check HR

  • instruct pt to take when a migraine begins (as soon as onset begins)

Phentermine

• action: Suppress appetite control centers in brain, Increases basal metabolic rate

• use: Obese pts w/ HTN, HHyperlipidemia, DM(diabetes mellitus)

• SE: elevated BP, palpitations, dysrhythmias, anxiety, agitation, dizziness, headache

• NI:

  • monitor cardiac function

  • assess for anxiety disorders

  • teach pt to limit caffeine

  • shud be used w/ diet and exercise plans

  • many interactions shud be monitored closely for physical and MH issues