Central Nervous System Stimulants, Central Nervous System Depressants, and Analgesics and Migraine Therapy

Analeptics 

CNS stimulants that primarily affect the brain stem and spinal cord

analeptics main therapeutic use is to

stimulate respiration

amphetamine-like Stimulants 

stimulate the cerebral cortex of the brain. Medically approved uses are limited to: 

• Attention-deficit/hyperactivity disorder (ADHD) in children  

• Narcolepsy 

• Reversal of respiratory distress 

Anorexiants 

suppress appetite by stimulating the satiety center in the hypothalamic and limbic areas of the brain. used to treat obesity.

examples of analeptics

Caffeine (for newborns with respiratory distress)  

Why should an amphetamine-like anorexiant not be administered with, or shortly after, an MAO inhibitor such as selegiline? 

Risk of Hypertensive Crisis due to excessive serotonin and norepinephrine levels.

Other medications that should be avoided with MAOIs include: 

• CNS stimulants 

• Vasoconstrictors  

• Cold medications containing phenylephrine and pseudoephedrine 

What teaching should be provided to a client taking extended-release methylphenidate regarding administration

• When to take: Extended-release methylphenidate is typically given once daily in the morning upon awakening. T]

• Avoid evening doses: The last daily dose should be taken 4 to 6 hours before bedtime to prevent insomnia.

What teaching should be provided to a client taking extended-release methylphenidate regarding caffeine?

avoid caffeine: Caffeine is a mild diuretic that can worsen dry mouth, a common side effect. 

What teaching should be provided to a client taking extended-release methylphenidate regarding appetite?

Monitor appetite: may suppress appetite; clients should be aware of changes in their eating habits and ensure adequate nutrition.

What teaching should be provided to a client taking extended-release methylphenidate regarding sleep?

• Common side effect: Insomnia is a frequent adverse effect 23. 

• Prevention strategy: Proper timing of doses during periods when symptom control is most needed without causing sleep alterations

What teaching should be provided to a client taking extended-release methylphenidate regarding heart rate and blood pressure?

Monitor vital signs: Methylphenidate can cause increased heart rate and elevated blood pressure

Explain how to identify a benzodiazepine drug by its name.

can be identified by their characteristic "-pam" or "-lam" suffix 

Explain how benzodiazepines enhance the inhibitory effects of GABA

Benzodiazepines act by binding to a GABA receptor site, increasing the frequency of chloride channel opening, which enhances GABA's inhibitory effect on neuronal excitability. benzodiazepines effectively calm excessive neuronal activity associated with anxiety. 

why benzos are used short term use for anxiety

they provide rapid relief from symptoms by enhancing GABA's inhibitory effects. there is a risk of dependence and tolerance and withdrawal concerns.

What cns depression findings suggest benzodiazepine toxicity?

• Depressed level of consciousness 

• Sedation  

• Confusion and agitation (if reversed too rapidly)  

• Perceptual distortions (emergence reactions)  

What respiratory findings suggest benzodiazepine toxicity?

• Respiratory depression  

• Decreased respiratory rate and effort 

What cardiovascular findings suggest benzodiazepine toxicity?

Decreased blood pressure 

What mental status changes findings suggest benzodiazepine toxicity?

• Altered mental status

• Amnesia (may not be reversed even with treatment) 

Reversal medication for benzodiazipine toxicity

Flumazenil

what is flumazenil

te reversal agent for the respiratory depressant and sedative effects of benzodiazepine drugs (e.g., diazepam, midazolam, chlordiazepoxide)

limitation to flumazenil

does not reverse the CNS depressant effects of nonbenzodiazepine agents such as alcohol, opiates, and barbiturates 

Why must alcohol and other CNS depressants be avoided while taking a benzodiazepine?

Combining alcohol and other CNS depressants with benzodiazepines can lead to excessive sedation, respiratory depression, and an increased risk of overdose.

driving and fall safety teaching for benzodiazepine

involves educating patients about the risks associated with driving or operating machinery while using benzodiazepines, emphasizing the potential for drowsiness, impaired coordination, and increased fall risk.

flumazenil vs naloxone

flumazenil reverses benzodiazepines

nalozone reveres opiods like morphine and heroin.

flumazenil mechanism

Reversal agent for respiratory depressant and sedative effects of benzodiazepines 

naloxone mechanism

Opioid antagonist that competitively binds to opioid receptor sites 

Identify the priority assessment for a client receiving an opioid who develops marked sedation and a depressed respiratory rate. 

Respiratory status is the priority: 

• Respiratory rate - assess if <10 breaths/min, which indicates respiratory depression 

• Depth and quality of respirations - shallow or labored breathing 

• Oxygen saturation - monitor SpO2 levels 

• Level of consciousness - degree of sedation and arousability 

• Pupillary constriction - pinpoint pupils are a sign of opioid toxicity

Identify the priority intervention for a client receiving an opioid who develops marked sedation and a depressed respiratory rate. 

administer naloxone

Which medication reverses opioid-induced respiratory depression

naloxone

what patient responses should be reassessed after naloxone is administered? 

• respiratory status

• loc and sedation

• withdrawal symptoms

• behavioral changes

opioid analgesics

Prescribed for moderate to severe pain; suppress pain impulses and act on the brain stem 

nonopiod analgesics

Used for mild to moderate pain (headaches, dysmenorrhea, inflammation, minor abrasions, muscular aches, mild to moderate arthritis)

nonopioid analgesics examples

Aspirin, acetaminophen, ibuprofen

opioid analgesic examples

Morphine, hydromorphone, codeine, meperidine

safety risks for opiod analgesics

• Respiratory depression (respiration <10 breaths/min) - most critical

• Orthostatic hypotension  

• Drowsiness, dizziness, weakness, confusion  

• Constipation and urinary retention  

• Pupillary constriction (sign of toxicity)  

• Tolerance - increased metabolism leads to need for higher doses  

• Psychological and physical dependence with prolonged use  

• Addiction/substance use disorder 

• Withdrawal syndrome within 24-48 hours of discontinuation (pupillary dilation, rhinorrhea, diaphoresis, hyperactivity, myalgia, tachycardia, increased blood pressure)  

safety risks for nonopioid analgesics

• Acetaminophen: Safe at therapeutic doses, causes little to no gastric distress, does not interfere with platelet aggregation  

• Acetaminophen does NOT increase bleeding potential (unlike aspirin/NSAIDs)  

• No link between acetaminophen and Reye syndrome  

• Not appropriate for inflammatory conditions (acetaminophen specifically)  

What history is essential for a client taking acetaminophen regularly?

• liver disease

• alcohol use,

• current medications

What teaching is essential for a client taking acetaminophen regularly?

• max dosage: 3000 mg per day

• avoid alcohol

• monitor for signs of toxicity and potential liver damage.

Abortive (acute) migraine medication

• Stop or reduce severity of an active migraine attack 

• Taken at onset of migraine symptoms 

preventative migraine medication

• Reduce frequency, intensity, and duration of future migraines 

• Taken daily on a regular schedule, regardless of symptoms