Stimulants: pharm

Definition and Composition: CNS stimulants act upon the brain and the spinal cord to regulate various body functions. These drugs are designed to stimulate all receptors within the CNS.
Primary Categories of CNS Stimulants:
- Amphetamines and Amphetamine-like Drugs: Primarily used for the treatment of ADHD (Attention Deficit Hyperactivity Disorder) and narcolepsy. These drugs stimulate the cerebral cortex of the brain.
- Analeptics: These drugs act on the brainstem and the medulla to stimulate respiration. A common example is caffeine.
- Anorexiants: These are used primarily as appetite suppressants to assist in weight loss, often colloquially referred to as "diet medications."

ADHD (Attention Deficit Hyperactivity Disorder):
- Neurotransmitter Dysregulation: ADHD is characterized by an imbalance or dysregulation of specific neurotransmitters, specifically serotonin, norepinephrine, and dopamine.
- Epidemiology: The condition is most commonly diagnosed in children before the age of $7$ , though it can be seen even earlier. It is significantly more prevalent in boys.
- Clinical Characteristics:
  - Restlessness and hyperactivity.
  - Inability to sit still or concentrate.
  - Extremely short attention span.
  - Boredom leading to an inability to complete tasks.
  - Poor coordination.
Narcolepsy:
- Definition: A condition characterized by "sleep paralysis," where an individual suffers from recurrent attacks of extreme drowsiness and falls asleep during normal waking activities.
- Scenarios: Sleep can occur while driving, talking, walking, or working.
Respiratory Distress:
- CNS stimulants (analeptics) are used to stimulate the brainstem and spinal cord, which in turn affects the cerebral cortex to increase respiration.
- Neonatal Application: These drugs are frequently used for premature infants ("preemies") whose lungs are not fully developed. Caffeine is often administered to these newborns to increase respiratory drive and treat respiratory distress.

Classification: Amphetamine-like drug.
Mechanism of Action (MOA): Methylphenidate moderates the serotonergic pathway by affecting changes in dopamine transport.
Medical Approval and Therapeutic Effects:
- Medically approved to treat ADHD and narcolepsy.
- Used for the reversal of respiratory distress.
- Therapeutic goal: Increase attention span and cognitive focus.

Side Effects (Stimulant Class):
- Insomnia: Due to the stimulating nature, taking the drug late in the day will prevent sleep.
- CNS Stimulation: Restlessness, tremors, and irritability.
- Gastrointestinal Effects: Dry mouth, diarrhea, and constipation.
Adverse Reactions:
- Cardiovascular Issues: Tachycardia (rapid heart rate), palpitations, hypertension (high blood pressure), and dysrhythmias. These are considered very serious, particularly in pediatric patients.
- Weight and Growth: Anorexia (loss of appetite) and subsequent weight loss. While weight loss might be acceptable for adults, it is a significant adverse reaction in children as it can suppress growth.

Cardiac Conditions: Because the drug stimulates the heart and vessels, it is contraindicated in patients with cardiac dysrhythmia or a history of Myocardial Infarction ( $MI$ ). The instructor notes a hypothetical scenario: "This is when you pick up the phone and say, Jojo, I don't think this is the right drug."
Glaucoma: Avoid use, especially in patients with closed-angle glaucoma, as the drug can cause pupil dilation.
Hyperthyroidism: These patients are already tachycardic, hypertensive, and anxious; adding a stimulant could induce a heart attack or stroke.
Psychological/Neurological Issues: Contraindicated in cases of severe anxiety (due to increased restlessness) and Parkinson’s disease.
Age Limits: While it can be given to children under $6$ , it must be done with extreme caution.

Caffeine: Patients must avoid caffeine (found in coffee, tea, chocolate, soft drinks, and energy drinks like Red Bull). Caffeine increases the effect of the drug, which can cause a patient to "bounce off the walls."
Antihypertensives: Methylphenidate can decrease the effectiveness of blood pressure medications. Because it causes vessel constriction, it may cause a patient's blood pressure to rise despite their medication.
Other CNS Stimulants: Taking multiple stimulants concurrently can lead to dangerous increases in heart rate and blood pressure due to an overactive sympathetic response (pupil dilation, bronchial dilation, vessel constriction, and "lazy bladder").
Over-the-Counter (OTC) Medications: Avoid medications like Sudafed because they contain alpha-adrenergics that also cause vessel constriction and increased heart rate.
Alcohol: Consumption of alcohol while on this medication is strictly prohibited.

Vital Signs Monitoring:
- Establish a baseline for blood pressure and heart rate before administration.
- Monitor vitals after administration to check for tachycardia or hypertension.
Growth and Weight Assessment:
- Height and Weight: Crucial for pediatric patients. Height should be checked during annual visits to ensure growth is not stunted.
- Weight Monitoring: Parents should weigh the child at least twice a week. Any weight loss must be reported to the physician immediately as an adverse reaction.
Medical History Review: Nurses must determine if the patient has a history of heart disease, hypertension, hyperthyroidism, Parkinson’s, or glaucoma before starting therapy.
Withdrawal Symptoms:
- Patients must never stop taking methylphenidate abruptly.
- The dose must be tapered off slowly.
- Abrupt cessation can lead to withdrawal symptoms: nausea, vomiting, weakness, and a "nasty headache."

Timing of Administration:
- The drug should be taken on an empty stomach for maximum absorption.
- Schedule: Take the first dose early in the morning (e.g., $07:00$ AM) at least $30$ to $45$ minutes before breakfast. If a second dose is needed at lunch, take it at $11:30$ AM before eating.
- Sleep Hygiene: To avoid insomnia, the medication should be taken at least $6$ hours before bedtime. Taking it as late as $09:00$ PM will cause restlessness and tremors.
Dietary Advice:
- Maintain a high-calorie, balanced diet to counteract drug-induced anorexia.
- Avoid all caffeine sources.
Symptom Reporting: Instruct the patient to report regular heart palpitations or irregular heartbeats to their physician immediately.