CNS Stimulants: Uses (p. 210) Analeptics (CNS stimulants) Appetite suppressants (anorexiant) Treatment of: Attention deficit hyperactivity disorder (ADHD) Narcolepsy Migraine headaches Can result from either excessive stimulation of excitatory neurons or blockade of inhibitory neurons ADHD: Stimulate areas in the brain responsible for mental alertness and attentiveness Anorexiant: Suppress appetite control center in the brain Analeptic: Neonatal apnea, bronchopulmonary dysplasia, postanesthetic respiratory depression NURSING APPLICATION: Ms. Jackson is complaining of a migraine. Would a CNS stimulant be recommended? Why or why not? Copyright © 2011 by Elsevier Inc. All rights reserved.

CNS Stimulants (p. 211) ADHD Amphetamine (Adderall, others) Methylphenidate (Concerta, Ritalin) Atomoxetine (Strattera) Nonaddictive May cause suicidal thinking and behavior Narcolepsy Modafinil (Provigil) Cautious and continuous assessment is required with drugs used for management of ADHD. Adverse effects (p. 213) Wide range, dose-related Tend to “speed up” body systems Common adverse effects include: Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others NURSING APPLICATION: If a CNS stimulate is being taken by Ms. Jackson's great granddaughter, what signs could indicate a serious adverse reaction? Copyright line.

CNS Stimulants (cont’d) (p. 211) Anorexiants Sibutramine (Meridia) Phentermine (Lonamin) Orlistat (Xenical) Lipase inhibitor, not a CNS stimulant Also used to treat obesity May cause fecal incontinence Also antimigraine (serotonin agonists), analeptics, and caffeine Assess for: Potential contraindications Potential interactions, including herbal therapies Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems For children, assess baseline height and weight NURSING APPLICATION: Why is a baseline measurement important before giving orlistat? Copyright © 2011 by Elsevier Inc. All rights reserved.

Nursing Implications (cont’d) (p. 212) Drugs for ADHD Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia Take on an empty stomach, 30 to 45 minutes before meals Drug “holidays” may be ordered Instruct parents to keep a journal to monitor child’s response to therapy Monitor child for continued physical growth, including height and weight Atomoxetine, a norepinephrine reuptake inhibitor, is a nonstimulant drug used to treat ADHD. This medication is associated with a low incidence of insomnia and has low abuse potential. NURSING APPLICATION: How will a holiday help maintain a therapeutic blood level? Copyright © 2011 by Elsevier Inc. All rights reserved.

Nursing Implications (cont’d) (p. 217) Serotonin agonists Dissolvable wafers, nasal spray, and self-injectable forms Provide specific teaching about correct administration Instruct patients to avoid foods that contain tyramine Instruct patients to keep a journal to monitor response to therapy Used to treat migraine headache Monitor for therapeutic responses ADHD: decreased hyperactivity, increased attention span and concentration Anorexiant: appetite control and weight loss Narcolepsy: decrease in sleepiness Serotonin agonist: decrease in frequency, duration, and severity of migraines Monitor for adverse effects NURSING APPLICATION: Explain how a CNS stimulate can help someone with migraines and also help someone who has ADHD. Copyright © 2011 by Elsevier Inc. All rights reserved.