 Describe the actions, intended effects, and related nursing care for patients receiving CNS Stimulants.  Discuss the nursing process as it relates to patients receiving CNS stimulants in various care situations.

 Drugs that stimulate a specific area of the brain or spinal cord  Sympathomimetic drugs

According to: Structural similarities or Site of therapeutic action in the central nervous system (CNS) or Major therapeutic usages

 Analeptics – Reversal of anesthesia-induced respiratory depression  Anorexiants – Thought to suppress the appetite control center in the brain  ADHD – Stimulate the areas in the brain responsible for mental alertness and attentiveness  Narcolepsy – Increase mental alertness  Migraine headaches – Caffeine, co-administered with other drugs, used to treat headaches

 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

ADHD  amphetamine (Adderall, others)  methylphenidate (Concerta, Ritalin)  atomoxetine (Strattera) Narcolepsy  modafinil (Provigil)

Anorexiants  sibutramine (Meridia)  phentermine (Ionamin)  orlistat (Xenical)  Lipase inhibitor, not a CNS stimulant  Also used to treat obesity

 Migraine Headaches Serotonin agonist – Dissolvable wafers, nasal spray, and self-injectable forms – Provide specific teaching about correct administration – Foods containing tyramine should be avoided – Patients should keep a journal to monitor response to therapy

Antimigraine (serotonin agonists)  almotriptan (Axert)  eletriptan (Relpax)  frovatriptan (Frova)  naratriptan (Amerge)  rizatriptan (Maxalt)  sumatriptan (Imitrex)  zolmitriptan (Zomig)

Responsive Respiratory Depression Syndromes: Analeptics  This use is now less frequent  Still used for neonatal apnea  doxapram (Dopram)  Methylxanthines, such as aminophylline, theophylline, and caffeine

 Found in:  OTC drugs  Combination prescription drugs  Foods  Use with caution in patients with history of:  Peptic ulcer  Recent myocardial infarction  Dysrhythmias

 Many uses  Neonatal apnea  Respiratory depression in adults  Enhance effects of analgesics and migraine medications  CNS stimulation (No-Doze, Vivarin)

 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

 Drugs for ADHD  Should be given at least 6 hours before bedtime to reduce problems from insomnia  May cause dry mouth; frequent oral care is needed  Take on an empty stomach, minutes before meals  Drug “holidays” may be ordered  Parents should keep a journal to note child’s response to therapy

 Obesity - With orlistat: – Follow instructions for diet and exercise – Adverse effects may be reduced if dietary fat is limited to 30% of total intake – Take with meals that contain fat – Fat-soluble vitamin supplementation may be needed

 Monitor for therapeutic responses  Monitor for adverse effects

 A patient with narcolepsy will begin treatment with a CNS stimulant. Which of the following adverse effects is this patient likely to encounter?  a. bradycardia  b. nervousness  c. mental clouding  d. drowsiness at night

 The parents of a 10-year old boy are concerned about the adverse effects of the medication their son is taking for ADHD. Discuss what they will need to monitor while he is taking medications for this condition.

 A patient calls the headache clinic because she is unhappy about her medication. She says, “I’ve been taking zolmitriptan (Zomig) to prevent headaches, but I am still having them.” Discuss what she needs to know about the proper use of this drug.