1. Central Nervous Stimulants
Classifications
Analeptic Resp. Stimulant (Doxapram)
Amphetamine (Dexadrine)
Xanthine Derivatives
Anorectic Agents (Sanorex, Dextrim)
Stimulants for Attention Deficit Disorder
-Methylphenidate (Ritalin)
-Pemoline (Cylert)

2. Respiratory Stimulants (Analeptics)
Used to antagonize respiratory depression caused by overdosage with CNS depressants; Doxapram
Act on respiratory center in the brain stem as well as on peripheral carotid chemoreceptors to increase the depth and rate of respiration
Doxapram: use/reversal of post anesthetic respiratory depression or apnea (except due to muscle relaxants such as Anectine)

3. Analeptics: Doxapram (cont.)
Side effects: also stimulate other centers causing CV stimulation, vomiting, hyperreflexia. Narrow safety margin
Given IV compatible with D5W, D10W, and N.S. (precipitates in alkaline forms. Overdose: greater than 3 GM/24 hours
Nursing: Baseline pulse, BP & deep tendon reflexes and monitor arterial blood gases. Close observation and frequent monitoring

4. Amphetamines Dextroamphetamine, Methamphetamine, Cocaine General
Produce mood elevation or euphoria
Increase mental alertness and capacity for work
Decrease fatigue and drowsiness and prolong wakefulness
Produce tolerance and psychological dependence
Schedule II drugs
High abuse potential: used at “Raves”, by truck drivers, athletes, dieters
Treatment: Narcolepsy Sleep Disorder

5. Nursing Implications Amphetamines
Observe closely for signs of tolerance
Monitor for Drug Interactions
Teaching
Last dose 6 hr. before bed
Caution with machinery
Post-stimulatory depression may occur
Diabetics: may alter insulin or dietary requirements
Habit forming: caution patients
Legal implications: abused by students, truck drivers
Athletes used in treatment of Narcolepsy Sleep Disorder

6. Xanthine Derivatives Caffeine
Cafergot (ergotamine + caffeine), NoDoz, Quick Prep, Vivarin, Excedrine, Vanquish, Midol, Mountain Dew
Xanthine derivative week CNS stimulant, smooth-muscle relaxant, vasodilator, diuretic and myocardial stimulant
Uses
Reduces fatigue and increases sensory awareness (orally)
Treatment of mild to moderate respiratory depression
Pain relief associated with vascular headaches (migraines)
Constricts cerebral vessels
Or spinal puncture
Common side effects
Nervousness, insomnia, gastric irritation

7. Caffeine (continued) Interactions
May cause hypertensive reaction with MAOI
Increase in CNS stimulation caused by oral contraceptives, Tagmet
Smoking may increase elimination of caffeine
Withdrawal Symptoms
Headaches withdraw slowly

8. Anorectic Agents
Diethylpropion Tenuate, Tepano; Fenfluramine, Pondamine, Phentermine, lonamin; Phenylpropranolamine, Acutrim, Dexatrim
Primarily indicated for the temporary adjunctive management of obesity in conjunciton with a carefully supervised program of diet and exercise
Psychological & Physical Dependence
Prescription only except for Acutrim/Dexatrim (OTC) Fenfluramine; used investigationally in treating autistic children with elevated serotonin levels
Side effects: nervousness, irritability, insomnia, palpitations

9. Stimulants for Attention Deficit Disorder
Methylphenidate (Ritaline) Pemoline (Cylert)
CNS stimulant similar to amphetamine, but having a more marked effect on mental rather than physical or motor activities at normal doses
Potential for habituation and psychological addiction
Adjunct in the therapy of ADD in children and Narcolepsy
Benefit of Cylert and Ritaline-SR: dose once per day
Side effects
Nervousness, insomnia
Children: anorexia, mild weight loss, tachycardia

10. Outcomes The client will: Maintain normal body weight & height
Demonstrate increased attentiveness
Continue normal growth and development
Experiences restful
Will be free of cardiac Sx
Maintain positive self-esteem
Remains compliant with drug regimen
Appear less anxious
Maintain normal vital signs

11. Patient Teaching Avoid other sources of CNS stimulants
Take med exactly as prescribed
Avoid taking OTC prep. Unless approved by doctor
Keep log of daily activities
Refrain from drinking alcohol
Do not step drug abruptly: withdrawal
Take at least 6 hrs. prior to bedtime
If taking for obesity; take min before meals for dry mouth suck or candy, chew gum…

12. Nursing Diagnosis Altered nutrition RT drugs effect (anorexia)
Altered sleep patterns RT drugs effects (insomnia)
Risk for altered cardiac output RT palpitations and tachycardia
Anxiety RT drug effects
Knowledge Deficit RT lack of information about drug regimen (tolerance)