1. 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.

2. 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?
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3. 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.

4. 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.

5. 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.