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 30-45 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)