1. Central Nervous System Stimulants and Related Drugs
Chapter 13
Central Nervous System Stimulants and Related Drugs
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CNS Stimulants
Drugs that stimulate a specific area of the brain or spinal cord
Sympathomimetic drugs
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Classification
Classified according to:
Chemical structural similarities or
Site of therapeutic action in the central nervous system (CNS)
Major therapeutic uses (attention deficit hyperactivity disorder [ADHD], narcolepsy, obesity, migraine, and respiratory depression syndromes)
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4. Drugs for ADHD and Narcolepsy
amphetamine (Dexedrine, Adderall)
methylphenidate (Concerta, Ritalin, Metadate CD)
atomoxetine (Strattera)
Nonaddictive
May cause suicidal thinking and behavior
lisdexamfetamine (Vyvanse)
Prodrug for dextroamphetamine
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5. Drugs for ADHD and Narcolepsy (cont’d)
modafinil (Provigil)
armodafinil (Nuvigil)
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6. Mechanism of Action and Drug Effects
Amphetamines
Stimulate areas of the brain associated with mental alertness
CNS effects
Mood elevation or euphoria
Increased mental alertness and capacity for work
Decreased fatigue and drowsiness
Prolonged wakefulness
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7. Mechanism of Action and Drug Effects (cont’d)
Respiratory effects
Relaxation of bronchial smooth muscle
Increased respiration
Dilation of pulmonary arteries
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Adverse Effects
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
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9. Classroom Response Question
A teenaged boy will be receiving atomoxetine (Strattera) as part of treatment for attention deficit hyperactivity disorder (ADHD). Which statement about this drug therapy is accurate?
Strattera is highly addictive.
Psychotherapy is rarely helpful in cases of ADHD.
The patient should be monitored for possible suicidal thoughts and behavior.
Strattera is used to treat narcolepsy as well as ADHD.
Correct answer: C
Rationale: Prescribers are advised to work with parents to monitor closely for suicidal thoughts and behavior. In addition, psychosocial problems within the patient’s family should be addressed if needed. Strattera is not addictive, and it is not used to treat narcolepsy.
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Anorexiants
Used to treat obesity
Anorexiants
benzphetamine (Didrex)
methamphetamine (Desoxyn)
phentermine (Ionamin)
orlistat (Xenical)
Lipase inhibitor, not a CNS stimulant
Also used to treat obesity
May cause fecal incontinence
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Mechanism of Action
Suppress appetite control centers in the brain
Increase the body’s basal metabolic rate
Mobilization of adipose tissue stores
Enhanced cellular glucose uptake
Reduce dietary fat absorption
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12. Classroom Response Question
A patient wants to take orlistat (Xenical) to assist in her weight loss program, but she is wary of its unpleasant adverse effects. What measure can be suggested to reduce these effects?
Restrict dietary intake of fat
Restrict dietary intake of fiber
Increase intake of dairy products
Avoid intake of carbonated beverages
Correct answer: A
Rationale: Restricting dietary intake of fat to less than 30% of total calories can help reduce some of the GI adverse effects of orlistat, which include oily spotting, flatulence, and fecal incontinence in 20% to 40% of patients.
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Adverse Effects
Possible elevated blood pressure and heart palpitations
Anxiety
Agitation
Dizziness
Headache
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Antimigraine Drugs
Antimigraine (serotonin agonists; also called triptans)
almotriptan (Axert)
eletriptan (Relpax)
frovatriptan (Frova)
naratriptan (Amerge)
rizatriptan (Maxalt)
sumatriptan (Imitrex)
zolmitriptan (Zomig)
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15. Antimigraine Drugs (cont’d)
Ergot alkaloids
ergotamine
dihydroergotamine mesylate (D.H.E. 45) (Migranal)
ergotamine tartrate with caffeine (Cafergot)
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16. Classroom Response Question
Prior to administering a serotonin agonist, it is most important for the nurse to assess the patient for a history of
hypertension.
allergy to penicillin.
chronic bronchitis.
cataracts.
Correct answer: A
Rationale: The nurse should complete a thorough cardiac history as well as measurement of blood pressure and pulse rate and rhythm. If a patient has a history of hypertension, there is risk of further increases in blood pressure to dangerous levels with use of these drugs, and thus the need for careful assessment and documentation. In fact, generally these drugs are not prescribed for patients with migraines who also have coronary artery disease unless a thorough cardiac evaluation has been performed.
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Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

17. Mechanism of Action and Drug Effects
Triptans
Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms
Reduce the production of inflammatory neuropeptides
Ergot alkaloids
Narrow or constrict blood vessels in the brain
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Adverse Effects
Triptans
Vasocontstriction
Irritation at injection site
Tingling, flushing
Ergot alkaloids
Nausea and vomiting
Cold or clammy hands and feet
Muscle pain
Dizziness
Others
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Analeptics
Used less frequently
Still used for neonatal apnea
Examples:
doxapram (Dopram)
Methylxanthines, such as aminophylline, theophylline, and caffeine
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Analeptics (cont’d)
doxapram (Dopram)
Treatment of respiratory depression associated with anesthetic drugs and drugs of abuse, COPD-induced hypercapnia
Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug
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Analeptics (cont’d)
Caffeine
Found in:
Over-the-counter drugs
Combination prescription drugs
Foods and beverages
Use with caution in patients with a history of:
Peptic ulcer
Recent myocardial infarction
Dysrhythmias
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Mechanism of Action
Stimulate areas of CNS that control respiration
Methylxanthines
Inhibit phoshodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP)
Caffeine
Antagonizes adenosine receptors
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Adverse Effects
Vagal
Stimulation of gastric secretions, diarrhea, and reflex tachycardia
Vasomotor
Flushing, sweating
Respiratory
Elevated respiratory rate
Musculoskeletal
Muscular tension and tremors
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Nursing Implications
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
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25. Nursing Implications (cont’d)
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
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26. Classroom Response Question
A patient is prescribed an anorexiant. Which statement will the nurse include in patient teaching?
“Take the medication with your evening meal.”
“You will need to take this drug for at least 2 years.”
“If you develop a dry mouth, stop taking the drug immediately.”
“Avoid intake of caffeine.”
Correct answer: D
Rationale: Caffeine in any form must be avoided by patients taking anorexiants. These medications should be taken in the morning to prevent interference with sleep. The drugs are taken on a short-term basis. Dry mouth frequently develops and can be managed by sucking ice chips and keeping a bottle of water nearby at all times. These drugs should not be abruptly stopped as a rebound increase of appetite may develop.
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Elsevier items and derived items © 2009, 2005, 2001 by Saunders, an imprint of Elsevier Inc.

27. Nursing Implications (cont’d)
Anorexiants
Follow instructions for diet and exercise
Take in the morning
Avoid caffeine
Fat-soluble vitamin supplementation may be needed
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28. Nursing Implications (cont’d)
SSRAs
Dissolvable wafers, nasal spray, and self-injectable forms
Provide specific teaching about correct administration
Instruct patients to keep a journal to monitor response to therapy
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29. Nursing Implications (cont’d)
Ergot alkaloids
Chest pain, confusion, slurred speech, vision changes need immediate medical attention
Analeptics
Pay close attention to ABCs because of patient’s diminished sensorium
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30. Nursing Implications (cont’d)
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
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