1. 1 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Chapter 20 CENTRAL NERVOUS SYSTEM STIMULANTS

2. 2 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. CNS Stimulants  Categories  Amphetamines  Analeptics, caffeine  Anorexiants  Medically approved uses  Attention deficit/hyperactivity disorder (ADHD)  Narcolepsy  Reversal of respiratory distress

3. 3 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Attention Deficit/Hyperactivity Disorder  Pathophysiology  Disregulation of transmitters Serotonin, norepinephrine, dopamine  Epidemiology  Usually occurs in children before age 7  More common in boys  Characteristics  Inattentiveness, inability to concentrate, restlessness, hyperactivity, inability to complete tasks, impulsivity

4. 4 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Narcolepsy  Characteristics  Recurrent attacks of drowsiness and sleep during daytime  Unable to control sleep  Falling asleep while Driving Talking Eating Standing

5. 5 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Amphetamines  Amphetamine (Adderall)  Dextroamphetamine (Dexedrine)  Action  They stimulate release of norepinephrine and dopamine.  Uses  They increase wakefulness in narcolepsy.  They increase attention span, cognition.  They decrease hyperactivity, impulsiveness, restlessness of ADHD.

6. 6 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Amphetamines (cont’d)  Side effects/adverse reactions  Tachycardia, palpitations, dysrhythmias, hypertension  Sleeplessness, restlessness  Irritability  Anorexia, dry mouth, weight loss, diarrhea, constipation  Impotence

7. 7 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Amphetamine-Like Drugs  ADHD  Methylphenidate (Ritalin)  Methamphetamine (Desoxyn)  Narcolepsy  Modafinil (Provigil)  Pemoline (Cylert)

8. 8 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Methylphenidate (Ritalin)  Action  Acts on cerebral cortex, reticular activity system  Uses: ADHD, fatigue, narcolepsy  Interactions  Caffeine may increase effects  Decreased effects of decongestants, antihypertensives, barbiturates  May alter insulin effects

9. 9 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Methylphenidate (Ritalin) (cont’d)  Side effects/adverse reactions  Tachycardia, palpitations, dizziness, hypertension  Sleeplessness, restlessness, nervousness, tremors, irritability  Increased hyperactivity  Anorexia, dry mouth, vomiting, diarrhea, weight loss  Thrombocytopenia

10. 10 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Methylphenidate (Ritalin) (cont’d)  Nursing interventions  Give before breakfast and lunch.  Report irregular heartbeat.  Record height, weight, and growth of children.  Avoid alcohol, caffeine.  Use sugarless gum to relieve dry mouth.  Do not stop abruptly; taper off to avoid withdrawal symptoms.  Counseling must also be used.

11. 11 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Anorexiants  Prescriptive or OTC  Dextroamphetamine (Dexadrine)  Action  Suppress appetite  Use  Obesity  Side effects  Nervousness, restlessness, irritability, insomnia, palpitations, hypertension

12. 12 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Analeptics  Caffeine (coffee, chocolate, cold medications), theophylline, NoDoz  Use  Stimulate respiration in newborns  Side effects  Restlessness, tremors, twitching  Palpitations, insomnia  Tinnitus, nausea, diarrhea  Psychologic dependence

13. 13 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Respiratory CNS Stimulants  Doxapram (Dopram)  Uses  Respiratory depression  Onset of action  20 to 40 seconds, peak within 2 minutes  Side effects  Hypertension, tachycardia, trembling, convulsions

14. 14 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Case Study A school nurse monitors a child who is taking methylphenidate (Ritalin). When the child comes to the nurse to receive her medication, she is drinking a carbonated beverage. Critical Thinking 1. Explain the action of methylphenidate and its uses. 2. What would appropriate monitoring of a child taking methylphenidate include?

15. 15 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #1 Which would indicate to the nurse that the child taking methylphenidate requires more teaching? A.The child drinking a carbonated beverage B.The child checking his weight more frequently C.The child taking the drug 45 minutes before a meal D.The child taking the drug before breakfast and lunch

16. 16 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #1 (cont’d) Answer: A Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.

17. 17 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #2 The nurse would expect the physician to order which drug for the treatment of attention deficit hyperactivity disorder (ADHD) in children? A. Zolmitriptan (Zomig) B. Doxapram HCl (Dopram) C. Benzphetamine HCl (Didrex) D. Methylphenidate HCl (Ritalin)

18. 18 Copyright © 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc. Practice Question #2 (cont’d) Answer: D Rationale: Methylphenidate is most commonly used to treat ADHD. Zolmitriptan is used to treat migraines, doxapram is used as a respiratory stimulant; and benzphetamine is an anorexiant.