1. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CHAPTER 16 Central Nervous System Stimulants and Related Drugs

2. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Stimulants  Drugs that stimulate a specific area of the brain or spinal cord  Sympathomimetic drugs

3. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Classification According to:  Structural similarities or  Site of therapeutic action in the central nervous system (CNS) or  Major therapeutic usages

4. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CNS Stimulants Used as  Analeptics (CNS stimulants)  Appetite suppressants (anorexiant)  Treatment of  Attention deficit hyperactivity disorder (ADHD)  Narcolepsy  Migraine headaches

5. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Mechanism of Action  Mechanisms of action and effects vary according to drug used  Effects are often dose related

6. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications  Analeptics  Reversal of anesthesia-induced respiratory depression  Anorexiants  Thought to suppress the appetite control center in the brain  ADHD  Stimulate the areas in the brain responsible for mental alertness and attentiveness

7. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Indications (cont'd)  Narcolepsy  Increase mental alertness  Migraine headaches  Caffeine, co-administered with other drugs, used to treat headaches

8. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. 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

9. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CNS Stimulant Drugs ADHD  amphetamine (Adderall, others)  methylphenidate (Concerta, Ritalin)  atomoxetine (Strattera) Narcolepsy  modafinil (Provigil)

10. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CNS Stimulant Drugs (cont’d) Anorexiants  sibutramine (Meridia)  phentermine (Ionamin)  orlistat (Xenical)  Lipase inhibitor, not a CNS stimulant  Also used to treat obesity

11. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CNS Stimulant Drugs (cont’d) Antimigraine (serotonin agonists)  almotriptan (Axert)  eletriptan (Relpax)  frovatriptan (Frova)  naratriptan (Amerge)  rizatriptan (Maxalt)  sumatriptan (Imitrex)  zolmitriptan (Zomig)

12. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. CNS Stimulant Drugs (cont’d) Analeptics  This use is now less frequent  Still used for neonatal apnea  doxapram (Dopram)  Methylxanthines, such as aminophylline, theophylline, and caffeine

13. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Caffeine  Found in:  OTC drugs  Combination prescription drugs  Foods  Use with caution in patients with history of:  Peptic ulcer  Recent myocardial infarction  Dysrhythmias

14. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Caffeine (cont’d)  Many uses  Neonatal apnea  Respiratory depression in adults  Enhance effects of analgesics and migraine medications  CNS stimulation (No-Doze, Vivarin)

15. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc.

16. 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

17. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Drugs for ADHD  Should be given at least 6 hours before bedtime to reduce problems from insomnia  May cause dry mouth; frequent oral care is needed  Take on an empty stomach, 30-45 minutes before meals  Drug “holidays” may be ordered  Parents should keep a journal to note child’s response to therapy

18. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  With orlistat:  Follow instructions for diet and exercise  Adverse effects may be reduced if dietary fat is limited to 30% of total intake  Take with meals that contain fat  Fat-soluble vitamin supplementation may be needed

19. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Serotonin agonist  Dissolvable wafers, nasal spray, and self- injectable forms  Provide specific teaching about correct administration  Foods containing tyramine should be avoided  Patients should keep a journal to monitor response to therapy

20. Mosby items and derived items © 2007, 2005, 2002 by Mosby, Inc., an affiliate of Elsevier Inc. Nursing Implications (cont’d)  Monitor for therapeutic responses  Monitor for adverse effects