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Chapter 13
Central Nervous System
Stimulants and Related Drugs
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Drugs that stimulate a spe$i!i$ area o! the brain
or spinal $ord
Sympathomimeti$ drugs
CNS Stimulants
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Classi!ied a$$ording to& Chemi$al stru$tural similarities
or Site o! therapeuti$ a$tion in the $entral nervous
system 'CNS(
or
Ma)or therapeuti$ uses 'attention de!i$it hypera$tivitydisorder *+D,D- nar$olepsy obesity migraine and
respiratory depression syndromes(
Classi!i$ation
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+D,D amphetamine 'De.edrine +dderall(
methylphenidate 'Con$erta Ritalin Metadate CD(
atomo.etine 'Strattera(
/ Nonaddi$tive
/ May $ause sui$idal thining and behavior
lisde.am!etamine 'yvanse(
/ rodrug !or de.troamphetamine
Drugs !or +D,D and Nar$olepsy
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Drugs !or +D,D and Nar$olepsy
'$ontd( Nar$olepsy
moda!inil 'rovigil(
armoda!inil 'Nuvigil(
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+mphetamines Stimulate areas o! the brain asso$iated 5ith mental
alertness
CNS e!!e$ts Mood elevation or euphoria
#n$reased mental alertness and $apa$ity !or 5or
De$reased !atigue and dro5siness rolonged 5ae!ulness
Me$hanism o! +$tion
and Drug "!!e$ts
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Me$hanism o! +$tion
and Drug "!!e$ts '$ontd( Respiratory e!!e$ts
Rela.ation o! bron$hial smooth mus$le
#n$reased respiration
Dilation o! pulmonary arteries
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8ide range dose9related
:end to ;speed up< body systems
Common adverse e!!e$ts in$lude& alpitations ta$hy$ardia hypertension angina
dysrhythmias nervousness restlessness an.iety
insomnia nausea vomiting diarrhea dry mouth
in$reased urinary !re=uen$y others
+dverse "!!e$ts
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Classroom Response ?uestion
+ teenaged boy 5ill be re$eiving atomo.etine 'Strattera( as
part o! treatment !or attention de!i$it hypera$tivity disorder
'+D,D(% 8hi$h statement about this drug therapy is
a$$urate@
+% Strattera is highly addi$tive%
A% sy$hotherapy is rarely help!ul in $ases o! +D,D%
C% :he patient should be monitored !or possible sui$idalthoughts and behavior%
D% Strattera is used to treat nar$olepsy as 5ell as +D,D%
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sed to treat obesity
+nore.iants benphetamine 'Didre.(
methamphetamine 'Deso.yn(
phentermine '#onamin(
orlistat 'Eeni$al(
/ Fipase inhibitor not a CNS stimulant/ +lso used to treat obesity
/ May $ause !e$al in$ontinen$e
+nore.iants
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Suppress appetite $ontrol $enters in the brain
#n$rease the bodys basal metaboli$ rate
Mobiliation o! adipose tissue stores
"nhan$ed $ellular glu$ose uptae
Redu$e dietary !at absorption
Me$hanism o! +$tion
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Classroom Response ?uestion
+ patient 5ants to tae orlistat 'Eeni$al( to assist in her
5eight loss program but she is 5ary o! its unpleasant
adverse e!!e$ts% 8hat measure $an be suggested to
redu$e these e!!e$ts@
+% Restri$t dietary intae o! !at
A% Restri$t dietary intae o! !iber
C% #n$rease intae o! dairy produ$tsD% +void intae o! $arbonated beverages
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+dverse "!!e$ts
ossible elevated blood pressure and heart
palpitations
+n.iety
+gitation Diiness
,eada$he
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+ntimigraine 'serotonin agonistsG also $alled triptans( almotriptan '+.ert(
eletriptan 'Relpa.(
!rovatriptan 'Hrova( naratriptan '+merge(
riatriptan 'Ma.alt(
sumatriptan '#mitre.(
olmitriptan 'Iomig(
+ntimigraine Drugs
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"rgot alaloids ergotamine
dihydroergotamine mesylate 'D%,%"% 4( 'Migranal(
ergotamine tartrate 5ith $a!!eine 'Ca!ergot(
+ntimigraine Drugs '$ontd(
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Classroom Response ?uestion
rior to administering a serotonin agonist it is most
important !or the nurse to assess the patient !or a history o!
+% hypertension%A% allergy to peni$illin%
C% $hroni$ bron$hitis%
D% $atara$ts%
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Me$hanism o! +$tion and Drug
"!!e$ts :riptans
Stimulate 9,: re$eptors in $erebral arteries $ausing
vaso$onstri$tion and redu$ing heada$he symptoms
Redu$e the produ$tion o! in!lammatory neuropeptides "rgot alaloids
Narro5 or $onstri$t blood vessels in the brain
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:riptans aso$ontstri$tion
#rritation at in)e$tion site
:ingling !lushing "rgot alaloids
Nausea and vomiting
Cold or $lammy hands and !eet
Mus$le pain
Diiness
Jthers
+dverse "!!e$ts
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sed less !re=uently
Still used !or neonatal apnea
".amples& do.apram 'Dopram( Methyl.anthines su$h as aminophylline theophylline
and $a!!eine
+nalepti$s
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do.apram 'Dopram( :reatment o! respiratory depression asso$iated 5ith
anestheti$ drugs and drugs o! abuse CJD9indu$ed
hyper$apnia Monitor deep tendon re!le.es in addition to vital signs
and heart rhythm to prevent overdosage o! this drug
+nalepti$s '$ontd(
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Ca!!eine Hound in&
/ Jver9the9$ounter drugs
/ Combination pres$ription drugs/ Hoods and beverages
se 5ith $aution in patients 5ith a history o!&
/ epti$ ul$er
/ Re$ent myo$ardial in!ar$tion/ Dysrhythmias
+nalepti$s '$ontd(
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Me$hanism o! +$tion
Stimulate areas o! CNS that $ontrol respiration
Methyl.anthines #nhibit phoshodiesterase leading to buildup o! $y$li$
adenosine monophosphate '$+M( Ca!!eine
+ntagonies adenosine re$eptors
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+dverse "!!e$ts
agal Stimulation o! gastri$ se$retions diarrhea and re!le.
ta$hy$ardia
asomotor Hlushing s5eating
Respiratory "levated respiratory rate
Mus$uloseletal Mus$ular tension and tremors
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+ssess !or& otential $ontraindi$ations
otential intera$tions in$luding herbal therapies
Conditions su$h as abnormal $ardia$ rhythms
seiures palpitations liver problems
Hor $hildren assess baseline height and 5eight
Nursing #mpli$ations
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Drugs !or +D,D Fast daily dose should be given 4 to 6 hours be!ore bedtime to
redu$e insomnia
:ae on an empty stoma$h 30 to 4 minutes be!ore meals
Drug ;holidays< may be ordered
#nstru$t parents to eep a )ournal to monitor $hilds response to
therapy
Monitor $hild !or $ontinued physi$al gro5th in$luding height and
5eight
Nursing #mpli$ations '$ontd(
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Classroom Response ?uestion
+ patient is pres$ribed an anore.iant% 8hi$h statement 5ill
the nurse in$lude in patient tea$hing@
+% ;:ae the medi$ation 5ith your evening meal%<A% ;Kou 5ill need to tae this drug !or at least 2 years%<
C% ;#! you develop a dry mouth stop taing the drug
immediately%<
D% ;+void intae o! $a!!eine%<
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+nore.iants Hollo5 instru$tions !or diet and e.er$ise
:ae in the morning
+void $a!!eine
Hat9soluble vitamin supplementation may be needed
Nursing #mpli$ations '$ontd(
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SSR+s Dissolvable 5a!ers nasal spray and sel!9in)e$table
!orms
rovide spe$i!i$ tea$hing about $orre$t administration #nstru$t patients to eep a )ournal to monitor response
to therapy
Nursing #mpli$ations '$ontd(
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Nursing #mpli$ations '$ontd(
"rgot alaloids Chest pain $on!usion slurred spee$h vision $hanges
need immediate medi$al attention
+nalepti$s ay $lose attention to +ACs be$ause o! patients
diminished sensorium
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Monitor !or therapeuti$ responses +D,D& de$reased hypera$tivity in$reased attention span and
$on$entration
+nore.iant& appetite $ontrol and 5eight loss
Nar$olepsy& de$rease in sleepiness
Serotonin agonist& de$rease in !re=uen$y duration and severity
o! migraines
Monitor !or adverse e!!e$ts
Nursing #mpli$ations '$ontd(
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