CNS Stimulants PP Liley Pharm

8/17/2019 CNS Stimulants PP Liley Pharm

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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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+ 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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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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+ 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




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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


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"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



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