CNS stimulants

1. Chapter 13
Central Nervous System
Stimulants and Related Drugs
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

2.  Drugs that stimulate a specific area of the brain
or spinal cord
 Sympathomimetic drugs
CNS Stimulants
2
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

3.  Classified according to:
 Chemical structural similarities
or
 Site of therapeutic action in the central nervous
system (CNS)
or
 Major therapeutic uses (attention deficit hyperactivity
disorder [ADHD], narcolepsy, obesity, migraine, and
respiratory depression syndromes)
Classification
3
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

4.  ADHD
 amphetamine (Dexedrine, Adderall)
 methylphenidate (Concerta, Ritalin, Metadate CD)
 atomoxetine (Strattera)
• Nonaddictive
• May cause suicidal thinking and behavior
 lisdexamfetamine (Vyvanse)
• Prodrug for dextroamphetamine
Drugs for ADHD and Narcolepsy
4
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

5. Drugs for ADHD and Narcolepsy
(cont’d)
 Narcolepsy
 modafinil (Provigil)
 armodafinil (Nuvigil)
5
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

6.  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
Mechanism of Action
and Drug Effects
6
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

7. Mechanism of Action
and Drug Effects (cont’d)
 Respiratory effects
 Relaxation of bronchial smooth muscle
 Increased respiration
 Dilation of pulmonary arteries
7
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

8.  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
Adverse Effects
8
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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?
A. Strattera is highly addictive.
B. Psychotherapy is rarely helpful in cases of ADHD.
C. The patient should be monitored for possible suicidal
thoughts and behavior.
D. Strattera is used to treat narcolepsy as well as ADHD.
9
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

10.  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
Anorexiants
10
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

11.  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
Mechanism of Action
11
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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?
A. Restrict dietary intake of fat
B. Restrict dietary intake of fiber
C. Increase intake of dairy products
D. Avoid intake of carbonated beverages
12
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

13. Adverse Effects
 Possible elevated blood pressure and heart
palpitations
 Anxiety
 Agitation
 Dizziness
 Headache
13
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

14.  Antimigraine (serotonin agonists; also called triptans)
 almotriptan (Axert)
 eletriptan (Relpax)
 frovatriptan (Frova)
 naratriptan (Amerge)
 rizatriptan (Maxalt)
 sumatriptan (Imitrex)
 zolmitriptan (Zomig)
Antimigraine Drugs
14
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

15.  Ergot alkaloids
 ergotamine
 dihydroergotamine mesylate (D.H.E. 45) (Migranal)
 ergotamine tartrate with caffeine (Cafergot)
Antimigraine Drugs (cont’d)
15
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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
A. hypertension.
B. allergy to penicillin.
C. chronic bronchitis.
D. cataracts.
16
Copyright © 2014 by Mosby, 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
17
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

18.  Triptans
 Vasocontstriction
 Irritation at injection site
 Tingling, flushing
 Ergot alkaloids
 Nausea and vomiting
 Cold or clammy hands and feet
 Muscle pain
 Dizziness
 Others
Adverse Effects
18
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

19.  Used less frequently
 Still used for neonatal apnea
 Examples:
 doxapram (Dopram)
 Methylxanthines, such as aminophylline, theophylline,
and caffeine
Analeptics
19
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

20.  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
Analeptics (cont’d)
20
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

21.  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
Analeptics (cont’d)
21
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

22. 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
22
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

23. Adverse Effects
 Vagal
 Stimulation of gastric secretions, diarrhea, and reflex
tachycardia
 Vasomotor
 Flushing, sweating
 Respiratory
 Elevated respiratory rate
 Musculoskeletal
 Muscular tension and tremors
23
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

24.  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
Nursing Implications
24
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

25.  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
Nursing Implications (cont’d)
25
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

26. Classroom Response Question
A patient is prescribed an anorexiant. Which statement will
the nurse include in patient teaching?
A. “Take the medication with your evening meal.”
B. “You will need to take this drug for at least 2 years.”
C. “If you develop a dry mouth, stop taking the drug
immediately.”
D. “Avoid intake of caffeine.”
26
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

27.  Anorexiants
 Follow instructions for diet and exercise
 Take in the morning
 Avoid caffeine
 Fat-soluble vitamin supplementation may be needed
Nursing Implications (cont’d)
27
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

28.  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
Nursing Implications (cont’d)
28
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

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
29
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.

30.  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
Nursing Implications (cont’d)
30
Copyright © 2014 by Mosby, an imprint of Elsevier Inc.