Ppt chapter 22

Chapter 22
Drugs Stimulating the Central
Nervous System
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins

Physiology
• The CNS is responsible for providing control systems and
surveillance for many vegetative and conscious functions.
• The control of respiration occurs in the pons and medulla.
• At a synaptic level in the CNS, normal arousal
mechanisms are affected through presynaptic release of
neurotransmitters.
• CNS stimulants may provoke an increased release of
neurotransmitters, a decreased reuptake of
neurotransmitters, or an inhibition of postsynaptic
enzymes.
• The result is a heightened postsynaptic response, leading
to increased arousal.

Regulatory Centers of the Brain

Narcolepsy
• Narcolepsy is characterized by irresistible bouts of rapid
eye movement (REM) sleep during nonsleep cycles.
• Associated features include disturbed nocturnal sleep and
REM sleep disturbances.
• Additional symptom of cataplexy is a brief, sudden loss of
motor control.
• Hypnagogic hallucinations are auditory, visual, or
kinesthetic sensations without stimuli, appearing in the
transition period between wakefulness and sleep.

Attention Deficit Hyperactivity Disorder
• Attention deficit hyperactivity disorder (ADHD) is the
most prevalent chronic health issue affecting school-aged
children.
• It is characterized by a persistent pattern of
inattentiveness, hyperactivity, and impulsivity.
• Current research suggests that ADHD has a biologic
basis.
• The management of ADHD is complex but usually
involves pharmacotherapy with one or more of the CNS
stimulants combined with behavior modification.

Overweight and Obesity
• Obesity has become one of the major health issues in the
United States.
• Overweight refers to an excess of body weight compared
with set standards. The excess weight may come from
muscle, bone, fat, or body water.
• Obesity refers specifically to having an abnormally high
proportion of body fat.
• Weight regulation is multifactorial.
• Treating obesity involves a combination of different
methods, including modifying eating behavior,
implementing and maintaining an exercise program, and
using adjunctive pharmacologic therapy to reduce
appetite.

Respiratory Stimulation
• In patients at risk for postoperative pulmonary
complications, respiratory depression may be a
complication arising from chronic obstructive lung
disease and frequent hypercapnia.
• Hypercapnia is a buildup of carbon dioxide levels that
may result from pulmonary compromise.
• Preterm infants may experience hypercapnia because of
their immature respiratory systems.
• Pharmacologic management of respiratory depression
includes administering CNS stimulants, such as caffeine
and doxapram.

Centrally Acting CNS Stimulants
• The centrally acting CNS stimulants are drugs that
stimulate the CNS directly or indirectly.
• This group of drugs includes the amphetamines,
methylphenidate, pemoline, and cocaine.
• Prototype drug: dextroamphetamine (Dexedrine)

Dextroamphetamine: Core Drug
Knowledge
• Pharmacotherapeutics
– Treatment of narcolepsy, ADHD, and obesity
• Pharmacokinetics
– Administered: oral. Metabolism: liver. Excreted:
kidneys. Onset: 20 to 60 minutes. Duration: 5 hours
• Pharmacodynamics
– The exact mechanism of action is unknown.

Dextroamphetamine: Core Drug
Knowledge (cont.)
• Contraindications and precautions
– Cardiac disease, hyperthyroidism, and
hypersensitivity
• Adverse effects
– Sudden death, stroke, MI, decreased appetite,
rebound irritability, depression, headache, and jittery
feeling
• Drug interactions
– Multiple drug interactions

Dextroamphetamine: Core Patient
Variables
• Health status
– Evaluate for preexisting conditions.
• Life span and gender
– Pregnancy Category C drug
• Lifestyle, diet, and habits
– Assess for consumption of caffeine.
• Environment
– Assess the environment where the drug will be given.
• Culture and inherited traits
– Determine if alternative therapies are used by the
patient.

Dextroamphetamine: Nursing Diagnoses
and Outcomes
• Disturbed Sleep Pattern related to drug effects or caffeine
use
– Desired outcome: The patient maintains normal
sleep patterns through proper use of sleep hygiene
measures and bedtime (hour of sleep [HS]) sedation.
• Delayed Growth and Development related to drug effects
– Desired outcome: The patient maintains a normal
growth and development profile.
• Disturbed Sensory Perception related to drug response
– Desired outcome: The patient remains free from
sensory and perceptual disturbances.

Dextroamphetamine: Nursing Diagnoses
and Outcomes (cont.)
• Imbalanced nutrition: Less than body requirements,
related to amphetamine abuse and anorexia
– Desired outcome: The patient maintains adequate
nutrition.
• Nonadherence to Therapeutic Regimen related to lack of
motivation, poor self-image, or negative effects of the
prescribed drug
– Desired outcome: The patient adheres to the drug
regimen.

Dextroamphetamine: Planning and
Interventions
• Maximizing therapeutic effects
– Administer with food in the morning and no fewer
than 6 hours before bedtime
• Minimizing adverse effects
– Monitor for adverse effects.
– Monitor for rebound irritability and depression.

Dextroamphetamine: Teaching,
Assessment, and Evaluations
• Patient and family education
– Discuss the importance of adherence to dosage
schedule.
– Discuss adverse effects of the drug.
• Ongoing assessment and evaluation
– Monitor periodic growth and development data for
children throughout therapy.
– Monitor for adverse effects.

Question
• Dextroamphetamine has which of the following effects on
glucose levels?
– A. Increased
– B. Decreased

Answer
• A. Increased
• Rationale: Dextroamphetamine can cause increased
serum glucose levels. This is the reason why it is
important for diabetic patients on this medication to
monitor glucose levels more closely.

Anorectic Agents
• Obesity is a complex problem that is very difficult to
treat.
• Although drug therapy is helpful, drugs alone cannot
manage weight loss.
• Diet and exercise are equally important.
• Prototype drug: phentermine (Adipex-P)

Phentermine: Core Drug Knowledge
– Manages obesity by promoting weight loss
– DEA Schedule IV drug
– Administered: oral. Metabolism: liver. Excreted:
kidneys
– Direct stimulation of satiety center in the
hypothalamic and limbic regions

Phentermine: Core Drug Knowledge
(cont.)
– Arteriosclerosis, hypertension, glaucoma, cardiac
arrhythmias
• Adverse effects
– Hypertension, constipation, insomnia, headache, and
dry mouth
– MAOIs and SSRIs

Phentermine: Core Patient Variables
• Health status
– Assess for contraindications to therapy.
– Assess diet and make modifications.
• Environment
– Assess the environment where the drug will be given.

Phentermine: Nursing Diagnoses and
Outcomes
• Imbalanced Nutrition: Less than Body Requirements,
related to anorexia
– Desired outcome: The patient maintains adequate
nutrition.
• Nonadherence to Therapeutic Regimen related to lack of
motivation, poor self-image, or negative effects of
prescribed drug
– Desired outcome: The patient adheres to drug
regimen.

Phentermine: Planning and Interventions
– Take daily.
– Exercise and low-calorie diet are important.
– Refrain from using drugs that may induce serotonin
syndrome or elevate the blood pressure.

Phentermine: Teaching, Assessment, and
Evaluations
– Medication is only one component of weight loss.
– Discuss adverse effects and not taking with other
OTC medication.
– Calculate BMI at each follow-up visit.
– Evaluating the patient routinely is important for
assessing progress.

Question
• The cornerstone of weight loss is
– A. Drug therapy
– B. Exercise
– C. Healthy eating
– D. Both A and B
– E. All of the above

Answer
• E. All of the above
• Rationale: Weight loss is a complex process that is
multifactorial. Diet, exercise, and drug therapy are all
a part of the process.

Respiratory Stimulants
• Respiratory stimulants are used to manage postsurgical
respiratory depression and apnea in preterm neonates.
• Prototype drug: caffeine

Caffeine: Core Drug Knowledge
– Managing neonatal apnea, asthma, drowsiness, and
fatigue
– Administered: oral or IV. Distribution: rapidly
throughout the body; crosses the placenta and
blood–brain barrier
– Direct stimulant at all levels of the CNS, which also
stimulates the cardiovascular system

Caffeine: Core Drug Knowledge (cont.)
– Anxiety disorders, panic disorder, or insomnia
• Adverse effects
– Tremor, sinus tachycardia, heightened attentiveness,
diarrhea, excitement, irritability, and insomnia
– Oral contraceptives, psychostimulants,
sympathomimetic agents, fluoroquinolone antibiotics,
lithium, and MAOIs

Caffeine: Core Patient Variables
• Health status
– Assess for contraindications to drug therapy.
– Limit intake of food and beverages that contain
caffeine.
• Environment
– Administration of IV form to neonates needs to be
done in an environment where the neonate can be
monitored closely.

Caffeine: Nursing Diagnoses and
Outcomes
• Disturbed Sleep Pattern related to insomnia
– Desired outcome: The patient will maintain
adequate sleep and rest cycles.
• Anxiety related to stimulatory effects of caffeine
– Desired outcome: The patient will remain calm
throughout therapy.
• Deficient Fluid Volume related to diuretic effect of
caffeine and potential diarrhea
– Desired outcome: The patient will remain well
hydrated.

Caffeine: Planning and Interventions
– Take medication as directed.
– Do not crush extended-release form of medication.
– Adhere to the contraindications and precautions for
caffeine therapy.
– Limit ingestion of caffeine from food and beverage
sources.

Caffeine: Teaching, Assessment, and
Evaluations
– Convey to the patient that caffeine is a drug and as
such may create serious adverse effects
– Discuss adverse effects of the drug.
– When used for respiratory depression or neonatal
apnea, monitor the patient’s vital signs carefully.
– When administering for migraine headaches, monitor
for potential adverse effects.

Question
• What is the effect of giving caffeine to a patient with panic
disorder?
– A. Improvement of symptoms
– B. Exacerbation of symptoms
– C. No effect on symptoms at all

Answer
• B. Exacerbation of symptoms
• Rationale: Caffeine will cause exacerbation of panic
disorder symptoms due to CNS stimulation.

Ppt chapter 22

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