Stimulants and Anxiety

Analeptic Actions

Increase depth of respirations by stimulating special receptors in the carotid arteries and aorta called chemoreceptors Chemoreceptors are sensitive to the arterial O² level...like built in oximetry A restorative drug used to combat resp. depression Also treats narcolepsy.

dextroamphetamine is used for...

ADHD

Generalized anxiety disorder:

chronic anxiety with exaggerated worry and tension

Drug for isolated episodes of intense anxiety

clonazepam (Klonopin)

Preanesthetic sedatives, muscle relaxants

diazepam (Valium), hydroxyzine (Vistaril), lorazepam (Ativan)

flumazenil

ANTIDOTE

dextroamphetamine

Adderall (ADHD)

CNS Stimulants- Uses

-ADHD -Drug-induced respiratory depression -Post anesthesia respiratory depression without the reversal of anesthesia (as would occur with opioid antagonist) -Narcolepsy -Obstructive Sleep apnea -Exogenous obesity -Fatigue (caffeine)

Drugs for temporary use for those with severe functional impairment

Alprazolam (Xanax), diazepam (Valium), buspirone (Buspar)...

Caffeine

An analeptic that stimulates the CNS at all levels and has mild diuretic activity. Causes Cardiac Stimulation. Increasing use in the neonatal setting for therapeutic stimulation of neonates

What type of medication for ADHD?

Analeptic

What drug class is used to restore resp. drive?

Analeptics

phentermine

Anorexiant to treat obesity

ADHD Meds should be taken how many minutes before meals?

30-45

diazepam

BENZO (Anxiety)

Chlordiazepoxide

BENZO (Anxiety, alcohol withdraw)

Antianxiety drugs or anxiolytics

Benzos and nonbenzos

Amphetamines work for ADHD by:

Blocking the reuptake of norepinephrine and dopamine- lessening the action of other neurotransmitters. THIS FOCUSES CONCENTRATION AND ATTENTION.

While administering meds for obesity...

Blood pressure, pulse, resp. before each outpatient visit.

Anxioletics is another name when...

referring to antianxiety meds

Do not administer CNS Stimulants to patients with...

cardiac disorders, severe hypertension, or hyperthyroidism.

A client's medication history includes a long-term prescription for modafinil. Which assessment question should the nurse ask to confirm why the medication was prescribed?

"Have you ever been diagnosed with narcolepsy?"

lorazepam

(Ativan) Anxiety

buspirone

(Buspar) Non Benzo- Short term anxiety

alprazolam

(Xanax) BENZO (Anxiety)

Antianxiety ongoing assessment

Check blood pressure before drug administration If systolic pressure has decreased equal to or more than 20 mm Hg, HOLD the drug—at increased risk for falls/syncopal episode. Notify provider At risk for ataxia with use Periodically monitor mental status and anxiety level Use numeric quantifier Ask patient or family about adverse effects of drug Document general summary of patient's outward behavior, complaints, or problems

Good to know about Amphetamines

Contraindicated in glaucoma Do not take amphetamines and anorexiants concurrently Do not take amphetamines within 14 days of an antidepressant

Modafinil (wakefulness drug) interaction with Oral Contraceptives

Decreased effectiveness of oral contraceptive

methamphetamine

Desoxyn (ADHD, Obesity)

How often should you check vitals when giving CNS stimulants?

Every 6-8 hours. More often if tachycardia, HTN, or palpations occur.

Drugs that are Nonbenzodiazepines

Examples are buspirone (Buspar an anxiolytic), doxepin (an antidepressant), and hydroxyzine (Vistaril, an antihistamine)

Neuromuscular Adverse Reactions of CNS Stimulants

Excessive CNS stimulation Headache Dizziness Apprehension Disorientation Hyperactivity

Kava

Herbal antianxiety. Can cause liver damage.

CNS stimulants contraindicated:

In patients with known hypersensitivity, convulsive disorders, ventilation mechanism disorders (COPD), Cardiac problems, severe hypertension, hyperthyroidism Not recommended for treatment of depression

While for administering meds for resp. depression

Initial assessments: blood pressure, pulse, respiratory rate. Review recent laboratory test results—Ensure a patent airway

Should people with convulsive disorders and ventilation (COPD) disorders take CNS Stimulants?

It is contraindicated.

Other adverse body system reactions of antianxiety drugs

Lethargy, apathy, fatigue Disorientation, anger, restlessness (paradoxical) Nausea, constipation or diarrhea, dry mouth Visual disturbances

Antianxiety drugs are used cautiously with elderly patients (greater chance of dementia) and in patients with impaired:

Liver function Kidney function Debilitation

atomexetine (Strattera) for ADHD

Monitor closely for suicidal thoughts. Teach families how to talk to and observe their children. Change in behavior may be a warning sign.

Other Adverse Reactions of CNS Stimulants

Nausea Vomiting Cough Dyspnea Urinary retention Tachycardia Palpitations

Can you stop benzos abruptly?

No. You must taper down to prevent withdraw.

hydroxyzine

Non Benzo- Anxiety- Used as a histamine

doxepin

Non Benzo- Treats anxiety and depression

Anxiety Preadministration assessment

Nurse obtains medical history, mental status, anxiety level (subjective—use numeric scale to quantify) before initiating therapy Physical assessment, physiologic manifestations of anxiety Physical assessment should include B/P, pulse, RR, and weight Ask about past/current drug or alcohol use Coping mechanisms

armodafinil

Nuvigil (Narcolepsy)

Prior to administering a CNS stimulant to reverse respiratory depression, which would the nurse need to ensure about the client?

Patent airway

Benzodiazepine toxicity may occur:

Presents as sedation, respiratory depression, coma Rare if meds are used correctly

modafinil brand name

Provigil

modafinil

Provigil (Narcolepsy)

Use CNS stimulants with caution in:

Respiratory illness Renal and/or hepatic impairment History of substance abuse Pregnant or lactating women

methylphenidate

Ritalin (ADHD)

Anorexiants

Similar to amphetamines Act on serotonin (releases more) to reduce food consumption and promote a feeling of satiety Act on the appetite center of the hypothalamus

Analeptics

Stimulate the respiratory center of brain and the cardiovascular system—used to treat narcolepsy and as adjuvant treatment for obstructive sleep apnea

Amphetamine Actions

Stimulates the sympathomimetic nerve pathway. Also produces euphoria.

Caffeine Adverse Effects

Tachycardia, dilation of coronary and peripheral blood vessels, constriction of cerebral blood vessels (this is why Excedrin has caffeine for HA), skeletal muscle stimulation

Can pt continue antianxiety med if experiencing mild hypotension and/or dry mouth?

Yes

Anorexiants

Used to suppress the appetite

Amphetamines

Used to treat children with ADHD

While administering ADHD meds...

Weigh patient and take blood pressure, pulse, and respiratory rate. Observe for patterns of abnormal behavior. Chart client's behavior for future comparison.

What pregnancy category are Anorexiants?

X

Drugs that are Benzodiazepines

alprazolam (Xanax), chlordiazepoxide (Librium), diazepam (Valium), and lorazepam (Ativan)

Obesity can be treated with...

anorexiant or amphetamine

Alcohol withdraw peaks...

at 72 hrs

doxapram

causes urinary retention; measure intake and output, notify primary health care provider if patient unable to void or bladder appears distended

Anxiolytic drugs:

block neurotransmitter receptor sites that perceive and react to anxiety

Nonbenzodiazepines:

exert effect in various ways Buspirone: acts on serotonin receptors Hydroxyzine: acts on hypothalamus and brainstem reticular formation useful antianxiety drugs Conditions such as GAD and PTSD are usually treated with antidepressant medications in another chapter.

Benzos during pregnancy, lactating, and labor are category D. It causes...

floppy infant syndrome manifested by sucking difficulties, lethargy, hypotonia in the newborn

Symptoms of benzodiazepine withdrawal:

increased anxiety, concentration difficulties, tremors, and sensory disturbances

Benzodiazepines:

potentiate effects (increase) of gamma-aminobutyric acid (GABA), a inhibitory transmitter long-term use can result in physical dependence or psychological addiction Should be used for short term relief Schedule IV controlled substances

Flumazenil

is the antidote (antagonist) for benzo toxicity and begins to work 6-10 minutes after IV administration Adverse reactions to flumazenil include agitation, confusion, and seizures May cause the patient to enter withdraw In some cases, symptoms of benzodiazepine withdrawal, relieved with administration of benzodiazepine

Buspirone (Buspar)

is the safest choice for geriatric patients because less sedation and decreased risk for falls

Alcohol withdrawal

lorazepam (Ativan), chlordiazepoxide (Librium)

Convulsions or seizures

lorazepam (Ativan), clonazepam (Klonopin)

Early reactions of antianxiety drugs

mild drowsiness or sedation, lightheadedness or dizziness, and headache

What is the central nervous system stimulant of choice to treat narcolepsy?

modafinil

Analeptics used for narcolepsy

modafinil (Provigil) and armodafinil (Nuvigil)

Analeptics used to treat narcolepsy (and sometimes sleep apnea to promote daytime wakefulness)

modafinil (Provigil) and armodafinil (Nuvigil)

After administering analeptic:

monitor respiratory rate and respiration pattern until respirations return to normal Monitor level of consciousness, blood pressure, and pulse rate at 5- to 15-minute intervals or as ordered by primary health care provider Take blood sample for arterial blood gas analysis, to determine effectiveness of analeptic Observe adverse drug reaction; report occurrence immediately to primary health care provider

Gamma-aminobutyric Acid (GABA):

neurotransmitter involved in the regulation of sleep and anxiety

Long-term use of benzos:

results in physical drug dependence and tolerance. Withdrawal symptoms may occur after as few as 4 to 6 months of therapy with benzodiazepines and are likely after 3 months of use Acute w/d symptoms can last 5-28 days with peak intensity in the second week

The nurse has learned that there is a high incidence of suicidal ideation in children and adolescents when using which of the following drugs?

strattera

Amphetamines:

used for short-term treatment of exogenous obesity (calorie intake exceeds the needs of the body), though use declining Long-term use: causes addiction and abuse

Stimulants for treatment of ADHD

used long term and must be monitored very closely Causes loss of appetite and retardation of growth in children—routinely check weight and height May take holiday to determine effectiveness of the medication vs. adverse effects