Chapter 20 Central Nervous System Stimulants

Which statements are true of methylphenidate?(select all). a. if taken with mono amine oxidase inhibitors it may increase a hypertensive crisis. b. the effects of anticoagulants may increase. c. hyperglycemia may occur d. insulin will be more effective e. there may be increased effects iftaken with caffeineaited bevaerages.

a. if taken with monoamine oxidase inhibitors it may increase a hypertensive crisis. b. the effects of anticouagulants may increase. c. hyperglycemia may occur

The patient has been prescribed methylphenidate for treatment of narcolepsy.what priority teaching considerations should be included for this patient?( select all) a. avoid operating hazardous equipment b. caffeine should be avoided c. nervousness and tremors may occur d. take the medication before meals e. report any weight gain

a.avoid operating hazardous equipment b.caffeine should be avioded c.nervousness and tremors may occur d.take the medication before meals

The patient is being treated with methylphenidate(ritalin) for ADHD. what common side/adverse effects should the patient and family be infromed about? a. euphoria b. headache c. hypertension d. irritability e. orthostatic hypotension f. vomiting

a.euphoria b.headache c.hypertension d.irritability f. vomiting

The pediatric patient had been started on methylphenidate for ADHD. what information should the nurse include in the health teaching? a. constipation is a common side effect. b. counseling should be combined with medication c. this medication will only be used for a few weeks d. weight gain is to be expected

b. counseling should be combined with medication

Anorexiants

Amphetamines once prescribed as anorexiants for short term use(4 to 12 weeks). Due to tolerance, psychological dependence and abuse not anymore. FDA called for removal of Phenylproanolamine in OTC cold and weight loss meds. Increased risk of hemorrhagic stroke in young women and 16 times greater risk in women who take as appetite suppressants. Phenylproanolamine might cause renal failure, psychosis, HTN, and arrhythmia. Topical use has no systemic effects. Most anorexiants do not have serious side effects. Emphasis on Proper diet, exercise and behavior modification, not just meds. Taken under care of health care provider

ADHD Pathophysiology

-might be causes by a dysregulation of the transmitter serotinin , dopamine and nor-epinephrine. - occurs usually before the age of 7 years, and continues into the teenage years. - three to seven times more common in boys than girls

Methylphenidate (Ritalin) should not be taken by patients with a history of which condition? a.Renal failure b.Cataracts c.Hypothyroidism d.Coronary artery disease

Answer: D Rationale: Methylphenidate (Ritalin) is contraindicated in patients who have a history of heart disease, hypertension, hyperthyroidism, parkinsonism, or glaucoma.

A child has been diagnosed with attention deficit/hyperactivity disorder (ADHD). Which drug does the nurse anticipate the health care provider will prescribe? a. Zolmitriptan (Zomig) b .Doxapram HCl (Dopram) c. Benzphetamine HCl (Didrex) d. Methylphenidate HCl (Ritalin)

Answer: D Rationale: Methylphenidate is most commonly used to treat ADHD. Zolmitriptan is used to treat migraines; doxapram is used as a respiratory stimulant, and benzphetamine is an anorexiant.

Patient teaching for methylphenidate (ritalin)

Teach patient to take drug before meals, advise patient to avoid alcohol especially Jack Daniels Encourage use of sugarless gum to relieve dry mouth. Teach patient to monitor weight twice a week and report weight loss. Advise patient to avoid driving and using hazardous equipment when experiencing tremors, nervousness, increases heart rate. Teach patient to taper off the drug to avoid withdrawal. Encourage patients to read labels on OTC products, many may contain caffeine which could be fatal. Teach nursing mothers to avoid taking all CNS stimulants because they are passed through the breast milk. Direct family to counsel children on ADHD. Long term use may lead to drug abuse.

Your done with this chapter! Congrats! Now go take a break.

And eat pizza

Amphetamines side effects

Anorexia, vomiting, diarrhea, insomnia, dizziness, nervousness, headache, abdominal pain, tremors.

CNS stimulants are absolutely contraindicated for patients with a history of which conditions? (select all) a. coronary artery disease b. diabetes c. hypothroidism d. hypertension e. liver failure

a. coronary artery disease d. hypertension e. liver failure

Which drug groups acts on the brainstem and medulla to stimulate respiration? a. amphetamine b. analeptic c. anorexiant d. triptan

b.analeptic

The patient has a history of migraines, depression, and hypertension and has been started on phentermine-topiramate(qsymia). for which condition is phentermine-topiramate used? a. ADHD b. Asthma c. Narcolepsy d. Short-term weight management

d. Short-term weight management

Narcolespy

falling asleep during normal waking activities such as driving a car or talking with someone.

Adverse effects of Anorexiants

heart palpitations, hypertension

Analeptic SE

Nervousness, restlessness, twitching, tremors and insomnia

SE of Doxapram

infrequent; however, with an overdose, hypertension, tachycardia, tremors, spasticity, and hyperactive reflexes may occur.

ADHD characteristics

intattentivness, inability to concentrate, restlessness ( fidgety), hyperactivity (excessive and purposeless activity) inablity to complete tasks, and implusivity

Doxapram (Dopram) (Respiratory stimulant)

is used to treat respiratory depression caused by drug overdose, pre- and postanesthetic respiratory depression, and COPD.

Analeptic Adverse

Diuresis, Gi irritation, palpitations, Tinnitus. More than 300mg- Arrhythmia and convulsions. Half-life is approximately 5 hours, prolonged in patients with liver disease, taking oral birth control and pregnant women.

The nurse is teaching a patient to self-administer medications. The nurse knows that which drug is used to treat narcolepsy? A. Modafinil B. Atomoxetine C. Lisdexamfetamine D. Methylphenidate

A. Modafinil

What would indicate to the nurse that the child taking methylphenidate requires more teaching? a. The child is seen drinking a cola product. b. The child checks his weight twice a week. c. The child takes the drug 45 minutes before a meal. d. The child takes the drug before breakfast and lunch.

Answer: A Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should be checked twice a week for weight loss. The drug should be taken 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping.

A patient has been ordered a transdermal patch of methylphenidate (Ritalin). The nurse teaches the family to leave the patch on for how long? a. 2 hours b. 9 hours c. 2 hours d. 24 hours

Answer: B Rationale: Transdermal methylphenidate (Ritalin) transdermal patches are worn for 9 hours.

When providing teaching to a group of parents regarding attention deficit/ hyperactivity disorder (ADHD), which information will the nurse include? a. Children with ADHD have low intelligence. b. Children with ADHD have an infection in their spinal fluid. c. EEG results are typically normal in children with ADHD. d. Learning disabilities are often present in the child who has ADHD.

Answer: D Rationale: Intelligence is usually not affected by ADHD. The CSF of children with ADHD is not affected. Children with ADHD often have learning disabilities. Children with ADHD often have abnormal EEG studies.

A newborn patient is in respiratory distress. The nurse anticipates preparation for which medication to be given? A. Modafinil B. Armodafinil C. Theophylline D. Amphetamine

C. Theophylline

The nurse monitoring a patient for methylphenidate withdrawal should observe the patient for which condition? A. Tremors B. Insomnia C. Weakness D. Tachycardia

C. Weakness

Analeptics

CNS stimulants. Mostly brain stem and spinal cord, possibly cerebral cortex. Primary use- stimulate respiration. Subgroup-Xanthines(Methylxanthines). Caffeine and Theophylline main drugs. Caffeine stimulates CNS and large doses respiration. Theophylline relaxes bronchioles.

SE of Anorexiants

Contraindicated in children under 12 years of age. long term use results in nervousness, restlessness, irritability, insomnia, heart palpitations, ypertension

Several children are admitted for diagnosis with possible ADHD. Which is the most important for the nurse to observe? A. A girl who is lethargic B. A girl who lacks impulsivity C. A boy with smooth coordination D. A boy with an inability to complete tasks

D. A boy with an inability to complete tasks

When a 12 year old is prescribed methylphenidate, which is most important for the nurse to monitor? A. Temperature B. Respirations C. Intake and Output D. Height and Weight

D. Height and Weight

Nursing interventions for methylphenidate (ritalin)

Monitor vital signs, evaluate height, weight, and growth of children, observe patient for withdrawal symptoms( nausea, vomiting, weakness, headaches). Monitor patients for side effects (insomnia, restlessness, nervousness, tremors, irritability, tachycardia, elevated BP).

Amphetamines

Release norepinephrine and dopamine from the brain and SNS (peripheral nerve terminals). Cause euphoria and alertness, but can cause sleeplessness, restlessness, tremors and irritability.

Amphetamines adverse effects

Tachycardia, hypertension, growth suppression, palpitations, seizures, exfoliative dermatitis, stroke, thrombocytopenia, hepatotoxicity.

Amphetamines commonly prescribed for.

They are commonly prescribed for narcolepsy and in some cases for ADHD, when amphetamine like drugs are ineffective. Adderall is commonly used for ADHD. Dextroamphetamine and methamphetamine may also prescribed for ADHD.

Which medical conditions are CNS stimulants approved to treat? (select all) a. attention deficit/hyperactivity disorder b. anorexia c. narcolepsy d. obesity e. posttraumatic stress disorder

a. attention deficit/hyperactivity disorder c. narcolepsy d. obesity

The patient is born at 28 weeks gestation and is scheduled to receive caffeine citrate 20 mg IV shortly after birth. the patient's mother asks "why are you giving my baby stuff that is in coffee?" What is the nurses best response? a. caffeine can help your baby breathe better b. it will help your baby gain weight faster c. the baby's temperature will be warmer with caffeine. d. this isn't the same substance that is in coffee

a. caffeine can help your baby breathe better

The patient has been prescribed methylphenidate for narcolepsy. the patient also has migraines and takes amitriptyline as a preventive. what should the nurse advise the patient to do before starting the new medication? a. contact your primary helath care provider to verify compatiblity. b. have baseline lab work drawn to assess liver fucntion c. immediately stop taking the amitriptyline d. increase fluid intake with the next meal

a. contact your primary helath care provider to verify compatiblity.

To maintain the half-life of methylphenidate(ritalin) how often should the medication be taken? a. daily b. twice per day c. three times per day d. every other day

b.twice per day

The 18-year old patient is brought into the emergency room by her roommates. Her blood pressure is 220/136 ,heart rate 142 beats per minute and a respiratory rate 20 breaths per minute. She is only responsive to deep pain. Her roommates say she has been trying to lose weight and has been taking these pills she gets over the internet. What will the nurse consider as the most likely cause for this patient's symptoms? a. cardiac arrest b. food posioning c. hemorrhagic stroke d. pregnancy-induced hypertension

c. hemorrhagic stroke

A new nurse is admitting a patient who has received doxapam(dopram). the nurse recongnizes that this is which type of medication? a. inahled respiratory atimulant b. Narcotic antagonist c. post-anesthethic respiratory stimulant d. long-acting narcotic

c. postanesthethic respiratory stimulant