Pharmacology Chapter 13 Central Nervous System Stimulants and Related Drugs

What is the correct dosage of atomoxetine for an adult patient who weighs 70 kg? 1 100 mg once daily 2 120 mg once daily 3 150 mg once daily 4 200 mg once daily

1 Atomoxetine is to be taken as 40 to 100 mg once or twice daily as prescribed. The dosage of 120 mg, 150 mg, and 200 mg once daily may cause toxicity due to overdosage in an individual with a weight of 70 kg.

Which drug is indicated for the improvement of wakefulness in patients who have excessive daytime sleepiness? 1 Modafinil 2 Sumatriptan 3 Phentermine 4 Atomoxetine

1 Modafinil is a psychostimulant that enhances the memory and brightens the mood. It is indicated for the improvement of wakefulness in patients who have excessive daytime sleepiness. Sumatriptan is a serotonin receptor agonist used in the treatment of acute migraines. Phentermine is a sympathomimetic anorexiant used to treat obesity. Atomoxetine is a selective norepinephrine reuptake inhibitor used in the treatment of attention deficit hyperactivity disorder.

A patient tells the nurse, "I feel sleepy during the daytime and often fall asleep in the middle of activities." Which drug does the nurse expect to be prescribed for the patient? 1 Modafinil 2 Atomoxetine 3 Benzphetamine 4 Methylphenidate

1 Patients who have narcolepsy suddenly fall asleep while doing daily actives, such as driving. The patient may also have cataplexy, which is associated with skeletal muscle weakness. Such patients experience buckling of the knees and may suddenly fall. They also have a tendency to become aggressive. Modafinil should be the prescribed drug for the patient with narcolepsy. The drug is a central nervous system stimulant and improves wakefulness. Atomoxetine is prescribed for attention deficit hyperactivity disorder (ADHD). Benzphetamine is an amphetamine drug prescribed to manage obesity. Methylphenidate is prescribed to children with ADHD, and it may cause substance abuse in the patient.

The nurse is assessing a child with attention deficit hyperactivity disorder (ADHD) who is prescribed amphetamine aspartate. The nurse instructs the parent to give medications 5 to 6 hours before bed. Why did the nurse give this instruction? 1 To prevent insomnia 2 To prevent gastric ulcer 3 To prevent hyperglycemia 4 To prevent nutrition deficiency

1 The child who is diagnosed with ADHD is usually prescribed amphetamine aspartate, which is a stimulant drug that causes alertness and insomnia. Therefore the nurse suggests giving the medication 5 to 6 hours before sleep. Giving the medicine at least 5 to 6 hours before sleep helps reduce the effect of the drug so the child does not stay awake for a longer period. The medication given in ADHD does not show adverse effects on the gastrointestinal system, so there is no risk of gastric ulcer. ADHD medications are usually central nervous system (CNS) stimulants and do not alter the levels of blood glucose. ADHD drugs do not affect the nutritional balance because they are CNS stimulants and affect CNS receptors directly.

An infant with dyspnea is treated with high-pressure mechanical ventilation and develops bronchopulmonary dysplasia. Which medication may be prescribed to minimize breathing difficulty in this infant? 1 Caffeine 2 Morphine 3 Diazepam 4 Phenobarbitone

1 The infant with breathing difficulty can be kept on mechanical ventilation under high pressure. Due to prolonged mechanical ventilation, the infant may develop bronchopulmonary dysplasia and have breathing difficulty. Therefore in order to prevent respiratory depression, analeptic medications, such as caffeine, can be administered to the infant. Morphine, diazepam, and phenobarbitone are central nervous system depressants that may cause respiratory depression. Therefore these should not be administered to the infant.

The nurse is educating a patient who has been prescribed methylphenidate for narcolepsy about the drug's adverse effects. What potential adverse effects would the nurse include in the patient teaching? Select all that apply. 1 Insomnia 2 Headache 3 Weight loss 4 Increased appetite 5 Decreased blood pressure

1, 2, 3 Adverse effects of methylphenidate on the cardiovascular system include increased heart rate and blood pressure. Other adverse effects include angina, anxiety, insomnia, headache, tremor, blurred vision, increased metabolic rate, gastrointestinal distress, dry mouth, and worsening of or new onset of psychiatric disorders, including mania, psychoses, or aggression. Increased appetite is not an adverse effect of methylphenidate.

A patient who has suspected migraine headache is admitted to the hospital. Which signs and symptoms support the diagnosis? Select all that apply. 1 Photophobia 2 Phonophobia 3 Pulsating headache 4 Daytime sleepiness 5 Skeletal muscle weakness

1, 2, 3 Migraine headache is the most common type of headache characterized by avoidance of light (photophobia) and sounds (phonophobia). The headache is pulsating in nature and worsens with every pulse. Daytime sleepiness is a common symptom of narcolepsy. Cataplexy is a symptom associated with narcolepsy. It is characterized by skeletal muscle weakness.

A patient who is obese and has attention deficit hyperactivity disorder (ADHD) has been prescribed phentermine and dexmethylphenidate. Which adverse effects may occur in this patient? Select all that apply. 1 Seizures 2 Insomnia 3 Headache 4 Dysrhythmias 5 Severe hypertension

1, 2, 4 Dexmethylphenidate is a central nervous system (CNS) stimulant currently indicated for ADHD. Phentermine is an anorexiant used to suppress appetite in people who are obese. Phentermine interacts with CNS stimulants and results in additive toxicities like seizures, insomnia, and dysrhythmias. Therefore the most likely adverse effects are seizures, insomnia, and dysrhythmias. Headache and severe hypertension are not the adverse effects associated with the interaction of these two drugs; these are the effects of interactions of phentermine with monoamine oxidase inhibitors.

In which individuals is the use of analeptics contraindicated? Select all that apply. 1 Individuals taking sildenafil 2 Individuals with hypotension 3 Individuals with hypertension 4 Individuals with peptic ulcer disease 5 Individuals taking oral contraceptives

1, 3, 4 Contraindications to the use of analeptics include drug allergy, peptic ulcer disease (especially for caffeine), and serious cardiovascular conditions. Concurrent use of other phosphodiesterase-inhibiting drugs such as sildenafil and similar drugs also is not recommended. Patients with hypotension can generally use analeptics safely with the recommendation of a primary health care provider. Analeptics have no known contraindications for oral contraceptives.

A nurse is assessing a patient who reports a throbbing, pulsating headache that is usually felt on one side of the head. The patient also experiences aura. The patient is given standard therapy based on the symptoms. Which common adverse effect does the nurse anticipate in the patient after the drug therapy? 1 Diarrhea 2 Chest congestion 3 Fecal incontinence 4 Enhanced urinary output

2 A migraine attack is a throbbing, pulsating headache that occurs usually on one side of the head. The patient may also experience aura. Triptan is the standard therapy for a migraine attack. The nurse anticipates that the patient may have chest congestion as a result, as this is the most common adverse effect seen with the use of this triptan. Diarrhea is a common adverse effect of analeptics. Fecal incontinence is a common adverse effect of anorexiants. Enhanced urinary output is a common side effect of caffeine therapy.

The nurse is assessing a patient with diabetes mellitus who has been prescribed insulin therapy. The patient asks the nurse, "How can I reduce my weight? Could you give me a suggestion?" What would be the best response given by the nurse? 1 "You should drink coffee and alcohol once a week to reduce obesity." 2 "You should follow a nutrition and exercise regimen for weight management." 3 "Ask the primary health care provider to prescribe an oral hypoglycemic medication." 4 "Ask the primary health care provider to prescribe an anorexiant because it will reduce obesity."

2 A nutritious diet and regular exercise may facilitate weight loss. Coffee and alcohol do not help with weight loss. Coffee is used to increase alertness and reduce sleep. Treatment with anorexiants, such as monotherapy, is not effective. Most of the oral hypoglycemic agents cause weight gain in the patient, so they do not help in reducing weight.

A nurse working with patients who are diagnosed with attention deficit hyperactivity disorder (ADHD) is aware such patients often take central nervous system (CNS) stimulant drugs. These medications are potent, with a high potential for abuse and dependence. Based on this potential, how are these medications classified? 1 Schedule I 2 Schedule II 3 Schedule III 4 Schedule IV

2 CNS stimulants are the first-line drugs of choice for both ADHD and narcolepsy. They are potent drugs with a strong potential for tolerance and psychological dependence and are therefore classified as Schedule II drugs under the Controlled Substances Act.

Which analeptic may cause gasping syndrome in a newborn? 1 Caffeine 2 Doxapram 3 Theophylline 4 Aminophylline

2 Doxapram is an analeptic that is used as a respiratory stimulant. It is contraindicated for newborns because it causes gasping syndrome as a result of the presence of benzyl alcohol. Caffeine is contraindicated in patients who have a history of peptic ulcers. Theophylline causes a delay gastric emptying, not gasping syndrome, in newborns. Aminophylline is used to treat apnea in newborns and does not cause gasping syndrome.

A patient reports having a pulsating headache on one side for more than 8 hours. The nurse finds that the patient also has nausea and vomiting. Which drug does the nurse expect to be prescribed to the patient to relieve these signs and symptoms? 1 Naproxen 2 Frovatriptan 3 Propranolol 4 Dihydroergotamine

2 Frovatriptan is a selective serotonin reuptake inhibitor (SSRI) useful in treating the acute attack of migraine headaches. Naproxen is a nonsteroidal antiinflammatory drug (NSAID) given as a second-line therapy for chronic migraine headache attacks; it is not prescribed in the case of acute attacks. Propranolol is prescribed to prevent migraine headaches. This drug may not be effective in the treatment of acute attacks. Dihydroergotamine is used as the second-line therapy for preventing recurrent migraine headache attacks.

While assessing a patient who has cholestasis, the nurse finds that the patient is consuming a high-fat diet and has a body mass index (BMI) of 34. What drug will the nurse expect to be prescribed for this patient? 1 Orlistat 2 Phentermine 3 Benzphetamine 4 Methamphetamine

2 Phentermine is the sympathomimetic drug that is similar in structure to amphetamine. It has less abuse potential, so it can be prescribed for obesity. Orlistat is a lipase inhibitor available over the counter. However, the drug is contraindicated in patients with cholestasis. Benzphetamine and methamphetamine are amphetamine derivatives, which are not prescribed for obesity due to their addictive tendencies.

A patient who has a peptic ulcer is diagnosed with chronic obstructive pulmonary disease (COPD). Which drug is contraindicated in the patient? 1 Orlistat 2 Caffeine 3 Sumatriptan 4 Atomoxetine

2 The patient with COPD has a peptic ulcer. Therefore the analeptic drug contraindicated in the patient is caffeine. Orlistat, sumatriptan, and atomoxetine are not used to treat COPD. Orlistat is a drug used to treat obesity. Sumatriptan is a serotonin receptor agonist indicated for acute migraine headache. Atomoxetine is a nonstimulant that is used to treat attention deficit hyperactivity disorder.

Which drugs are indicated as first-line abortive therapy for migraine headaches? Select all that apply. 1 Diazepam 2 Naratriptan 3 Ergotamine 4 Sibutramine 5 Zolmitriptan 6 Atomoxetine

2, 5 Selective serotonin receptor agonists (SSRAs) are the medications most commonly used as abortive therapy for migraine headaches. SSRAs include naratriptan and zolmitriptan. Diazepam, a benzodiazepine, is used to ease anxiety, induce muscle relaxation, and relieve seizures. Ergot alkaloids such as ergotamine are rarely used as abortive therapy and are no longer considered first-line drugs. Sibutramine is an anorexiant, and atomoxetine is used for attention deficit hyperactivity disorder.

A patient weighs 68 kg and is 160 cm tall. What is the body mass index (BMI) of the patient? Record the answer using a whole number. _____

26 BMI is calculated using the formula BMI = weight ÷ height2 where weight is in kilograms (kg) and height is in meters (e). Because the patient weighs 60 kg and is 160 cm tall, the height of the patient in meters is 1.6 because 1 m = 100 cm. Therefore the BMI of the patient is 60 ÷ (1.6) 2= 26.56 = 26.6, rounding off to 26. So, the BMI is between 25 and 29.9, which implies that the patient is overweight.

Which statement correctly identifies the pharmacodynamics of central nervous system (CNS) stimulants? 1 CNS stimulants block the activity of inhibitory neurons. 2 CNS stimulants decrease the production of excitatory neurotransmitters. 3 CNS stimulants increase release of and block reuptake of neurotransmitters. 4 CNS stimulants enhance the effects of phosphodiesterase and subsequent breakdown of cyclic adenosine monophosphate (cAMP).

3 CNS stimulation occurs when the amount of neurotransmitters being released and the duration of action of excitatory neurotransmitters are increased.

A patient is diagnosed with narcolepsy. Which symptom does the nurse expect to find in the patient? 1 Hyperactivity 2 Pulsating headache 3 Skeletal muscle weakness 4 High body mass index (BMI)

3 Cataplexy is a symptom associated with narcolepsy, and is characterized by skeletal muscle weakness. Hyperactivity is not a symptom of narcolepsy. It is seen in attention deficit hyperactivity disorder. Pulsating headache is a symptom of migraine headache. High BMI is not seen in narcolepsy; it is the symptom associated with obesity.

The nurse is assessing a 9-year-old child who has attention deficit hyperactivity disorder (ADHD). On reviewing the patient's medication history, the nurse finds that the primary health care provider (PHP) has replaced dexmethylphenidate with atomoxetine. Why did the PHP replace the medication? 1 Dexmethylphenidate does not improve attention. 2 Dexmethylphenidate induces sedation in the child. 3 Dexmethylphenidate has more addictive properties. 4 Dexmethylphenidate is contraindicated in pediatric patients.

3 Dexmethylphenidate is a d-isomer of methylphenidate. It is a phenidate used in the treatment of ADHD. Unlike atomoxetine, phenidates can lead to substance abuse due to the addictive properties. Therefore to prevent substance abuse, the PHP has replaced dexmethylphenidate with atomoxetine. Atomoxetine is a controlled substance, as it has addictive properties and is used in adult patients with ADHD. Dexmethylphenidate improves attention and is used for the treatment of ADHD, and it is safe to be prescribed for a 9-year-old patient. Dexmethylphenidate causes insomnia due to its stimulant effect, but does not cause sedation.

A patient reports feeling sleepy during the daytime. The patient also experiences severe migraine headaches frequently. Which combination of drugs will the nurse expect the provider to order? 1 Modafinil and doxapram 2 Atomoxetine and orlistat 3 Modafinil and sumatriptan 4 Doxapram and sumatriptan

3 Feeling sleepy during the daytime is a symptom of narcolepsy (sleep attacks). The patient also reports having frequent migraine headaches. Therefore a combination of drugs used to treat narcolepsy and migraine headache would be helpful to treat the patient. The primary health care provider (PHP) has to prescribe modafinil, which is used to treat narcolepsy, along with sumatriptan, which reduces migraine headache. Orlistat is a drug used to treat obesity. So, a combination of orlistat and atomoxetine does not help in treating this patient. Doxapram is an analeptic used to treat drug-induced respiratory depression. Therefore a combination of modafinil and doxapram is not helpful for the patient's condition. Similarly a combination of doxapram and sumatriptan is not useful to treat narcolepsy in the patient.

Which drug should be used with caution with the herbal drug ginseng to prevent possible drug interactions? 1 Aspirin 2 Warfarin 3 Metformin 4 Disulfiram

3 Metformin is an antidiabetic drug that should be used with caution when the herbal drug ginseng is used, as it may cause possible drug interactions. Aspirin may cause complications when it is used along with ginkgo biloba, but not with ginseng. Ginkgo biloba, not ginseng, may affect clotting when taken with warfarin. The use of disulfiram may cause drug interactions when combined with the herbal drug guarana, not ginseng.

The nurse is assessing a patient who is obese. On assessment, the nurse finds that the patient is frequently hungry and tends to eat to satisfy hunger. Which drug would the nurse expect to be prescribed for the patient? 1 Caffeine 2 Almotriptan 3 Phentermine 4 Dextroamphetamine

3 Patients who frequently feel hungry might overeat to satisfy hunger. In order to reduce the appetite, the patient must be given anorexiants, such as phentermine. Caffeine, almotriptan, and dextroamphetamine do not have any anorexiant effects. These drugs may not be useful for the patient. Caffeine may impair the absorption of calcium and cause osteoporosis. Almotriptan and dextroamphetamine are prescribed for the treatment of attention deficit hyperactivity disorder and migraine headache, respectively.

The nurse observes that a patient with a body mass index (BMI) of 38 has a dysrhythmia. Which drug would the nurse expect the primary health care provider (PHP) to prescribe to the patient? 1 Orlistat 2 Phentermine 3 Diethylpropion 4 Amphetamine aspartate

3 The BMI of the patient is 38, which indicates that the patient is obese (BMI above 30). Anorexiants are used to treat obesity by suppressing the appetite. The patient has dysrhythmia, which is a cardiovascular complication. So, the PHP has to prescribe an anorexiant, which has no or little cardiovascular activity. In this case, diethylpropion would be effective in the patient to treat obesity. Orlistat, phentermine, and amphetamine aspartate may increase the patient's blood pressure and even cause dysrhythmia at higher doses. Therefore these drugs cannot be prescribed to the patient. Amphetamine aspartate is an amphetamine salt, which has high abuse potential, so it is no longer used for treating obesity.

A patient who has migraine headaches has been prescribed sumatriptan nasal spray. The nurse demonstrates the use of the nasal spray to the patient. Arrange the order of instructions given by the nurse to the patient during the demonstration. 1. Insert the nozzle into the open nostril. 2. Breathe in through nose and out through mouth. 3. Breathe gently to clear out the nasal passage. 4. Keep your head upright and close a nostril.

3, 4, 1, 2 The patient is first instructed to breathe gently to clear out the nasal passage. This ensures easy passage of the drug during spraying. Positioning the head in an upright position ensures ease in the delivery of the formulation. Then, the patient must close one nostril and keep another nostril open for the insertion of the nozzle. The spray nozzle is inserted into the open nostril. Breathing in through the nose facilitates the absorption of the drug. Then, the patient is instructed to breathe out through the mouth so that the medication is not lost.

The nurse prepares to collect the health history of a patient with narcolepsy. Which strategy should be used to complete this assessment? 1 Provide a structured form for the patient to complete in writing. 2 Seek information from significant others rather than the patient. 3 Use the patient's past medical records to locate important information. 4 Use short, focused interview sessions with active participation by the patient.

4 A patient with narcolepsy will be drowsy or fall asleep easily. To obtain accurate information, the nurse should keep the dialogue short and focused. Narcolepsy is an incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. For this reason, it is difficult for patients to complete a structured form. Seeking information from significant others may not always work. Using the patient's past medical information may be helpful, but few critical factors may be missed if the patient is not interviewed.

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug? 1 Heart block 2 Constipation 3 Myelin degeneration 4 Cardiac dysrhythmias

4 Caffeine stimulates the central nervous system, causing sympathomimetic effects, including cardiac dysrhythmias. It does not cause heart block, constipation, or myelin degeneration.

To reduce the gastrointestinal side effects of orlistat, what will the nurse encourage the patient to do? 1 Increase fluid and fiber in the diet. 2 Take the medication with an antacid. 3 Supplement diet with fat-soluble vitamins. 4 Limit dietary intake of fat to less than 30% of total calories.

4 Orlistat is an anorexiant that works by blocking the absorption of fat from the gastrointestinal tract. Limiting intake of fat reduces the gastrointestinal side effects associated with increased fat content in stool (flatulence, oily spotting, and fecal urgency).

After administering phentermine, which assessment finding would the nurse expect? 1 Syncope 2 Drowsiness 3 Bradycardia 4 Increased blood pressure

4 Phentermine is a central nervous system (CNS) stimulant. It increases blood pressure and heart rate. Other adverse effects of CNS stimulants are anxiety, agitation, dizziness, and headache. Syncope, drowsiness, and bradycardia are not related effects of CNS stimulants.