Pharm. Chapter 13 CNS Stimulants and Related Drugs

The Medication order reads: "Atomoxtine (Strattera) 1.2 mg/kg/day in 2 divided doses". The child weights 66 lbs. How much will be given each dose.

18 mg per dose

Which statement correctly identifies the pharmacodynamics of CNS stimulants?

CNS stimulants increase release of and block reuptake of neurotransmitters.

The nurse explains to a patient using caffeine that which disease process/condition may be exacerbated by this drug?

Cardiac dysrhythmias

The nurse is reviewing the history of a patient who will be starting the triptan sumatriptan (Imitrex) as part of treatment for migraine headaches. Which condition, if present, may be a contraindication to triptan therapy?

Cardiovascular disease

A Pt. at a weight management clinic who was given a prescription for orlistat (Xenical) calls the clinic hotline complaining of a "terrible side effect". The nurse suspects that the patient is referring to which problem?

Fecal incontinence

The nurse is developing a plan of care for a patient receiving an anorexiant. Which nursing diagnosis is most appropriate?

Imbalanced nutrition, less than body requirements

When assessing for side effects expected in a patient taking analeptics, the nurse would monitor for which effect?

Insomnia

To reduce the gastrointestinal side effects of orlistat (Xenical), what will the nurse encourage the patient to do?

Limit dietary intake of fat to <30% of total calories.

A pt. with narcolepsy will begin treatment with a CNS stimulant. The use expects to see which adverse effect?

Nervousness

A nurse working with patients who are diagnosed with ADHD is aware such patients often take CNS stimulant drugs. These medications are potent with a high potential for abuse and dependence. Based on this potential, how are these medications classified?

Schedule II

A patient has anew prescription for sumatriptan (Imitrex). The nurse providing patient reaching on self-administration will include which information?

Take the medication before the headache worsens

CNS stimulant drugs are classified in three ways.

The first is on the basis of chemical structural similarities. Major chemical classes of CNS stimulants include amphetamines, serotonin agonists, sympathomimetics, and xanthines. Second, these drugs can be classified according to their site of therapeutic action in the CNS. Third, they can be categorized according to five major therapeutic usage categories for CNS stimulant drugs. These include anti-attention deficit, antinarcoleptic, anorexiant, antimigraine, and analeptic drugs.

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.)

Weight Loss Headache Insomnia

Both amphetamine and nonamphetamine stimulants have a wide range of adverse effects that most often arise when these drugs are administered at high doses. Adverse effects associated with CNS stimulants include

changes in mental status or sensorium, changes in mood or affect, tachycardia, loss of appetite, nausea, altered sleep patterns (e.g., insomnia), physical dependency, irritability, and seizures.

Therapeutic responses to drugs for ADHD include

decreased hyperactivity, increased attention span and concentration, improved behavior, and, for adults, increased effectiveness at work.

contraindications for analeptics include

drug allergy peptic ulcer disease cardiovascular conditions

Contraindications to triptans include

drug allergy and the presence of serious cardiovascular disease, because of the vasoconstrictive potential of these medications.

Contraindications to anorexiants include

drug allergy, any severe cardiovascular disease, uncontrolled hypertension, hyperthyroidism, glaucoma, mental agitation, history of drug abuse, eating disorders (e.g., anorexia, bulimia), and use of monoamine oxidase inhibitors (MAOIs).

Contraindications to the use of analeptics include

drug allergy, peptic ulcer disease (especially for caffeine), and serious cardiovascular conditions.

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 classified as Schedule II drugs under the Controlled Substances Act.

For drugs used to treat narcolepsy, therapeutic responses include a decrease in daytime sleepiness. Adverse effects for which to monitor include

headache, nausea, nervousness, insomnia, and anxiety.

Other contraindications to the use of anorexiants, as well as other CNS stimulants, include

hypersensitivity, seizure activity, convulsive disorders, and liver dysfunction.

The central nervous system (CNS) is a very complex system in the human body. Many therapeutic drugs either work

in the CNS or cause adverse effects in the CNS.

Contraindications to the use of amphetamine and nonamphetamine stimulants include

known drug allergy or cardiac structural abnormalities. These drugs can also exacerbate the following conditions: marked anxiety or agitation, Tourette's syndrome and other tic disorders (hyperstimulation), hypertension, and glaucoma.

caffeine citrate is recommended for

neonatal apnea including cases not responsive to other methylzanthines such as theophylline

Indications for analeptics include

neonatal apnea, bronchopulmonary dysplasia, hypercapnia with chronic obstructive pulmonary disease (COPD), and respiratory depression related to anesthesia and secondary to drugs of abuse.

Anorexiants are used for the treatment of

obesity. Current evidence-based guidelines for the treatment of obesity do not support the use of anorexiants as monotherapy.

Doxapram use is contraindicated in newborns because

of the benzyl alcohol contained in the injectable formulation of the drug associated with gasping syndrome in infants and may displace bilirubin into the blood from albumin binding sited in the circulation

SSRAs may be taken during aura symptoms, but are not indicated for

preventive therapy. Preventive therapy is indicated if migraines occur one or more days per week.

With the exception of diethylpropion, anorexiants may

raise blood pressure and cause heart palpitations and even dysrhythmias at higher dosages. Ironically, at therapeutic dosages, they may actually reflexively slow the heart rate.

Actions of adrenergic drugs often

resemble or mimic the actions of the sympathetic nervous system.

caffeine sodium benzoate is used for

respiratory depression in adults only, because it contains the preservative benzyl alcohol

CNS stimulants are a broad class of drugs that

stimulate specific areas of the brain or spinal cord. Most CNS stimulant drugs act by stimulating the excitatory neurons in the brain.

At higher dosages, analeptics

stimulate the vagal, vasomotor, and respiratory centers of the medulla and the brainstem, as well as increase blood flow to skeletal muscles.

Serotonin Receptor agonists

used for treatment of migraine headache called triptans

Ergot alkaloids such as ergotamine tartrate (Ergostat) exert a therapeutic effect by causing

vasoconstriction.

Therapeutic effects of anorexiants include. Adverse effects of these drugs include

- appetite control and weight loss for the treatment of obesity - dry mouth, headache, insomnia, constipation, tachycardia, cardiac irregularities, hypertension, changes in mental status or sensorium, changes in mood or affect, alteration of sleep patterns, and seizures.

Triptans have potential vasoconstrictor effects, including effects on the

- coronary circulation. Injectable dosage forms may cause local irritation at the site of injection. Other adverse effects include tingling, flushing, and a congested feeling in the head or chest.

The nurse is reviewing medication therapy with the parent of an adolescent with ADHD. Which statement is correct?

- the last dose should be taken 4 to 6 hours before bedtime to avoid interference with sleep - be sure to contact the physician right away if you notice expression of sducidal thoughts - we will need to check you child's height and weight periodically to monitor physical growth

The mother of a child with attention deficit hyperactivity disorder (ADHD) who has been prescribed methylphenidate (Ritalin) expresses concern regarding the use of a controlled substance to treat her child and asks if there are any other options. The nurse's response is based on the knowledge that an option for treatment for ADHD might include which non-controlled central nervous system (CNS) stimulant?

atomoxetine (Strattera)

In newborns, administration of caffeine is associated with

less tachycardia, CNS stimulation, and feeding intolerance than administration of theophylline or aminophylline.

CNS effects include

mood elevation or euphoria, increased mental alertness and capacity for work, decreased fatigue and drowsiness, and prolonged wakefulness.

Ergot alkaloids are associated with the adverse effects of

nausea, vomiting, cold or clammy hands and feet, muscle pain, dizziness, numbness, a vague feeling of anxiety, a bitter or foul taste in the mouth or throat, and irritation of the nose.

Analeptics include doxapram (Dopram) and the methylxanthines aminophylline, theophylline, and caffeine. These drugs are sometimes used to treat

neonatal and postoperative respiratory depression.

The triptan antimigraine drugs, also referred to as selective serotonin receptor agonists (SSRAs), are indicated for

abortive therapy of an acute migraine headache. The SSRAs are a newer class of CNS stimulants and are not to be given to patients with coronary heart disease.

Included in the family of CNS stimulants are

amphetamines, analeptics, and anorexiants with therapeutic uses for ADHD, narcolepsy, and appetite control.

Dozapram (Dopram)

an analeptic that is commonly used in conjunction with supportive measures in cases of respiratory depression that involve anesthetics or drugs of abuse and in COPD- associated hypercapnia

analeptics

are sometimes used to treat neonatal and postoperative respiratory depression

Because anorexiants are generally used for a short period of time, emphasize to the patient and all members of the patient's support system that

a suitable diet, appropriate independent and/or supervised exercise program, and behavioral modifications are necessary to support a favorable result and to help the patient cease overeating and experience healthy weight loss.

At higher dosages, analeptics

stimulate the vagal, vasomotor, and respiratory centers of the medulla in the brainstem, as well as increasing blood flow to skeletal muscles.

Analeptics work by

stimulating areas of the CNS that control respiration, mainly the medulla and spinal cord.

Serotonin agonists may be administered as a

subcutaneous injection, as a nasal spray, and as oral tablets. Any chest pain or tightness, tremors, vomiting, or worsening symptoms needs to be reported to the prescriber immediately.

Anorexiants are CNS stimulants that are believed to work by

suppressing appetite control centers in the brain. Some evidence suggests that they also increase the body's basal metabolic rate, including mobilization of adipose tissue stores and enhanced cellular glucose uptake, as well as reduce dietary fat absorption.

Amphetamines stimulate areas of the brain associated with mental alertness, such as the cerebral cortex and the thalamus. Pharmacologic actions of CNS stimulants are similar to the actions of the

sympathetic nervous system in that the CNS and respiratory systems are the primary systems affected.

Adrenergic drugs are also called

sympathomimetic drugs.

CNS stimulants are drugs that stimulate

the brain or spinal cord. The actions of these stimulants mimic those of the neurotransmitters of the sympathetic nervous system.

Contraindications to the use of ergot alkaloids include

uncontrolled hypertension; cerebral, cardiac, or peripheral vascular disease; dysrhythmias; glaucoma; and coronary or ischemic heart disease.