Chapter 13 CNS stimulants

CNS stimulants
Stimulate specific area of the brain or spinal cord by acting on neurons that contain receptors for excitatory neurotransmitters of dopamine, norepinephrine, and serotonin.

Amphetaminesamphetamine, dextroamphetamine (Dexedrine), mixture of both (Adderall, Adderall XL), lisdexamfetamine (Vyvanse)
MOA
stimulate areas of brain associated with mental alertness, similar to sympathetic stimulation.
causes mood elevation, euphoria, increased mental alertness, prolonged wakefulness

amphetamine, dextroamphetamine (Dexedrine), mixture of both (Adderall, Adderall XL), lisdexamfetamine (Vyvanse)
Indications
ADHD, narcolepsy

Contraindications Amphetamines
allergy, cardiac abnormalities, HTN, Tourette’s, glaucoma

A/E amphetamines
palpitations, tachycardia, HTN, angina, insomnia, N/V/D

Amphetamines Interactions
: MAOIs, other CNS stimulants, caffeine

Nursing Implications Amphetamines
Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia.
Take on an empty stomach 30 to 45 minutes before meals.
Drug “holidays” may be ordered.
Instruct parents to keep a journal to monitor the child’s response to therapy.
Monitor the child for continued physical growth, including height and weight.

Nonamphetamines
Atomoxetine (Strattera) lacks addictive properties

Nonamphetamines atomoxetine (Strattera) MOA
selective reuptake of norephinephrine

Indications atomoxetine (Strattera)
ADHD in children over 6 years, no addictive properties

Contraindications atomoxetine
allergy, glaucoma, MAOIs

A/E atomoxetine (Strattera)
risk of suicidal ideations, palpitations, tachycardia, HTN, angina, insomnia, N/V/D

Interactions
MAOIs, paroxetine

Nursing Implications
same

Nonamphetamines methylphenidate (Ritalin) MOA
increases effects of norepinephrine and dopamine

Indications Ritalin
ADHD, narcolepsy

Contraindications Ritalin
allergy

A/E Ritalin
palpitations, tachycardia, HTN, angina, insomnia, N/V/D

Interactions Ritalin
same,MAOIs, other CNS stimulants, caffeine

Nursing Implications Ritalin
Same

nonamphetamines modafinil( Provigil), armodafinil (Nuvigil) MOA
reduces GABA neurotransmission, low abuse potential.

modafinil (Provigil), armodafinil (Nuvigil) Indications
narcolepsy, shift work sleep disorder

modafinil (Provigil), armodafinil (Nuvigil)
A/E
palpitations, tachycardia, HTN, angina, insomnia, N/V/D

Interactions
same,MAOIs, other CNS stimulants, caffeine

Nursing Implications
same

Anorexiants phentermine (Ionamin), orlistat (Xenical), lorcaserin (Belviq)
Anorexiants amphetamines- – benzphetamine (Didrex), methamphetamine (Desoxyn)
phentermine – suppresses appetite center through dopamine & norepinephrine receptors; orlistat inhibits the enzyme lipase reducing fat reabsorption; lorcaserin is a serotonin receptor agonist

Contraindications anorexiants
allergy, HTN, cardiac disorder, MAOIs, eating disorder, glaucoma.
orlistat – GI malabsorption

Anorexiants A/E
URI, palpitations, tachycardia, HTN, angina, insomnia, N/V/D, HA
Interactions: MAOIs, other CNS stimulants, caffeine

anorexiants Implications
Follow instructions for diet and exercise, avoid caffeine
Take in the morning.
Fat-soluble vitamin supplementation may be needed.

Antimigrainesumatriptan (Imitrex), almotriptan (Axert), rizatriptan (Maxalt)
MOA
serotonin receptor agonists, vasoconstrict cerebral arteries & reduce inflammation

sumatriptan (Imitrex), almotriptan (Axert), rizatriptan (Maxalt)
Contraindications
allergy, cardiovascuar disease

sumatriptan (Imitrex), almotriptan (Axert), rizatriptan (Maxalt)
A/E
tingling, flushing, congeste feelings

sumatriptan (Imitrex), almotriptan (Axert), rizatriptan (Maxalt)
interactions
SSRI, egot alkaloids, MAOIs

sumatriptan (Imitrex), almotriptan (Axert), rizatriptan (Maxalt)
Nursing Implications
migraine preventative meds include propranolol, amitriptyline, valproic acid, topiramate
Dissolvable wafers, nasal spray, and self-injectable forms
Provide specific teaching about correct administration.
Instruct patients to keep a journal to monitor response to therapy, identify triggers, etc.

antimigraine dihydroergotamine mesylate (D.H.E. 45, Migranal), ergotamine tartrate with caffeine (Cafergot) MOA
ergot alkaloids, vasoconstricts cerbral vessels

dihydroergotamine mesylate (D.H.E. 45, Migranal), ergotamine tartrate with caffeine (Cafergot)
Indicatiions
2nd line therapy that is treatment and prevenion

dihydroergotamine mesylate (D.H.E. 45, Migranal), ergotamine tartrate with caffeine (Cafergot)
Contraindications
HTN, cerbral, cardia, PVD

dihydroergotamine mesylate (D.H.E. 45, Migranal), ergotamine tartrate with caffeine (Cafergot)
A/E
N/V, cold & clammy hands or feet, dizziness, bitter/foul taste

interactions
azoles, protease inhibitors (HIV drugs), macrolides

Nursing Implications
monitor for chest pain, confusion, slurred speech, and vision changes need immediate medical attention.

Analeptics doxapram (Dopram), aminophylline, theophylline, caffeine
MOA
blocks adenosine receptors in brain promoting wakefulness, doxapram stimulates center triggered by carbon dioxide

Indications
neonatal & post-operative respiratory depression, hypercapnia, over-sedation from opioids, alcohol, barbiturates

Contraindications
PUD, cardiovascular disease; doxapram in newborns, epilepsy, head injury, HTN, stroke

A/E
high doses tachycardia, diarrhea, muscle tension, tremors, reduced deep tendon reflexes, flushing diaphoresis

nursing implications
Pay close attention to the ABCs because of the patient’s diminished sensorium.

Stimulants stimulate specific area of brain or spinal cord, sympathomimetic agents CNS stimulants use Analeptics: increase mental alertness Tx of post anesthesia resp depression Doxapram (Dopram) Narcolepsy- Adderall, Provigil OTC: caffeine Anorexiants: suppress appetite contorl center in brain Orlistat “Xenical”, …

Central Nervous System Depressants Zolpidem Tartrate (Ambien) Alprazolam (Xanax) What the antagonist of Alprazolam (Xanax)? Flumazenil (Romazicon) WE WILL WRITE A CUSTOM ESSAY SAMPLE ON ANY TOPIC SPECIFICALLY FOR YOU FOR ONLY $13.90/PAGE Write my sample What type of CNS …

Ergot Alkaloids Notes – Action – serotonin agonist/vasoconstrictor – Risk of physical dependence – Ergotamine tartrate (Ergomar, Ergostat) – SL; ergotamine tartrate/caffeine (Cafergot) – suppositories, oral ;dihydroergotamine mesylate (DHE 45, Migranal) – nasal spray, IV, IM, SC Ergot Alkaloids Indications …

Ventolin, Proventil. Pro-Air Generic name: Albuterol Classification: Beta 2 agonist inhaler (SABA, rescue, either MDI or nebulizer via liquid) – bronchodilator Indications: Side Effects: trembling to shaking of hands, arms – “hyperkinesia”, legs or feet. Drowsy/dizzy, headache, dry mouth, arrhythmias …

Overview This chapter describes two groups of drugs that act primarily to stimulate the central nervous system (CNS). The first group, the psychomotor stimulants, cause excitement and euphoria, decrease feelings of fatigue, and increase motor activity. The second group, the …

Antihistamines MOA also known as histamine antagonists block the histamine receptors Histamine: dilates blood vessels, allergic reactions, stimulates secretions Antihistamine: reduces dilation of blood vessels, inhibit allergic reaction, reduces secretions Antihistamines Indications nasal allergies seasonal allergic rhinitis common cold allergic …

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