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Transcript
Central Nervous Stimulants
Classifications
• Analeptic Resp. Stimulant (Doxapram)
• Amphetamine (Dexadrine)
• Xanthine Derivatives
• Anorectic Agents (Sanorex, Dextrim)
• Stimulants for Attention Deficit Disorder
-Methylphenidate (Ritalin)
-Pemoline (Cylert)
Respiratory Stimulants
(Analeptics)
• Used to antagonize respiratory depression
caused by overdosage with CNS depressants;
Doxapram
• Act on respiratory center in the brain stem as
well as on peripheral carotid chemoreceptors to
increase the depth and rate of respiration
• Doxapram: use/reversal of post anesthetic
respiratory depression or apnea (except due to
muscle relaxants such as Anectine)
Analeptics: Doxapram (cont.)
• Side effects: also stimulate other centers
causing CV stimulation, vomiting, hyperreflexia.
Narrow safety margin
• Given IV compatible with D5W, D10W, and N.S.
(precipitates in alkaline forms. Overdose:
greater than 3 GM/24 hours
• Nursing: Baseline pulse, BP & deep tendon
reflexes and monitor arterial blood gases. Close
observation and frequent monitoring
Amphetamines
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Dextroamphetamine, Methamphetamine, Cocaine
General
Produce mood elevation or euphoria
Increase mental alertness and capacity for work
Decrease fatigue and drowsiness and prolong
wakefulness
Produce tolerance and psychological dependence
Schedule II drugs
High abuse potential: used at “Raves”, by truck drivers,
athletes, dieters
Treatment: Narcolepsy Sleep Disorder
Nursing Implications
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Amphetamines
Observe closely for signs of tolerance
Monitor for Drug Interactions
Teaching
Last dose 6 hr. before bed
Caution with machinery
Post-stimulatory depression may occur
Diabetics: may alter insulin or dietary requirements
Habit forming: caution patients
Legal implications: abused by students, truck drivers
Athletes used in treatment of Narcolepsy Sleep Disorder
Xanthine Derivatives
Caffeine
• Cafergot (ergotamine + caffeine), NoDoz, Quick Prep,
Vivarin, Excedrine, Vanquish, Midol, Mountain Dew
• Xanthine derivative week CNS stimulant, smooth-muscle
relaxant, vasodilator, diuretic and myocardial stimulant
• Uses
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Reduces fatigue and increases sensory awareness (orally)
Treatment of mild to moderate respiratory depression
Pain relief associated with vascular headaches (migraines)
Constricts cerebral vessels
Or spinal puncture
• Common side effects
– Nervousness, insomnia, gastric irritation
Caffeine (continued)
• Interactions
• May cause hypertensive reaction with
MAOI
• Increase in CNS stimulation caused by
oral contraceptives, Tagmet
• Smoking may increase elimination of
caffeine
• Withdrawal Symptoms
– Headaches withdraw slowly
Anorectic Agents
• Diethylpropion Tenuate, Tepano; Fenfluramine,
Pondamine, Phentermine, lonamin;
Phenylpropranolamine, Acutrim, Dexatrim
• Primarily indicated for the temporary adjunctive
management of obesity in conjunciton with a carefully
supervised program of diet and exercise
• Psychological & Physical Dependence
• Prescription only except for Acutrim/Dexatrim (OTC)
Fenfluramine; used investigationally in treating autistic
children with elevated serotonin levels
• Side effects: nervousness, irritability, insomnia,
palpitations
Stimulants for Attention Deficit
Disorder
• Methylphenidate (Ritaline) Pemoline (Cylert)
• CNS stimulant similar to amphetamine, but having a
more marked effect on mental rather than physical or
motor activities at normal doses
• Potential for habituation and psychological addiction
• Adjunct in the therapy of ADD in children and Narcolepsy
• Benefit of Cylert and Ritaline-SR: dose once per day
• Side effects
• Nervousness, insomnia
• Children: anorexia, mild weight loss, tachycardia
Outcomes
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The client will:
Maintain normal body weight & height
Demonstrate increased attentiveness
Continue normal growth and development
Experiences restful
Will be free of cardiac Sx
Maintain positive self-esteem
Remains compliant with drug regimen
Appear less anxious
Maintain normal vital signs
Patient Teaching
• Avoid other sources of CNS stimulants
• Take med exactly as prescribed
• Avoid taking OTC prep. Unless approved by
doctor
• Keep log of daily activities
• Refrain from drinking alcohol
• Do not step drug abruptly: withdrawal
• Take at least 6 hrs. prior to bedtime
• If taking for obesity; take 30-45 min before meals
for dry mouth suck or candy, chew gum…
Nursing Diagnosis
• Altered nutrition RT drugs effect (anorexia)
• Altered sleep patterns RT drugs effects
(insomnia)
• Risk for altered cardiac output RT
palpitations and tachycardia
• Anxiety RT drug effects
• Knowledge Deficit RT lack of information
about drug regimen (tolerance)