Download Roach: Central Nervous System Stimulants

Introduction to Clinical
Pharmacology
Chapter 19Central Nervous System
Stimulants
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
CNS Stimulants: Action
• Analeptics:
– Increase depth of respirations
• Caffeine:
– Cardiac stimulation; dilation of coronary;
peripheral blood vessels; constriction of
cerebral blood vessels; skeletal muscle
stimulation
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CNS stimulants: Actions (cont’d)
• Modafinil:
– Exact mechanism of action is not known,
but drug is thought to bind to dopamine
thereby reducing number of episodes
• Amphetamines (sympathomimetics):
– Elevate blood pressure; wakefulness;
increase or decrease-pulse rate; produce
euphoric state
• Anorexiants: Suppress appetite
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
CNS Stimulants: Uses
• CNS stimulants-treatment:
– *Attention deficit hyperactivity disorder
–
–
*drug-induced respiratory depression
postanesthesia respiratory depression without
reduction of analgesia
–
narcolepsy
–
*sleep apnea
–
exogenous obesity
–
fatigue
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
CNS Stimulants: Adverse Reactions
• Neuromuscular reactions:
– Excessive CNS stimulation; headache;
dizziness; apprehension; disorientation;
hyperactivity
• Other:
– Nausea; vomiting; cough; dyspnea;
urinary retention; tachycardia;
palpitations; anorexia
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CNS Stimulants: Contraindications
• CNS stimulants contraindicated:
– In patients with known hypersensitivity;
convulsive disorders; ventilation mechanism
disorders
• Nurse should not administer CNS stimulants to
patients with:
– Cardiac problems; severe hypertension;
hyperthyroidism
• Amphetamines:
– *Contraindicated in glaucoma
– *Amphetamines and anorexiants should not be
taken concurrently or within 14 days of
antidepressant medications
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
CNS Stimulant: Interactions
Interactant drug
Effect of interaction
Anesthetics
Increased risk of cardiac
arrhythmias
Theophylline
Increased risk of
hyperactive behaviors
Oral contraceptives and
modafinil
Decreased effectiveness of
the oral contraceptive
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration assessment:
– Respiratory depression:
•Initial assessments: Blood pressure,
pulse, respiratory rate
•Note: Depth of respirations; any
pattern to respiratory rate
•Review: Recent laboratory test results
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration assessment (cont’d):
– Attention deficit hyperactivity disorder:
• Amphetamine prescribed: Weigh patient and
take blood pressure; pulse; and respiratory
rate
• Child with ADHD: Observe for patterns of
abnormal behavior
• Record summary: Document/chart client’s
behavior; provides comparison/future
changes
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Preadministration assessment (cont’d):
– Obesity:
•Anorexiant or amphetamine:
•Used for outpatient use
•Obtain and record:
•Blood pressure; pulse; respiratory
rate; weight- before therapy starts
and at each outpatient visit
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Assessment
• Ongoing assessment
– Respiratory depression:
•Take blood sample: For arterial blood
gas analysis; determine effectiveness of
analeptic
•Observe: Adverse drug reaction; report
occurrence immediately to PHCP
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Nursing Diagnosis and
Planning
• Disturbed sleep pattern; ineffective
breathing pattern; imbalanced nutrition
• Expected outcomes:
– Depends on reason for administration
– Optimal response to therapy
– Support patient needs: Manage adverse
drug reactions
– Understanding: Drug regimen
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Nursing Process: Implementation
• Promoting an optimal response to therapy:
– Amphetamines: Used for short-term
treatment of exogenous obesity
•Long term use: Causes addiction and
abuse
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and managing patient needs:
– Disturbed sleep patterns:
•CNS stimulant therapy: Causes
insomnia; administer early in the day
•Avoid: Coffee, tea, cola drinks,
chocolate
•Vital signs: Checked every 6 to 8 hours
•Adverse reactions: Amphetamine use
may require discontinuation of drug
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and managing patient needs
(cont’d):
– Ineffective breathing pattern:
•Use of analeptic drugs for respiratory
stimulation: Enhances breathing
pattern
•Doxapram: Causes urinary retention;
measure intake and output, notify PHCP
if patient unable to void or bladder
appears distended
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Geriatrics
• *Older adults are more sensitive to CNS stimulants and
may exhibit anxiety, nervousness, insomnia, mental
confusion
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and managing patient needs
(cont’d):
– Imbalanced nutrition: Less than bodily
requirement
•Adverse reactions: Use of CNS
stimulants-child with ADHD decreases
appetite
•Long-term treatment: CNS stimulantsretards growth in children
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Monitoring and managing patient needs
(cont’d):
– Imbalanced nutrition (cont’d):
•Monitor: Weight, growth patterns in
children on long-term treatment with
CNS drugs
•Frequently check: Height, weight of
child to monitor growth
•PHCP may periodically interrupt therapy
to monitor effectiveness of therapy
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the patient and family:
– Therapeutic regimen, adverse drug
reactions are explained to patient and
family
– Emphasize: Need to follow recommended
dosage schedule
– Develop a teaching plan
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Additional teaching points:
•Attention deficit hyperactivity disorder
•Administer drug in morning 30 to 45
minutes before breakfast and before
lunch.
•Monitor and record behavior of child
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Implementation
• Educating the patient and family (cont’d):
– Additional teaching points (cont’d):
•Narcolepsy:
•Record: Number of times per day
periods of sleepiness occur
• Amphetamines and anorexiants:
•Avoid: coffee, tea, carbonated
beverages containing caffeine
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Process: Evaluation
• Child’s behavior, school performanceimproves
• Weight loss is achieved
• Respiratory depression: Reversed
• Fewer episodes of inappropriate sleep
patterns reported
• Adverse reactions are identified, reported,
and managed
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