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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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 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 Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins