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

• 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

• 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 DerivativesCaffeine

• 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– 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

• 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)