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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).

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central nervous stimulants
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
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
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
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
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 derivatives caffeine
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
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
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
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
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
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
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)