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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).

Samuel
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Central Nervous Stimulants

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  1. 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)

  2. 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)

  3. 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

  4. 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

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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

  10. 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

  11. 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…

  12. 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)

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