Introduction to Clinical Pharmacology Chapter 18 Central Nervous System Stimulants

1. Introduction to Clinical PharmacologyChapter 18Central Nervous System Stimulants

2. CNS Stimulants: Action #1 • Analeptics: • Used for narcolepsy • Increase depth of respirations- by stimulating chemoreceptors located in the carotid and upper aorta • Caffeine: • Cardiac, Respiratory, and CNS stimulation; dilation of coronary and peripheral blood vessels; constriction of cerebral blood vessels; skeletal muscle stimulation; diuretic

3. CNS Stimulants: Actions #2 • Modafinil and armodafinil (treat narcolepsy): • Exact mechanism of action is not known, but drug is thought to bind to dopamine, thereby reducing number of episodes • Amphetamines: • Elevate blood pressure; wakefulness; increase or decrease pulse rate; produce euphoric state • Anorexiants: suppress appetite; ensure patient not taking any antidepressants

4. 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

5. CNS Stimulants: Adverse Reactions • Neuromuscular reactions: • Excessive CNS stimulation; headache; dizziness; apprehension; disorientation; hyperactivity • Other: • Nausea; vomiting; cough; dyspnea; urinary retention; tachycardia; palpitations

6. CNS Stimulants: Contraindications • CNS stimulants contraindicated: • Inpatients with known hypersensitivity; convulsive disorders (epilepsy); ventilation mechanism disorders such as COPD • Nurse should not administer CNS stimulants to patients with: • Cardiac problems; severe hypertension; hyperthyroidism; peptic ulcer • Amphetamines: • Contraindicated in glaucoma

7. CNS Stimulants: Precautions • Use CNS stimulants with caution in: • Respiratory illness • Renal and/or hepatic impairment • History of substance abuse • Pregnant or lactating women

8. CNS Stimulant: Interactions

9. Nursing Process: Assessment #1 • 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

10. Nursing Process: Assessment #2 • Preadministration assessment (cont.) • 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

11. Nursing Process: Assessment #3 • Preadministration assessment (cont.) • 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

12. Nursing Process: Assessment #4 • Ongoing assessment: • Respiratory depression: • After administering analeptic: monitor respiratory rate and respiration pattern until respirations return to normal • Monitor level of consciousness, blood pressure, and pulse rate at 5- to 15-minute intervals or as ordered by primary health care provider

13. Nursing Process: Assessment #5 • Ongoing assessment (cont.) • Respiratory depression (cont.) • Take blood sample for arterial blood gas analysis, to determine effectiveness of analeptic • Observe adverse drug reaction; report occurrence immediately to primary health care provider

14. Nursing Process: Nursing Diagnosis and Planning • Disturbed Sleep Pattern; Ineffective Breathing Pattern; Imbalanced Nutrition • Expected outcomes: • Depend on reason for administration • Optimal response to therapy • Support patientneeds: manage adverse drug reactions • Understanding: drug regimen

15. Nursing Process: Implementation #1 • Promoting an optimal response to therapy: • Amphetamines: used for short-term treatment of exogenous obesity • Long-term use: causes addiction and abuse

16. Nursing Process: Implementation #2 • Monitoring and managing patientneeds taking amphetamines: • Disturbed sleep patterns: • CNS stimulant therapy: causes insomnia; anxiety, and confusion • Avoid coffee, tea, cola drinks • Vital signs: checked every 6 to 8 hours • Adverse reactions: amphetamine use may require discontinuation of drug

17. Nursing Process: Implementation #3 • Monitoring and managing patientneeds (cont.) • Ineffective breathing pattern: • Respiratory depression: requires administration of respiratory stimulant • Before administering drug: record rate, depth, character of respirations; ensure patent airway

18. Nursing Process: Implementation #4 • Monitoring and managing patientneeds (cont.) • Ineffective breathing pattern (cont.) • After administration: monitor respirations closely; record effects of therapy • Respiratory depression: assess patient’slevel of pain

19. Nursing Process: Implementation #5 • Monitoring and managing patient needs (cont.) • Ineffective breathing pattern (cont.) • Use of analeptic drugs for respiratory stimulation: enhances breathing pattern; keep record of number of times periods of sleepiness occur during the day and bring information to doctor visits • Doxapram: causes urinary retention; measure intake and output, notify primary health care provider if patientunable to void or bladder appears distended

20. Nursing Process: Implementation #6 • Monitoring and managing patient needs (cont.) • Imbalanced nutrition: less than bodily requirements • Adverse reactions: use of CNS stimulants in child with ADHD decreases appetite • Long-term treatment: CNS stimulants retard growth in children

21. Nursing Process: Implementation #7 • Monitoring and managing patientneeds (cont.) • Imbalanced nutrition (cont.) • Monitor weight, growth patterns in children on long-term treatment with CNS drugs • Frequently check height, weight of child to monitor growth • Primary health care provider may periodically interrupt therapy to monitor effectiveness of therapy

22. Nursing Process: Implementation #8 • Educating the patientand family: • Therapeutic regimen, adverse drug reactions are explained to patientand family • Emphasize need to follow recommended dosage schedule • Develop a teaching plan • Instruct the client to administer the drug early in the day, avoid caffeine and other CNS stimulants, be active during the day, and not nap during the day to aid in sleep alteration caused by the use of a CNS stimulant.

23. Nursing Process: Implementation #9 • Educating the patient and family (cont.) • 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 • Ensure that weight and growth are monitored and recorded on routine health visits

24. Nursing Process: Implementation #10 • Educating the patient and family (cont.) • Additional teaching points (cont.) • Narcolepsy: • Record number of times per day periods of sleepiness occur • Amphetamines and anorexiants: • Avoid coffee, tea, carbonated beverages containing caffeine

25. Nursing Process: Implementation #11 • Educating thepatientand family (cont.) • Additional teaching points (cont.) • Caffeine: • Should not be used if heart palpitations, dizziness, or lightheadedness occurs

26. Nursing Process: Evaluation #1 • Child’s behavior, school performance improve • Weight loss is achieved • Respiratory depression is reversed • Fewer episodes of inappropriate sleep patterns are reported • Adverse reactions are identified, reported, and managed

27. Nursing Process: Evaluation #2 • Patientcomplies with prescribed drug regimen • Patient and family demonstrate understanding of drug regimen • Patient verbalizes importance of complying with prescribed therapeutic regimen

28. Question #1 • Is the following statement true or false? • CNS stimulants enhance neurotransmission and stimulate receptors in different parts of the brain.

29. Answer to Question #1 • True • CNS stimulants enhance neurotransmission and stimulate receptors in different parts of the brain. These drugs are used for ADHD, narcolepsy, respiratory depression, and weight loss. They should not be used to treat clinical depression.

30. Question #2 • Is the following statement true or false? • There is a low degree of addiction potential with CNS stimulant drugs due to depression of the brain’s pleasure centers with enhanced neurotransmission of dopamine.

31. Answer to Question #2 • False • There is a high degree of addiction potential with these drugs due to stimulation of the brain’s pleasure centers with enhanced neurotransmission of dopamine.

32. Question #3 • Is the following statement true or false? • When used routinely, administration of stimulants is offered in long-acting form or in the morning and at lunchtime to reduce the incidence of insomnia.

33. Answer to Question #3 • True • When used routinely, administration of stimulants is offered in long-acting form or in the morning and at lunchtime to reduce the incidence of insomnia.