Central Nervous System Stimulants and Related Drugs

Question 1

Central Nervous System Stimulants

Answer 1

Drugs that stimulate a specific area of the brain or spinal cord

Neurons contain receptors for excitatory neurotransmitters, including dopamine (dopaminergic drugs), norepinephrine (adrenergic drugs), and serotonin (serotonergic drugs).

Sympathomimetic drugs

Question 2

Classification

Answer 2

Chemical structural similarities: amphetamines, serotonin agonists, sympathomimetics, and xanthines

Site of therapeutic action in the central nervous system (CNS)

Major therapeutic uses: anti–attention-deficit/hyperactivity disorder, antinarcoleptic, anorexiant, antimigraine, and analeptic drugs

Question 3

Attention-Deficit Hyperactivity Disorder

Answer 3

Most common neurodevelopmental disorder in children, affecting 3 to 10% of school-age children

Boys affected two to nine times more often than girls are
-May be related to the underdiagnosing in girls

Question 4

Primary symptom of attention-deficit/hyperactivity disorder (ADHD):

Answer 4

inappropriate ability to maintain attention span, or hyperactivity and impulsivity

Drug therapy for both childhood and adult ADHD is the same.

Question 5

Narcolepsy

Answer 5

Incurable neurological condition in which patients unexpectedly fall asleep in the middle of normal daily activities

Commonly knees buckle, and the individual falls to the floor while still awake.

Question 6

Cataplexy

Answer 6

sudden acute skeletal muscle weakness
-Triggered by strong emotion

Question 7

Obesity

Answer 7

Approximately 7 million obese adults and
600 000 obese school-aged children in Canada

Associated health risks

Expected to rise 4 to 5 % per year

Question 8

Migraine

Answer 8

Common type of recurring headache, usually lasting from 4 to 72 hours

Typical features: pulsatile quality with pain that worsens with each pulse

Most commonly unilateral but may occur on both sides of the head

Associated symptoms: nausea, vomiting, photophobia (patient avoids light), phonophobia (patient avoids sounds)

Aura

Question 9

Drugs for ADHD and Narcolepsy

Answer 9

Amphetamines: methylphenidate (Ritalin)

Nonamphetamine stimulant
-Modafinil

Nonstimulant drugs
-atomoxetine; also used to treat ADHD
-lisdexamfetamine (Vyvanse®): prodrug for dextroamphetamine

Question 10

Amphetamines

Answer 10

Stimulate areas of the brain associated with mental alertness

Question 11

Amphetamines

CNS effects

Answer 11

Mood elevation or euphoria

Increased mental alertness and capacity for work

Decreased fatigue and drowsiness

Prolonged wakefulness

Question 12

Amphetamines

Respiratory effects

Answer 12

Relaxation of bronchial smooth muscle

Increased respiration

Dilation of pulmonary arteries

Question 13

Amphetamines
: Common Adverse Effects

Answer 13

Wide range; dose related

Tend to “speed up” body systems

Common adverse effects include:
Palpitations, tachycardia, hypertension, angina, anxiety, insomnia, headache, tremor, nausea, vomiting, diarrhea, dry mouth, increased metabolic rate, others

Question 14

Principal Drugs Used to Treat ADHD and Narcolepsy

Answer 14

Amphetamine derivatives

Nonamphetamine stimulants

Atomoxetine

Question 15

Atomoxetine

Answer 15

nonstimulant drug also used for ADHD

Question 16

Amphetamines

amphetamine aspartate (Adderall®):

Answer 16

amphetamine aspartate (Adderall®): one of the most commonly prescribed drugs for ADHD

Question 17

atomoxetine hydrochloride (Strattera®)

Answer 17

Approved for treating ADHD in children older than 6 years of age and in adults

Health Canada has issued a warning describing cases of suicidal thinking and behaviour in small numbers of adolescent patients receiving this medication.

Question 18

methylphenidate hydrochloride (Ritalin®)

Answer 18

First prescription drug indicated for ADHD

Also used for narcolepsy

Extended-release dosage forms:
-Ritalin SR®
-Concerta®
-Biphentin®

Question 19

modafinil (Alertec®)

Answer 19

Use: improvement of wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and with “shift work” sleep disorder

Less potential for misuse than amphetamines and methylphenidate

Available with a prescription

Question 20

Anorexiants

1. Usage
2. Example of a medication

Answer 20

Used to treat obesity

Effectiveness has not been proven

None currently available in Canada to treat obesity

Related drug, orlistat (Xenical®), a nonstimulant drug to treat obesity
-Inhibits absorption of caloric intake from fatty foods

Question 21

Adverse Effects of Orlistat

Answer 21

Headache

Upper respiratory infection

Gastrointestinal (GI) distress, fecal incontinence

Question 22

Antimigraine Drugs

1. Also called?
2. Medication

Answer 22

Antimigraine (serotonin agonists; also called triptans)

sumatriptan (Imitrex®)

Question 23

Antimigraine Drugs

Ergot alkaloids

Answer 23

Were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy

Obtained from a fungus and cause vasoconstriction of blood vessels in the brain and carotid arteries

Question 24

Triptans
(antimigraine)

Answer 24

Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms

Reduce the production of inflammatory neuropeptides

Question 25

Ergot alkaloids
(antimigraine)

Answer 25

Constrict or narrow blood vessels in the brain

Question 26

Triptans adverse effects

Answer 26

Vasoconstriction

Irritation at injection site

Tingling, flushing, congestion

Question 27

Ergot alkaloids
adverse effects

Answer 27

Nausea and vomiting

Cold or clammy hands and feet

Muscle pain

Dizziness

Question 28

Analeptics

Answer 28

Used less frequently

Still used for neonatal apnea

Examples:
-Methylxanthines, such as aminophylline, theophylline, and caffeine

Question 29

Analeptics: Caffeine

1. Found in?
2. Use with caution in patients with a history of:
3. Available in

Answer 29

Found in:
-Over-the-counter drugs
-Combination prescription drugs: Fiorinal-C 1/2®
-Foods and beverages

Use with caution in patients with a history of:
-Peptic ulcer
-Recent myocardial infarction
-Dysrhythmias

Available in oral form

Question 30

Caffeine mechanism of action

Answer 30

Antagonizes adenosine receptors

Question 31

Methylxanthines
mechanism of action

Answer 31

Inhibit phosphodiesterase, leading to buildup of cyclic adenosine monophosphate

Question 32

Analeptic mechanism of action

Answer 32

Stimulate areas of CNS that control respiration

Question 33

Analeptic Adverse Effects

Answer 33

Vagal
-Stimulation of gastric secretions, diarrhea, and reflex tachycardia

Vasomotor
-Flushing, sweating

Respiratory
-Elevated respiratory rate

Musculoskeletal
-Muscular tension and tremors

Question 34

Nursing Implications

Answer 34

Assess for:

-Potential contraindications
-Potential interactions, including with herbal therapies
-Conditions such as abnormal cardiac rhythms, seizures, palpitations, liver problems
-For children, baseline height and weight

Question 35

Drugs for ADHD
nursing implications

Answer 35

-Last daily dose should be given 4 to 6 hours before bedtime to reduce insomnia.

-Take on an empty stomach 30 to 45 minutes before meals.

-Medication-free times may be ordered.

-Instruct parents to keep a journal to monitor the child’s response to therapy.

-Monitor the child for continued physical growth, including height and weight.

Question 36

Anorexiants nursing implication

Answer 36

Follow instructions for diet and exercise.

Take in the morning.

Avoid caffeine.
Fat-soluble vitamin supplementation may be needed

Question 37

Selective serotonin receptor agonists
nursing implications

Answer 37

-Dissolvable wafers, nasal spray, and self-injectable forms

-Provide specific teaching about correct administration.

-Instruct patients to keep a journal to monitor response to therapy.

Question 38

Ergot alkaloids
nursing implications

Answer 38

Chest pain, confusion, slurred speech, and vision changes need immediate medical attention.

Question 39

Analeptics nursing implications

Answer 39

Pay close attention to airway, breathing, and circulation because of the patient’s diminished sensorium.

Question 40

Monitor for therapeutic responses.

Answer 40

ADHD: decreased hyperactivity, increased attention span and concentration

Anorexiant: appetite control and weight loss

Narcolepsy: decrease in sleepiness

Serotonin agonist: decrease in frequency, duration, and severity of migraines
Monitor for adverse effects.