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Pharm Test 2 > Chapter 13 Central Nervous System Stimulants and Related Drugs > Flashcards

Chapter 13 Central Nervous System Stimulants and Related Drugs Flashcards

1
Q

CNS Stimulants

A
  • 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
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2
Q

Major therapeutic uses of CNS Stimulants

A

anti–attention deficit disorder, antinarcoleptic, anorexiant, antimigraine, and analeptic drugs

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3
Q

Attention Deficit Hyperactivity Disorder (ADHD)

A
  • Most common psychiatric disorder in children, affecting 4% to 10% of school-age children
  • Boys are affected from two to nine times more often than girls.
  • Drug therapy for both childhood and adult ADHD is the same.
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4
Q

Narcolepsy

A

Incurable neurologic condition in which patients unexpectedly fall asleep in the middle of normal daily activities. These “sleep attacks” are reported to cause car accidents or near-misses in 70% or more of patients.

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5
Q

Cataplexy

A

sudden acute skeletal muscle weakness. Associated symptom in at least 70% of narcolepsy cases. It involves sudden acute skeletal muscle weakness.

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6
Q

Analeptic-Responsive Respiratory Depression Syndromes

A
  • Neonatal apnea
  • Bronchopulmonary dysplasia
  • Postanesthetic respiratory depression
  • Drugs: analeptic drugs such as theophylline, aminophylline, caffeine, and doxapram
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7
Q

Drugs for Attention Deficit Hyperactivity Disorder (ADHD) and Narcolepsy

A

-Amphetamines: methylphenidate
-Nonamphetamine stimulants
Pemoline and Modafinil
Atomoxetine: nonstimulant drug that is also used to treat ADHD
Lisdexamfetamine (Vyvanse) prodrug for dextroamphetamine

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8
Q

Amphetamines

A

Stimulate areas of the brain associated with mental alertness

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9
Q

CNS effects

A
  • Mood elevation or euphoria
  • Increased mental alertness and capacity for work
  • Decreased fatigue and drowsiness
  • Prolonged wakefulness
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10
Q

Respiratory effects

A
  • Relaxation of bronchial smooth muscle
  • Increased respiration
  • Dilation of pulmonary arteries
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11
Q

Adverse Effects of Stimulants

A

-Wide range; dose related
-Tend to “speed up” body systems
-Common adverse effects include:
Palpitations, tachycardia, hypertension, angina, dysrhythmias, nervousness, restlessness, anxiety, insomnia, nausea, vomiting, diarrhea, dry mouth, increased urinary frequency, others

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12
Q

Principal Drugs Used to Treat ADHD and Narcolepsy

A
  • Amphetamines
  • Nonamphetamine stimulants
  • Atomoxetine: nonstimulant drug also used for ADHD
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13
Q

Atomoxetine (Strattera)

A
  • Approved for treating ADHD in children older than 6 years of age and in adults
  • In September 2005, the FDA issued a warning describing cases of suicidal thinking and behavior in small numbers of adolescent patients receiving this medication.
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14
Q

Methylphenidate (Ritalin)

A

-First prescription drug indicated for ADHD
-Also used for narcolepsy
-Extended-release dosage forms
Ritalin SR
Concerta
Metadate CD

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15
Q

Modafinil (Provigil)

A
  • Use: improvement of wakefulness in patients with excessive daytime sleepiness associated with narcolepsy and with shift work sleep disorder
  • Less abuse potential than amphetamines and methylphenidate
  • Schedule IV drug
  • Armodafinil (Nuvigil): similar to modafinil
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16
Q

Anorexiants

A

-Used to treat obesity
-Anorexiants
phentermine (Ionamin)
benzphetamine (Didrex)
methamphetamine (Desoxyn)
diethylpropion (Tenuate)

17
Q

Orlistat (Xenical)

A

-related nonstimulant drug used to treat obesity
Mechanism of action: works locally in the small and large intestines, where it inhibits absorption of caloric intake from fatty foods.

18
Q

Mechanism of Action for Obesity Drugs

A
  • Suppress appetite control centers in the brain
  • Increase the body’s basal metabolic rate
  • Mobilization of adipose tissue stores
  • Enhanced cellular glucose uptake
  • Reduce dietary fat absorption
19
Q

Adverse effects of obesity drugs

A
  • Possible elevated blood pressure and heart palpitations
  • Anxiety
  • Agitation
  • Dizziness
  • Headache
20
Q

Antimigraine Drugs

A

Antimigraine (serotonin agonists; also called triptans)

21
Q

Ergot alkaloids

A
  • Were the mainstay of treatment of migraine headaches but have been replaced by the triptans for first-line therapy
  • Dihydroergotamine mesylate (D.H.E. 45): injectable form and as a nasal spray (Migranal)
  • Ergotamine tartrate with caffeine (Cafergot): tablet form
  • Narrow or constrict blood vessels in the brain
22
Q

Triptans

A
  • Stimulate 5-HT receptors in cerebral arteries, causing vasoconstriction and reducing headache symptoms
  • Reduce the production of inflammatory neuropeptides
23
Q

Adverse affects of triptans

A
  • Vasoconstriction
  • Irritation at injection site
  • Tingling, flushing
24
Q

Adverse affects of Ergot Alkaloids

A 
Nausea and vomiting
Cold or clammy hands and feet
Muscle pain
Dizziness
Others
25
Q

Sumatriptan (Imitrex)

A
  • Original prototype drug for this class
  • Seven triptans
  • Slight pharmacokinetic differences exist between some of these products.
  • Effects are comparable overall.
26
Q

Analeptics

A
  • Include doxapram and the methylxanthines aminophylline, theophylline, and caffeine. Sometimes used to treat neonatal and postoperative respiratory depression.
  • Used less frequently
27
Q

Doxapram (Dopram)

A
  • Treatment of respiratory depression associated with anesthetic drugs and drugs of abuse, COPD-induced hypercapnia
  • Monitor deep tendon reflexes, in addition to vital signs and heart rhythm, to prevent overdosage of this drug.
28
Q

Caffeine Found in:

A
  • Analeptic
  • Over-the-counter drugs: NoDoz
  • Combination prescription drugs: Fioricet, Fiorinal
  • Foods and beverages
29
Q

Caffeine Use with caution in patients with a history of:

A
  • Peptic ulcer
  • Recent myocardial infarction
  • Dysrhythmias
30
Q

Methylxanthines

Mechanism of Action:

A
  • Inhibit phosphodiesterase, leading to buildup of cyclic adenosine monophosphate (cAMP)
  • Analeptic
31
Q

Caffeine

Mechanism of Action:

A

-Antagonizes adenosine receptors

32
Q

Analeptic Adverse Effects

A 
-Vagal
      Stimulation of gastric secretions, diarrhea, and 
       reflex tachycardia
-Vasomotor
       Flushing, sweating
-Respiratory
       Elevated respiratory rate
-Musculoskeletal
       Muscular tension and tremors
33
Q

Nursing Implications:

Drugs for ADHD

A
  • 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.
  • Drug “holidays” 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
34
Q

Nursing Implications:

Anorexiants

A
  • Follow instructions for diet and exercise.
  • Take in the morning.
  • Avoid caffeine
  • Fat-soluble vitamin supplementation may be needed.
35
Q

Nursing Implications:

Selective Serotonin Receptor Agonists (SSRAs)

A
  • 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.
36
Q

Nursing Implications:

Ergot alkaloids

A

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

37
Q

Nursing Implications:

Analeptics

A

Pay close attention to the ABCs because of the patient’s diminished sensorium

38
Q

Nursing Implications:

Monitor for therapeutic responses

A
  • 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

Pharm Test 2 (8 decks)

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