CNS Stimulants and Related Chapter 13

Question 1

amphetamines (Amphetamine Salt, Adderall) uses

Answer 1

Therapeutic- CNS stimulant

Question 2

amphetamines (Amphetamine Salt, Adderall) dose

Answer 2

Dosage- PO(Adult) 20mg/day for ADHD, 10-60mg/day in divided doses q 8-12 hr for Narcolepsy.

Question 3

amphetamines (Amphetamine Salt, Adderall) side effects

Answer 3

Side effects- Hyperactivity, insomnia, restlessness, tremor, SUDDEN DEATH, palpitations, tachycardia, anorexia

Question 4

amphetamines (Amphetamine Salt, Adderall) nursing implications

Answer 4

NI: Assessment- Monitor BP, HR, and respirations before and periodically during treatment. Obtain history, physical exam, to assess for cardiac disease, and further evaluation (ECG, echocardiogram) if indicated. If exertional chest pain, unexplained syncope, or other cardiac symptoms occur, evaluate promptly. Monitor closesly for behavior changes, Has high dependence and abuse potential. Tolerance to medication occurs rapidly; don’t increase dosage.
Lab Test Considerations- May interfere with urinary steroid determinations. May cause increase plasma corticosteroid concentrations; greatest in the evening.

Question 5

amphetamines (Amphetamine Salt, Adderall) interactions

Answer 5

Interaction- DD- Use with MAO inhibitors or meperidine can result in hypertensive crisis. Increase adrenergic effects with other adrenergics or thyroid preparations. Drugs that alkalinize urine (sodium bicarbinate, acetazolamide)) decrease excretion, increase effects. Drugs that acidify urine (ammonium chloride, large doses of ascorbic acid) increase excretion, decrease effects. Increased risk of hypertension and bradycardia with beta blockers. Increased risk of arrhythmias with digoxin. Tricyclic antidepressants may increase effect of amphetamine but may increase risk of arrhythmias, hypertension, or hyperpyrexia. Proton pump inhibitors may increase effects.
Drug-Natural products- Use with St. John’s wort may increase serious side effects (avoid concurrent use).
Drug-Food: Foods with alkalinize the urine (fruit juices) can increase effect of amphetamine.

Question 6

amphetamines (Amphetamine Salt, Adderall) contraindications

Answer 6

Contraindications- Hyperexcitable states including hyperthyroidism; Psychotic personalities, Suicidal or homicidal tendencies; chemical dependence; Glaucoma; structural cardiac abnormalities (may increase the risk of sudden death); potentially embryotoxic.

Question 7

caffeine use

Answer 7

Therapeutic- CNS stimulant, analeptic drug
Pharmacologic- respiratory stimulant
Pregnancy category C

Question 8

caffeine dose

Answer 8

Dosage- PO 300-400mg; IV 500mg

Question 9

caffeine side effects

Answer 9

Side effects- stimulation of Vagal effects (gastric secretions, diarrhea, and reflex tachycardia). Stimulation of Vasomotor effects include flushing (warmth, redness) and sweating of the skin. Respiratory rate can be elevated. Muscular tension and tremors, reduced deep tendon reflexes.

Question 10

caffeine nursing implications

Answer 10

NI: Assessment- Assess respiratory status frequently throughout therapy. Monitor patient for signs of necrotizing enterocolitis (abdominal distention, vomiting, bloody stools, lethargy). May be fatal. Monitor serum glucose levels, may cause hypoglycemia or hyperglycemia.
Lab Test Consideration- Therapeutic range: 8-20mcg/mL.

Question 11

caffeine interactions

Answer 11

Interaction-Cimetidine, fluconazole, and ketonconazole decrease metabolism. Phenobarbital and phenytoin may increase caffeine metabolism (increased doses of caffeine may be necessary). Because caffeine is a significant metabolite of theophylline, concurrent administration is not recommended.

Question 12

caffeine contraindications

Answer 12

Contraindications- Hypersensitivity. Use cautiously in history of seizure disorders, history of CV disease.

Question 13

methylphenidate (Ritalin) use

Answer 13

Therapeutic: CNS stimulant
Schedule II
Pregnancy Category C

Question 14

methylphenidate (Ritalin) dose

Answer 14

Dosage- PO (Adult) ADHD- 5-20mg 2-3 times daily as prompt-release tablets. When maintenance dose is determined, may change to extended-release formulation. Narcolepsy- 10mg 2-3 times/day; maximum dose 60/mg day.

Question 15

methylphenidate (Ritalin) side effects

Answer 15

Side effects- CNS hyperactivity, insomnia, restlessness, tremor, SUDDEN DEATH, hypertension, palpitations, tachycardia, anorexia.

Question 16

methylphenidate (Ritalin) nursing implications

Answer 16

NI: Assessment- Monitor BP, pulse, and respirations before and during therapy. Obtain a history (including family history of sudden death or ventricular arrhythmia), physical exam to assess for cardiac disease, and further eval. (ECG and electrocardiogram), if indicated. Monitor closely for behavior changes, May produce false sense of euphoria and well being. Provide frequent rest periods and observe patient for rebound depression.
Lab Test Considerations- Monitor CBC (Complete blood count), differential, and platelet count periodically in patients receiving prolonged therapy.

Question 17

methylphenidate (Ritalin) interactions

Answer 17

Interaction- DD- Increase sympathomimetic effects with other adrenergics, including vasoconstrictors, decongestants, and halogenated anesthetics. Use with MAO inhibitors or vasopressors may result in hypertensive crisis (concurrent use or use within 14 days of MAO inhibitors is contraindicated). Metabolism of warfarin, phenytoin, phenobarbital, primidone, phenylbutazone, selective serotonin reuptake inhibitors, and tricyclic antidepressants may be decreased and effects increased. Avoid concurrent use with pimozide (may mask cause of tics). May decrease the effectiveness of antihypertensives.
Drug-Natural products- Use with caffeine-containing herbs (guarana, tea, coffee) increase stimulant effect. St. John’s wort may increase serious side effects (concurrent use is NOT recommended).
Drug-Food- Excessive use of caffeine-containing foods or beverages (coffee, cola, tea) may cause increased CNS stimulation.

Question 18

methylphenidate (Ritalin) contraindications

Answer 18

Contraindications- Hypersensitivity; hyperexcitable states; hyperthyroidism; Patients with psychotic personalities or suicidal or homicidal tendencies; Personal or family histroy of Tourette’s syndrome; Glaucoma; Motor tics; Concurrent use or use within 14 days of MAO inhibitors; Fructose intolerance, glucose-galactose malabsorption, or sucrose-isomaltase insufficiency; Surgery.

Question 19

phentermine (Ionamin) uses

Answer 19

Therapeutic- weight control agents

Pharmacologic- appetite suppressants

Question 20

phentermine (Ionamine) dose

Answer 20

Dosage- PO (Adult)- tablet or capsule 15-37.5mg once daily; disintegrating tablets 15-30mg/day.

Question 21

phentermine (Ionamine) side effect

Answer 21

Side effect- CNS stimulation, VALVULAR ABNORMALITIES, hypertension, palpitations, PULMONARY HYPERTENSION

Question 22

phentermine (lonamine) interaction

Answer 22

Interaction- Short-term treatment of obesity in conjunction with other interventions (dietary restriction, exercise); used to produce and maintain weight loss in patients with a BMI >30kg/m2 or >27kg/m2 in the presence of other risk factors (diabetes, hypertension, hyperlipidemia.

Question 23

Phentermine (lonamine) nursing implications

Answer 23

NI- Assessment- NONE, the drug is not used any more. It is replaced with orlistat (Xenical a lipase inhibitor.

Question 24

Phentermine (lonamine) contraindications

Answer 24

Contraindications- Hypersensitivity or known intolerance to sympathomimetic amines; Cardiovascular disease; Hyperthyroidism; Moderate to sever hypertension; History of drug abuse; Agitation; Glaucoma; Concurrent or recent (within 14 days MAO inhibitor therapy); Concurrent SSRI antidepressants.

Question 25

sumatriptan (Imitrex) uses

Answer 25

Therapeutic- vascular headache suppressants Pharmacologic: 5-HT1 agonists Pregnancy Category C

Question 26

sumatriptan (Imitrex) dose

Answer 26

Dosage- PO (Adults)- 25mg initially; if response is inadequate at 2 hr, up to 100 mg may be given (initial doses of 25-50mg may be more effective than 25 mg). If headache recurs, doses may be repeated q 2hr (not to exceed 300mg/day). Subcut (Adult) 6mg; may repeat after 1 hr (not to exceed 12 mg in 24 hr).

Question 27

sumatriptan (Imitrex) side effects

Answer 27

Side effects- dizziness, vertigo, MI, tingling, warm sensation, injection site reaction.

Question 28

sumatriptan (Imitrex) nursing implications

Answer 28

NI- Assessment Assess pain location, intensity, duration, and associate symptoms (photophobia, phonophobia, nausea, vomiting) during migraine attack. Monitor for serotonin syndrome in patients taking SSRIs or SNRIs concurrently with sumatriptan. Give initial subcut dose under observation to patients with potential for coronary artery disease including postmenopausal women, men>40yr, patients with risk factors for coronary artery disease such as hypertension, hypercholesterolemia, obesity, diabetes, smoking, or family history. Monitor BP before and for 1 hr after initial injection. If angina occurs, monitor ECG for ischemic changes.

Question 29

sumatriptan (Imitrex) interactions

Answer 29

Interaction- DD- Risk of vasospastic reactions may be increased by concurrent use of ergotamine or dihydroergotamine (avoid within 24 hr of each other). Avoid concurrent use with ofther 5HT1 agonists. MAO inhibitors may increase levels. Increased risk of serotonin syndrome when used with SSRI or SNRI antidepressants. Drug-Natural Products- Increased risk of serotinergic side effects including serotonin syndrome with St. John's wort and SAMe.

Question 30

sumatriptan (Imitrex) contraindications

Answer 30

Contraindications- Hypersensitivity; Ischemic heart disease or signs and symptoms of ischemic heart disease, Prinzmetal's angina, or uncontrolled hypertension; Stroke or transient ischemic attack; Peripheral vascular disease (including, but not limited to, ischemic bowel disease); Concurrent MAO inhibitor therapy; Hemiplegic or basilar migrain; Concurrent use of (within 24hr) ergotamine-containing or ergot-type drugs or other 5HT1 agonists;