CNS Stimulants and Related Drugs

Question 1

Methylphenidate (Ritalin)

Functional Classification

Answer 1

Cerebral Stimulant

Question 2

Methylphenidate (Ritalin)

Mechanism of Action

Answer 2

Increases release of norepinephrine, dopamine in cerebral cortex to reticular activating system; exact action not known

Question 3

Methylphenidate (Ritalin)

Uses

Answer 3

Attention Deficit Disorder (ADD), attention-deficit/hyperactivity disorder (ADHD); narcolepsy (except Concerta, Metadate CD, Ritalin LA)

Question 4

Methylphenidate (Ritalin)

Contraindications

Answer 4

Children s syndrome; glaucoma, anorexia nervosa, tartrazine dye hypersensitivity

Question 5

Methylphenidate (Ritalin)

Side Effects

Answer 5

CNS: Hyperactivity, Insomnia, Restlessness, Talkativeness, dizziness, drowsiness, toxic psychosis, headache, akathisia, dyskinesia, masking or worsening of Gilles de la Tourette’s syndrome, SEIZURES, hallucinations, MALIGNANT NEUROLEPTIC SYNDROME, aggression; CEREBRAL VASCULITIS, HEMORRHAGE, STROKE (RARE)
CV: Palpitations, Tachycardia, BP changes, angina, DYSRHYTHMIAS
ENDO: growth retardation
GI: nausea, anorexia, dry mouth, weight loss, abdominal pain
HEMA: LEUKOPENIA, ANEMIA, THROMBOCYTOPENIC PURPURA
INTEG: EXFOLIATIVE DERMATITIS, urticaria, rash, erythema multiforme, HYPERSENSITIVITY REACTIONS
MISC: fever, arthralgia, scalp hair loss

Question 6

Methylphenidate (Ritalin)

Nursing Considerations

Answer 6

ASSESS:

• ADHD: attention span, decreased hyperactivity
• VS, BP; may reverse antihypertensives; check patients with cardiac disease more often for increased BP
• CBC with differential, platelets, LFTs, urinalysis; in diabetes: blood glucose, urine glucose; insulin changes may have to be made because eating will decrease
• Height, growth rate q3mo in children; growth rate may be decreased
• Mental status: mood, sensorium, affect, stimulation, insomnia, aggressiveness
• WITHDRAWAL SYMPTOMS: headache, nausea, vomiting, muscle pain, weakness
• Appetite, sleep, speech patterns
• NARCOLEPSY: identify frequency, length of narcoleptic episodes

Question 7

Methylphenidate (Ritalin)

Overdose Treatment

Answer 7

Administer fluids; hemodialysis or peritoneal dialysis; antihypertensive for increased BP; administer short-acting barbiturate before lavage

Question 8

Sumatriptan (Imitrex)

Functional Classification

Answer 8

Antimigraine Agent

Question 9

Sumatriptan (Imitrex)

Chemical Classification

Answer 9

5-HT1B/D receptor agonist, abortive agent, triptan

Question 10

Sumatriptan (Imitrex)

Mechanism of Action

Answer 10

Binds selectively to vascular 5-HT1B/D receptor subtype, exerts antimigraine effect; causes vasoconstriction in cranial nerves

Question 11

Sumatriptan (Imitrex)

Uses

Answer 11

Acute treatment of migraine with/without aura and cluster headache

Question 12

Sumatriptan (Imitrex)

Contraindications

Answer 12

Angina pectoris, history of MI, documented silent ischemia, Prinzmetal’s angina, ischemic heart disease, IV use, concurrent ergotamine-containing preparations, uncontrolled hypertension, hypersensitivity, basilar or hemiplegic migraine

Question 13

Sumatriptan (Imitrex)

Side Effects

Answer 13

CNS: Tingling, Hot Sensation, Burning, Feeling of Pressure, Tightness, Numbness, Dizziness, Sedation, headache, anxiety, fatigue, cold sensation
CV: Flushing, MI, hypo/hypertension
EENT: throat, mouth, nasal discomfort; vision changes
GI: abdominal discomfort
INTEG: Inj site reaction, sweating
MS: Weakness, Neck Stiffness, myalgia
RESP: chest tightness, pressure

Question 14

Sumatriptan (Imitrex)

Nursing Considerations

Answer 14

ASSESS:

• MIGRAINE: type of pain, aura; alleviating, aggravating factors; sensitivity to light, noise
• SEROTONIN SYNDROME: delirium, coma, agitation, diaphoresis, hypertension, fever, tremors; may resemble neuroleptic malignant syndrome in patients taking SSRIs, SNRIs
• BP, signs, symptoms of coronary vasospasms, ECG
• Tingling, hot sensation, burning, feeling of pressure, numbness, flushing, inj site reaction
• Stress level, activity, reaction, coping mechanisms
• Neurologic status: LOC, blurring vision, nausea, vomiting, tingling in extremities preceding headache
• Ingestion of tyramine foods (pickled products, beer, wine, aged cheese), food additives, preservatives, colorings, artificial sweeteners, chocolate, caffeine, which may precipitate these types of headaches
• Renal function, urine output

PERFORM/PROVIDE
-Quiet, calm environment with decreased stimuli: noise, bright light, excessive talking

Question 15

Methylphenidate (Ritalin)

Chemical Classification

Answer 15

Piperdine derivative