CNS Stimulants.pptx Flashcards
CNS Stimulants For children
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Methylphenidate, amphetamine, Illicit drug= cocaine
Non amphetamine Stimulants for children
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Modafinil
Miscellaneous ADHD Agents for children
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Atomoxetine
Guanfacine (alpha 2 agonist)
Treat:
ADHD, Narcolepsy
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
MECHANISM OF ACTION
These agents typically result in increased levels of norepinephrine and dopamine in the central nervous system (CNS)- may also increase serotonin levels
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
THERAPEUTIC OUTCOME
Improved ability to stay awake (narcolepsy, sedation from opioids)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
THERAPEUTIC OUTCOME
Improvement of ADHD symptoms (ability to focus)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
ADVERSE EFFECTS
CNS Stimulation- restlessness, insomnia (avoid evening administration, take off patches after ~9 hours) causes - Anxiety, irritability, depression
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
ADVERSE EFFECTS
CNS Stimulation- restlessness, insomnia (avoid evening administration, take off patches after ~9 hours) causes - Anxiety, irritability, depression
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Norepinephrine◦Increased Blood pressure, and Heart Rate (tachycardia/palpitations)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Increased risk for chest pain, MI, sudden death if heart abnormalities
Report SOB, chest pain, dizziness
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Cocaine users will receive Beta Blockers in E.D. with chest pain
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Decreased appetite/weight loss, growth suppression, etc.
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Dopamine/ Toxicity
Palpitations, Dysrhythmias, Hypertension, Hallucinations, Paranoia, Seizures
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Nursing Considerations
Encourage regular meal times
Assess growth/height/weight in children
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Some providers will have patients take “DRUG HOLIDAYS”, stop taking on weekends/holidays/vacations, to allow appropriate growth
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Monitor- BP, HR, height/weight, growth,
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Drug to drug
Avoid other drugs (OTCs, stimulants like pseudoephedrine, limit caffeine, no alcohol, no MAO-Is, etc)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Administration
Take first thing in the AM (some recommend 30 minutes before food)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Administration
Take first thing in the ? (some recommend ? minutes before food)
AM
30
if taking multiple times per day, avoid evening hours (4 pm cut off per ATI)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
if taking multiple times per day, avoid evening hours (? pm cut off per ATI)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
4
Patches should be applied in AM, removed in PM ( 9 hour ON time)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Don’t crush XR/XL/ER pills
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
SCHEDULE II SUBSTANCES!- Hand written prescriptions, no refills- high risk for Misuse & Euphoria RISK — tolerance/dependence potential—- Withdrawal symptoms
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
CNS Stimulants: Methylphenidate, Amphetamine, Illicit drug= cocaine
Non-Amphetamine CNS Stimulants: Modafinil
Treat:
Shift Work Sleep Disorders, Narcolepsy, , Fatigue
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Non-Amphetamine CNS Stimulants: Modafinil
Treat
Shift Work Sleep Disorders
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Non-Amphetamine CNS Stimulants: Modafinil
Treat:
ADHD
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Miscellaneous ADHD Agent:atomoxetine
MECHANISM OF ACTION
Inhibits reuptake of Norepinephrine
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Miscellaneous ADHD Agent:atomoxetine
ADVERSE EFFECTS/ Nursing Considerations
Similar to amphetamines/ Non- Amphetamines
Watching Blood Pressure and Heart RateWatching growth- height/weight/appetite- especially in children
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Miscellaneous ADHD Agent:atomoxetine
Hepatotoxicity- LFTs
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Miscellaneous ADHD Agent:atomoxetine
BOXED WARNING
Boxed Warning about Suicidal Ideation
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
Miscellaneous ADHD Agent:atomoxetine
Treat:
Hypertension
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
a-2 specific agonists: Guanfacine
MECHANISM OF ACTION
stimulate α2 receptors on presynaptic nerve terminals in brain stem (vasomotor center), which reduces sympathetic outflow from CNS
ADVERSE EFFECTS
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
a-2 specific agonists: Guanfacine
ADVERSE EFFECTS
Anticholinergic: xerostomia (dry mouth)
Drowsiness
Decreased HR/BP
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
a-2 specific agonists: Guanfacine
Nursing Considerations Monitor vital signs Taper off Anticholinergic effects CNS sedation- counsel patients (driving, alcohol, weight gain)
Amphetamine Modafinil Methylphenidate Atomoxetine Illicit drug= cocaine Guanfacine (alpha 2 agonist)
a-2 specific agonists: Guanfacine