Stimulants Nursing Pharmacology PDF

Stimulants Nursing Pharmacology Melissa M Fischer MSN, RN 1 CNS Stimulants Medically approved uses Attention-deficit/hyperactivity disorder (ADHD) Narcolepsy Reversal of respiratory distress Categories Amphetamines Act on cerebral cortex...

Stimulants Nursing Pharmacology Melissa M Fischer MSN, RN 1 CNS Stimulants Medically approved uses Attention-deficit/hyperactivity disorder (ADHD) Narcolepsy Reversal of respiratory distress Categories Amphetamines Act on cerebral cortex Analeptics, caffeine Act on brainstem and medulla Anorexiants Act on satiety center in hypothalamic and limbic areas 2 Attention-Deficit/Hyperactivity Disorder Pathophysiology Dysregulation of transmitters Serotonin, norepinephrine, dopamine Epidemiology Usually occurs in children before age 7 years More common in boys Characteristics Inattentiveness, inability to concentrate Restlessness, hyperactivity, impulsivity Inability to complete tasks, poor coordination 3 Narcolepsy Characteristics Recurrent attacks of drowsiness and sleep during normal waking activities Driving Talking Sleep paralysis 4 Amphetamines Action Stimulate release of norepinephrine and dopamine Block reuptake of norepinephrine and dopamine Side effects/adverse reactions Dizziness, headache Tachycardia, palpitations, hypertension Nervousness, restlessness, irritability, euphoria Insomnia, dysrhythmias, tremors Anorexia, dry mouth, weight loss, diarrhea, Erectile dysfunction Excess use: psychosis 5 Amphetamine-Like Drugs for ADHD Methylphenidate Dexmethylphenidate Uses Increase attention span and cognitive performance Memory, reading Decrease impulsiveness, hyperactivity, and restlessness 6  Amphetamine-Like Drugs for Narcolepsy Methylphenidate uses Increase attention span and cognitive performance Modafinil uses Increase wakefulness in patients with sleep disorders Action Inhibits reuptake of dopamine and norepinephrine Stimulates CNS and augments serotonin action 7 Methylphenidate Uses ADHD, narcolepsy, increase attention span Interactions Caffeine may increase effects Increases effects of oral anticoagulants, barbiturates, anticonvulsants, TCAs, MAOIs Decreased effects of antihypertensives 8 Methylphenidate Side effects Anorexia, dry mouth, N/V, diarrhea Restlessness, tremors, irritability Dizziness, headache, blurred vision Euphoria, confusion, insomnia Weight loss Adverse Reactions Tachycardia, palpitations, hypertension Growth suppression Seizures, psychosis Blood dyscrasias, hepatotoxicity 9 Modafinil Uses Narcolepsy, ADHD, shift work disorder, and sleep apnea Side Effects HA, dizziness Anxiety Anorexia, nausea, diarrhea, dry mouth Insomnia Rhinitis Back pain 10 Anorexiants Anorexiants (Phentermine and Phentermine derivatives) Cause stimulant effect on hypothalamic and limbic areas of brain to suppress appetite Short term use for obesity (8-12 weeks) Should not be given to children under 12 Side effects Restlessness, euphoria, insomnia Tachycardia, palpitations, hypertension Seizures, erectile dysfunction 11 Anorexiants Contraindicated in: Hypertension Hyperthyroidism Glaucoma Within 14 days of an MAOI Use with Caution: Diabetes mellitus Seizures Tourette syndrome Bipolar disorder 12 Analeptics Mostly affect the brain stem and spinal cord but can affect the cerebral cortex to stimulate respiration Caffeine/ xanthines (methylxanthines) Used for neonatal apnea Used for mental alertness Side effects Headache, withdrawal Palpitations, tachycardia, dysrhythmias Insomnia, tremors, restlessness Nausea, urinary frequency, seizures 13 Practice Questions 14  What would indicate to the nurse that the child taking methylphenidate requires more teaching? Practice A. The child is seen drinking a cola product. Question B. The child checks his weight #1 C. twice a week. The child takes the drug 45 minutes before a meal. D. The child takes the drug before breakfast and lunch. 15  A child has been diagnosed with attention-deficit/hyperactivity disorder. Which drug does the nurse anticipate the health care Practice provider will prescribe? Question A. Zolmitriptan #2 B. Doxapram C. Benzphetamine D. Methylphenidate 16  Methylphenidate should not be taken by patients with a history of which condition? Practice A. Renal failure Question B. Glaucoma #3 C. Hypothyroidism D. Heart disease 17  When providing teaching to a group of parents regarding attention-deficit/hyperactivity disorder (ADHD), which information will the nurse include? Practice Question A. Children with ADHD have low intelligence. #4 B. Children with ADHD have an infection in their spinal fluid. C. EEG results are typically normal in children with ADHD. D. Learning disabilities are often present in the child who has ADHD. 18