describe the actions, intended effects, and related nursing care for patients receiving cns...
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Describe the actions, intended effects, and related nursing care for patients receiving CNS Stimulants.
Discuss the nursing process as it relates to patients receiving CNS stimulants in various care situations.
Drugs that stimulate a specific area of the brain
or spinal cord
Sympathomimetic drugs
According to:
• Structural similaritiesor
• Site of therapeutic action in the central nervous system (CNS)
or• Major therapeutic usages
Analeptics– Reversal of anesthesia-induced respiratory
depression Anorexiants
– Thought to suppress the appetite control center in the brain
ADHD– Stimulate the areas in the brain responsible
for mental alertness and attentiveness Narcolepsy
– Increase mental alertness Migraine headaches
– Caffeine, co-administered with other drugs, used to treat headaches
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
ADHD amphetamine (Adderall, others)
methylphenidate (Concerta, Ritalin)
atomoxetine (Strattera)
Narcolepsy modafinil (Provigil)
Anorexiants
sibutramine (Meridia)
phentermine (Ionamin)
orlistat (Xenical)Lipase inhibitor, not a CNS stimulantAlso used to treat obesity
Migraine Headaches
Serotonin agonist
– Dissolvable wafers, nasal spray, and self-injectable forms
– Provide specific teaching about correct administration
– Foods containing tyramine should be avoided
– Patients should keep a journal to monitor response to therapy
Antimigraine (serotonin agonists)
almotriptan (Axert) eletriptan (Relpax) frovatriptan (Frova) naratriptan (Amerge) rizatriptan (Maxalt) sumatriptan (Imitrex) zolmitriptan (Zomig)
Responsive Respiratory Depression Syndromes:
Analeptics
This use is now less frequent Still used for neonatal apnea doxapram (Dopram) Methylxanthines, such as
aminophylline, theophylline, and caffeine
Found in:OTC drugsCombination prescription drugsFoods
Use with caution in patients with history of:Peptic ulcerRecent myocardial infarctionDysrhythmias
Many uses
Neonatal apnea
Respiratory depression in adults
Enhance effects of analgesics and migraine medications
CNS stimulation (No-Doze, Vivarin)
Assess for:
Potential contraindicationsPotential interactions, including herbal
therapiesConditions such as abnormal cardiac
rhythms, seizures, palpitations, liver problems
For children, assess baseline height and weight
Drugs for ADHD
Should be given at least 6 hours before bedtime to reduce problems from insomnia
May cause dry mouth; frequent oral care is needed
Take on an empty stomach, 30-45 minutes before meals
Drug “holidays” may be ordered
Parents should keep a journal to note child’s response to therapy
Obesity - With orlistat:
– Follow instructions for diet and exercise
– Adverse effects may be reduced if dietary fat is limited to 30% of total intake
– Take with meals that contain fat
– Fat-soluble vitamin supplementation may be needed
Monitor for therapeutic responses
Monitor for adverse effects
A patient with narcolepsy will begin treatment with a CNS stimulant. Which of the following adverse effects is this patient likely to encounter?
a. bradycardia b. nervousness c. mental clouding d. drowsiness at night
The parents of a 10-year old boy are concerned about the adverse effects of the medication their son is taking for ADHD. Discuss what they will need to monitor while he is taking medications for this condition.
A patient calls the headache clinic because she is unhappy about her medication. She says, “I’ve been taking zolmitriptan (Zomig) to prevent headaches, but I am still having them.” Discuss what she needs to know about the proper use of this drug.