Chapter 19 CNS Stimulants Case Study
Chapter 19 CNS Stimulants
CLASS | MOA | NURSING DX | INDICATIONS | AE/SE | CONTRA | CUATION | INTERACTIONS | Analeptics | Stimulate resp center of brain CV system by the carotid arteries and upper aorta | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | Narcolepsy, sleep apnea, resp. depression, deug-induced resp. depression, fatigue(caffine) | Excessive CNS stimulation, headache, dizziness, apprehension, disorientation, insominia, nausea, vomiting, cough, dyspnea, urinary retention, tachy, palpitations | Hypersensitivity, convulsive disorders, ventilation disorders (COPD), HTN, Hyperthyrodism, depression, do not give amphetamines and anorexoants concurrently, within 14 days of antidepressant, glaucoma, pregnancy
(anorexiants class X) | Resp. illness, renal/hepatic impairment, substance abuse, pregnancy and lactation | Anesthetics- cardiac arrythmisa, theophylline – increased risk of hyperactive disorders, oral contraceptives – birth control, caffeine | Amphetamines | Stimulate CNS, adregenic | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | ADHD, narcolepsy, obesity | Inc. BP; wakefulness; inc. HR, euphoria; same as above | Same | Same | Same | Anorexiants | Suppress appetite by stimulating the hypthalamus | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | Obesity | Same as above | Same | Same | Same |
NURSING IMPLICATIONS * Modafinil: analeptic; treats narcolepsy by binding to dopamine resulting in decrease in episodes * Caffeine: analeptic; Stimulates all levels of CNS; mild analeptic properties and cardiac stimulation; dilation of coronary and peripheral blood vessels, constriction of cerebral blood vessels; diuretic * Atomoxetine: ADHD; increased suicide ideation in PEDS * Doxapram: urinary retention, measure I&O palpate for distended bladder * Amphetamines and Anorexiants have high potential for abuse; short term use * Resp. Depression: initial assessment- BP, pulse, RR; lab results, identify drug that caused resp. depression; ongoing- monitor RR until pattern returns to normal, level of consciousness, BP, HR at 5 to 15 min intervals * ADHD: initial assessment weight, BP, HR, RR, record summary of behavior pattern; decreased appetite may occur and child must be weighed and charted frequently, give 3-=45 min before breakfast or lunch * Narcolepsy: record number of episodes daily * Obesity: initial assessment- BP, pulse, RR and weight * Insomnia: give analeptic early in the day, avoid day napping, provide distraction, avoid caffeine, check vitals every 6-8 hrs if HTN/tachy/palpitations (symptoms may decrease with continued use) * Elderly alert: excessive anxiety, nervousness, insomnia and mental confusion, worsened CV disorders * Ineffective breathing: rate, depth, charac. of RR, patent airway, suction kit * CNS drugs should be taken early in the day to avoid insomnia
CLASS | MOA | NURSING DX | INDICATIONS | AE/SE | CONTRA | CUATION | INTERACTIONS | Analeptics | Stimulate resp center of brain CV system by the carotid arteries and upper aorta | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | Narcolepsy, sleep apnea, resp. depression, deug-induced resp. depression, fatigue(caffine) | Excessive CNS stimulation, headache, dizziness, apprehension, disorientation, insominia, nausea, vomiting, cough, dyspnea, urinary retention, tachy, palpitations | Hypersensitivity, convulsive disorders, ventilation disorders (COPD), HTN, Hyperthyrodism, depression, do not give amphetamines and anorexoants concurrently, within 14 days of antidepressant, glaucoma, pregnancy
(anorexiants class X) | Resp. illness, renal/hepatic impairment, substance abuse, pregnancy and lactation | Anesthetics- cardiac arrythmisa, theophylline – increased risk of hyperactive disorders, oral contraceptives – birth control, caffeine | Amphetamines | Stimulate CNS, adregenic | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | ADHD, narcolepsy, obesity | Inc. BP; wakefulness; inc. HR, euphoria; same as above | Same | Same | Same | Anorexiants | Suppress appetite by stimulating the hypthalamus | Disturbed sleep pattern, ineffective breathing pattern, imbalanced nutrition | Obesity | Same as above | Same | Same | Same |
NURSING IMPLICATIONS * Modafinil: analeptic; treats narcolepsy by binding to dopamine resulting in decrease in episodes * Caffeine: analeptic; Stimulates all levels of CNS; mild analeptic properties and cardiac stimulation; dilation of coronary and peripheral blood vessels, constriction of cerebral blood vessels; diuretic * Atomoxetine: ADHD; increased suicide ideation in PEDS * Doxapram: urinary retention, measure I&O palpate for distended bladder * Amphetamines and Anorexiants have high potential for abuse; short term use * Resp. Depression: initial assessment- BP, pulse, RR; lab results, identify drug that caused resp. depression; ongoing- monitor RR until pattern returns to normal, level of consciousness, BP, HR at 5 to 15 min intervals * ADHD: initial assessment weight, BP, HR, RR, record summary of behavior pattern; decreased appetite may occur and child must be weighed and charted frequently, give 3-=45 min before breakfast or lunch * Narcolepsy: record number of episodes daily * Obesity: initial assessment- BP, pulse, RR and weight * Insomnia: give analeptic early in the day, avoid day napping, provide distraction, avoid caffeine, check vitals every 6-8 hrs if HTN/tachy/palpitations (symptoms may decrease with continued use) * Elderly alert: excessive anxiety, nervousness, insomnia and mental confusion, worsened CV disorders * Ineffective breathing: rate, depth, charac. of RR, patent airway, suction kit * CNS drugs should be taken early in the day to avoid insomnia