CNS Stimulants
By: Angel Mendez, Sujin Ham, Brennette Jaime
Classifications
● Analeptics - respiratory stimulation
● Anorexiants - decreased appetite
● Psychomotor Stimulants - stimulate the prefrontal cortex &
the frontostriatal circuits of the brain
Sub-Classifications
● CNS Stimulants are also classified as controlled substances
● CNS Stimulants = Schedule II drugs
Prototype Drug
●
Definition = drug that is the most
representational of a particular class of drugs
●
Similarities: pharmacokinetics,
pharmacodynamics, therapeutic effects, side
effects, contraindications, drug/food
interactions
●
CNS Stimulant Prototype Drug =
methylphenidate
Effects on Body Systems
01
02
Nervous
Cardiovascular
Dilated pupils, increased
motor activity & mental
alertness, diminished fatigue
Increased blood pressure &
heart rate
03
04
Respiratory
Gastrointestinal
Increased respiratory rate
Decreased appetite
Therapeutic Action / Uses
❖ Primary Uses
➢ Treatment of narcolepsy
➢ Management of attention deficit hyperactivity disorder (ADHD)
❖ Other Uses
➢ Treatment of obesity
➢ Adjuvant treatment of depression
➢ Treatment of respiratory depression & recovery from anesthesia
Drug Examples
methylphenidate
(Ritalin)
Usually prescribed for children
diagnosed with ADHD
dextroamphetamine/
amphetamine combination
(Adderall)
Prescribed for ADHD & narcolepsy
Side Effects/Adverse Reactions
CNS
CV
EENT
Anxiety, seizures, psychosis,
paranoia
Palpitations, chest pain,
tachycardia, arrhythmias
Dry mouth/throat, blurred
vision
RESP
GI, GU
HEME
Shortness of breath, cough,
dyspnea
Abdominal pain,
hepatotoxicity, hematuria,
priapism
↓ platelet count, leukopenia
Drug Interactions
Antihypertensives
Anticonvulsants
Decreased effectiveness of
antihypertensives
Inhibited metabolism &
increased blood level of these
drugs
MAO inhibitors
Possibly increased adverse
effects of methylphenidate,
possibly severe hypertension
SSRIs, tricyclic
antidepressants
Increased risk of serotonin
syndrome
Food Interactions
● Caffeine: Increase methylphenidate effects
● Acidic foods (cranberries, dairy products,
grains, nuts): Decrease absorption of
medication which reduces medication’s
effect
Toxicities
Cocaine & Amphetamines
● S/S of toxicity: Dysrhythmias, lethargy,
skin pallor, psychosis
Nicotine
● S/S of toxicity: Heart palpitations,
tachyarrhythmias, confusion, depression,
seizures
Nursing Implications
Educate patients on the short-term and longterm effects of stimulants
While caffeine is a relatively safe stimulant, other stimulants can pose a
significant health threat.
Monitor and manage patient needs
Disturbed sleep pattern -> drug to be given daily in the morning
Check vital signs every 6 to 8 hours if tachycardia, hypertension, or
palpitations occur.
Nursing Assessments
Assessment of the patient receiving a CNS stimulant depends on the drug, the patient, and the reason
for administration.
Nursing Assessments (Cont.)
Use general survey techniques such as simply observing the patient
to assess for cues of behavior.
●
Patient’s mood, hygiene, appearance, or movement.
Assess patient’s cardiac history
●
Patient history of previous cardiac disease, seizures or
palpitations.
Physical examination, BP, Pulse, Respiration Rate
●
Including a careful cardiac examination
Use therapeutic communication to ask questions.
●
●
Determine how your patient is feeling emotionally and
perceiving the world
“Tell me more about how you are feeling today?”
Nursing Assessments (Cont.)
ADHD
Assess attention span, impulse control, and interactions with others
in children.
Therapy may be interrupted at intervals to determine if symptoms
are sufficient to warrant continued therapy.
Narcolepsy
Observe and document frequency of episodes
Nursing Assessments (Cont.)
ADHD - amphetamine is prescribed
Respiratory Depression - analeptic is used
Obesity - anorexiant is used
Nursing Interventions
Administer medication during the day
●
It can allow for undisturbed nighttime sleep.
Monitor unexpected weight loss
●
It can be imbalance nutrition; related to diminished appetite
Monitor CNS stimulants closely due to the potential for abuse
●
Patients can become tolerant to the euphoric and appetite suppressant effects of the drug
Nursing Interventions (Cont.)
Taper the dose gradually when withdrawing patients from
CNS stimulants
●
Patients may experience depression and severe fatigue if they stop taking the drug abruptly
Monitor Vital Signs closely
●
●
It may affect patient’s heart and blood pressure.
Unexpected or undesired increases in either of these may indicate the need for a lower dosage.
Monitor breathing pattern
●
It could be related to respiratory depression.
Patient Education
Take the drug as early in the day as possible, with
the last dose no later than 4:00 p.m
Report to provider if patients experience anorexia
or unexpected weight loss
Report to provider cardiovascular effects, such as
palpitations or tachycardia.
Patients should taper the drug slowly. -> it can
develop abstinence syndrome when they quit
taking medication abruptly; this results in severe
exhaustion, hypersomnia, or excessive slope,
mental depression and an overwhelming urge to
eat
NCLEX Question #1
1. The nurse is developing a plan of care for a patient
receiving an anorexiant. Which nursing diagnosis is most
appropriate?
A.
B.
C.
D.
Deficient fluid volume
Sleep deprivation
Impaired memory
Imbalanced nutrition, less than body requirements
NCLEX Question #1
1. The nurse is developing a plan of care for a patient
receiving an anorexiant. Which nursing diagnosis is most
appropriate?
A.
B.
C.
D.
Deficient fluid volume
Sleep deprivation
Impaired memory
Imbalanced nutrition, less than body requirements
NCLEX Question #2
1. The nurse is reviewing medication therapy with the parents of an
adolescent with ADHD. Which statement is correct (select all that apply)
A. “Be sure to have your child blow his nose before administering the nasal
spray”
B. “This medication is used only when symptoms of ADHD are severe”
C. “The last dose should be taken 4 to 6 hours before bedtime to avoid
interference with sleep”
D. “Be sure to contact the physician right away if you notice expression of
suicidal thoughts”
E. “If adverse effects become severe, stop the medication for 3 to 4 days”
NCLEX Question #2
1. The nurse is reviewing medication therapy with the parents of an
adolescent with ADHD. Which statement is correct (select all that apply)
A. “Be sure to have your child blow his nose before administering the nasal
spray”
B. “This medication is used only when symptoms of ADHD are severe”
C. “The last dose should be taken 4 to 6 hours before bedtime to avoid
interference with sleep”
D. “Be sure to contact the physician right away if you notice expression of
suicidal thoughts”
E. “If adverse effects become severe, stop the medication for 3 to 4 days”
References
●
●
●
●
●
Adams, M., Holland, L. N., & Urban, C. Q. (2020). Pharmacology for Nurses: A Pathophysiologic Approach
(6th ed.). Pearson.
Bartlett, J. L. (2023) Nurse's Drug Handbook. Jones & Bartlett Learning.
Central Nervous System Stimulants. Basicmedical Key. (2016, August 14). Retrieved March 26, 2023,
from https://basicmedicalkey.com/central-nervous-system-stimulants/
Farzam K., Faizy R. M., & Saadabadi A. (2023) Stimulants. StatPearls Publishing.
Vallerand, A. H., & Sanoski, C. A. (2021). Davis's Drug Guide for Nurses (17th ed.). F.A. Davis Company.
Thank
you!
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