ch 20
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| CNS stimulates | ☺are used to treat ADHD, narcolepsy, reversal of resp distress
☻includes amphetamines and caffeine to stimulate the cerebral cortex
♥analeptics and caffeine to stimulate respiration
♦anorexiants - diethylpropion - suppress appetite by stimulating satiety center in hypothalamic and limbic areas
♣amphetatimes are related to anorexiants and are abused
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| migraine HA | ☺thought to be caused by changes in the brainstem which activates the trigeminal nerve, low serotonin levels may trigger the trigeminal system to release neuropeptides which causes pain
☺triggers: beer, red wine, aged cheese, chocolate, caffeine, MSG, skipping meals, intense exercise, female hormone changes, bright lights, BC, vasodilators
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| cluster HA | ☺same cause as migraine
☻recur 1-3/day ina period lasting from 2 weeks to 3 months
♥do not usually have triggers but etoh, nicotine and nitro may lead to severe HA
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| ADHD | ☺dysregulation of serotonin, norepi, dopamine
☻more common in boys
♥child may display poor coordination and there may be abnormal EEG findings
♦intelligence is not affected but may have learning disabilities
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| narcolepsy |
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| amphetamines | ☺stimulate the release of norepi and dopamine
☻cause euphoria and alertness; also cause sleeplessness, restlessness, tremors, irritability, ↑HR, palpitations, dysrhythmias, ↑BP
♥half-life 4-30 hrs
♦used for narcolepsy and ADHD
♣include: amphetamine (Adderall), dextroamphetamine (Dexedrine), methamphetamine (Desoxyn)
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| s/e of amphetamines | restlessness, insomnia, tachycardia, HTN, palpitations, dry mouth, anorexia, wt loss, diarrhea, constipation, impotence
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| methylphenidate (Ritalin) | ☺ADHD and narcolepsy
☻CI: hyperthyroidism, anxiety, seizures, CAD, HTN, Tourette's, glaucoma, psychosis, mental depression, parkinsonism
♥caution: not to be used by children <6 yo, substance abuse, pregnancy
s/e: anorexia, vomiting, diarrhea, insomnia, dizziness, nervousness, euphoria, blurred vision, HA, ↑hyperactivity, abd pain, anemia, URI
a/e: tachycardia, HTN, growth suppression, palpitations, seizures, wt loss, exfoliative dermatitis, stroke, thrombocytopenia, hepatoxicity
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| NC Ritalin | ☺may reverse the effects of antiHTNs
☻evaluate height, weight, and growth in children
♥report s/e
♦teach: take before meals, avoid etoh, use sugarless gum for dry mouth, do not abruptly d/c - can cause withdrawal, read OTCs for caffeine content - high levels of caffeine could be fatal, no BF, get counseling, eat a good breakfast,
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| anorexiants | ☺amphetamines are no longer used for appetite control
☻↑risk of hemorrhagic stroke in women but not in men
♥may cause renal failure, psychosis, HTN, dysrhythmias
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| lipase inhibitors | ☺replaced anorexiants for wt loss
☻s/e: oily spotting, fecal urgency and incontinence, steatorrhea, flatus with discharge, HA, n/v, abd cramps, hypoglycemia
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| analeptics | ☺CNS stimulant
☻use: stimulate respiration
♥xanthines - caffeine and theophylline
♦newborns may be given caffeine to ↑resp
♣theophylline is used to relax the bronchioles and ↑resp in newborn
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| s/e of caffeine | ☺same as for anorexiants plus GI irritation, tinnitus, psychological dependence
☻half-life is approx 5 hrs, this is prolonged in pts with liver disease, those taking BC or pregnant
♥no caffeine while pregnant b/c effect on fetus is unk
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| resp stimulants | ☺doxapram (Dopram)
☻used to treat resp depression due to OD, postanesthetic resp depression, COPD
♥can ↑BP
♣IV - onset 20-40 seconds with peak in 2 minutes
♠s/e: HTN, tachycardia, tremors, spasticity and hyperactive reflexes
•mechanical ventilation is more effective for treating resp depression
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