CNS STIMULANTS CNS STIMULANTS

ADHD/ADD Stimulants
Methlyphenidate (Ritalin), Amphetamine (Adderall) Lisdexamfetamine (Vyvanse) Dexmethylphenidate (Focalin)

COMMON USES
Drugs of choice for the treatment of ADD and ADHD.

WHAT I NEED TO KNOW AS A BRAND NEW NURSE

* Adverse effects include hypertension, tachycardia, HA, insomnia, dry mouth, decreased appetite, blurred vision and anxiety. * Sudden death has been reported in children taking Adderall with structural cardiac abnormalities. * High abuse potential due to stimulant and euphoric effects

Anorexiants
Common examples: Phenteramine (Ionamin)

Appetite Suppressant. Indicated for the treatment of obesity (BMI > 30) and for individuals who are overweight (BMI 27-30) who have comorbidities, ie. hypertension, high cholesterol, diabetes, etc.

* Adverse effects include: anxiety, hypertension, dizziness, insomnia and HA. * High abuse potential.

*Non-Stimulant Anorexiants*
Lipase Inhibitor:
Orlistat (Xenical), OTC strength - Alli

Inhibits gastric and pancreatic lipases reducing fat absorption by 30%.

* Common adverse effects include: oily spotting, increased flatulence and fecal incontinence. These adverse effects can be lessened by decreasing dietary fat intake. * Contraindicated with cholestiasis and malabsorption syndromes.

CNS STIMULANTS
Serotonin Agonists (SSRAs Selective Serotonin Receptor Agonists)
Triptans:
Common examples: Sumatriptan (Imitrex), Almotriptan (Axert)

COMMON USES

WHAT I NEED TO KNOW AS A BRAND NEW NURSE

Indicated for the treatment of migraine headaches and cluster headaches.

* Adverse effects include: nausea and vomiting, dizziness, hyper or hypotension, cardiac arrhythmias, coronary artery vasospasms. * Contraindicated with history of coronary artery disease, uncontrolled hypertension, cerebrovascular disease, or prior MI. *Adverse effects include:weakness, GI disturbances, abnormal pulse, pruritus, delirium, convulsive seizures, intermittent claudication * Adverse effects include: nervousness, insomnia, irritability, flushing, palpitations and cardiac arrhythmias. * Use caution in patients who have a history of cardiac disease or peptic ulcer disease. *Has a pronounced diuretic effect

Ergot Alkaloids:
Common Examples: Ergotamine tartrate (Ergostat), Ergotamine with caffeine (Cafergot, Ercaf)

Indicated for the termination of migraine headaches when the Triptans are ineffective. Mild CNS stimulant found in many OTC drugs and combination prescription drugs. Also found in many foods and beverages.

Caffeine

CNS DEPRESSANTS CNS DEPRESSANTS

Barbituates
Common examples: Phenobarbital (Luminal), Secobarbital (Seconal), Pentobarbital (Nembutal)

COMMON USES
Indicated uses include anesthesia induction, short-term anesthesia, control of convulsions (antiseizure).

WHAT I NEED TO KNOW AS A BRAND NEW NURSE

* Adverse effects include drowsiness, lethargy, dizziness, HA, hangover effect, respiratory depression, and mental depression. * Interfere with REM sleep. * Cautious use in elderly, associated with increased risk of falls. * Loading dose may be required.

Benzodiazepines
Common examples: *As sedative-hypnotic, preanesthetic, or treatment of anxiety: Flurazepam (Dalmane), Temazepam (Restoril), Triazolam (Halcion), Midazolam (Versed), Lorazepam (Ativan) * *For the treatment of epilepsy, as a skeletal muscle relaxant or alcohol withdrawal: Diazepam (Valium), Clonazepam (Klonopin)

Commonly prescribed sedativehypnotic. Also used for sleep induction, anxiety, alcohol withdrawal and epilepsy. Often used in combination therapy with anesthesia or analgesics for balanced anesthesia or conscious sedation

* Adverse effects include: HA, drowsiness, lethargy, dizziness, hangover effect and memory impairment. * Cautious use in elderly, associated with increased risk of falls. *Major advantage: they do not produce life-threatening respiratory depression or coma if taken in excessive amounts. *Result in less physical dependence than the barbituates

Skeletal Muscle Relaxants

Common examples: Lioresal (Baclofen), Cyclopenzaprine (Flexeril), Dantrolene (Dantrium) Methocarbamol (Robaxin)

Indicated in the treatment of painful muscle spasms. Baclofen and Dantrium indicated for the treatment of spasticity associated with chronic disorders, ie: multiple sclerosis, cerebral palsy, etc.

* Adverse effects include: dizziness, drowsiness, fatigue, lightheadedness, dry mouth, hypotension, bradycardia, edema of the tongue, anaphylaxis, and muscle weakness. * Monitor ALT, AST with long-term Dantrium use, associated with hepatotoxicity.

Miscellaneous SedativeHypnotics
Common examples: 1. Chloral Hydrate (Noctec)

1. Sedation, short-term treatment of insomnia, alcohol withdrawal.

1. *Adverse effects include: drowsiness, hangover effect, cardiac arrhythmias and sudden death. * Does not interfere with REM sleep. 2. * Adverse effects include: HA, tachycardia, nervousness, depression and anxiety. 1. *Adverse effects include: aplastic anemia, agranulocytosis, respiratory depression, arrhythmias, AV block, Stevens Johnson Syndrome

2. Eszoplicone (Lunesta), Zolpidem (Ambien)

2. Treatment of insomnia.

Miscellaneous Anti-Seizure
Common examples: 1. Carbamazepine Tegretol)

1. Anti-seizure. Alcohol withdrawal, acute mania associated with bipolar disorder, Trigeminal neuralgia 2. Anti-seizure, adjunctive therapy for partial seizures. Peripheral neuropathy and migraine prophylaxis. Treatment of vasomotor symptoms in women with breast cancer or postmenopausal women. 3. Anti-seizure, migraine prophylaxis, mania Unlabeled use: febrile seizures. 4. Anti-seizure Unlabeled use: Antiarrhythmic

2. Gabapentin (Neurontin)

2. * Adverse effects include: drowsiness, dizziness, fatigue, increased frequency of partial seizures, leukopenia * Cautious use in the elderly.

3. Valproic Acid (Depakote)

3. * Adverse effects include: drowsiness, weight loss, bone marrow depression, pancreatitis, hepatotoxic, Stevens Johnson Syndrome, and deep coma and death with overdose. 4. * Adverse effects include: Aplastic anemia, agranulocytosis, pancytopenia, gingival hyperplasia, Stevens Johnson Syndrome and hepatitis. BLACK BOX WARNING: Administration IV should not exceed 50mg/min in adults. Administer IVP slowly.

4. Phenytoin (Dilantin)