CNS

Stimulants
Methylphenidate [Ritalin,
concerta]
 Mild CNS stimulant
 ADHD and narcolepsy
 Pharmacologic action similar to
amphetamines
 Adverse effects: insomnia, HTN,
reduced appetite, emotional lability
 Abuse liability [Schedule II]
 Available as Short duration and
intermediate duration: taken 2-3x/day
and long duration: taken once a day
Contraindications
 Marked anxiety, tension, and agitation are
contraindications to Ritalin, since the drug may
aggravate these symptoms.
 Ritalin is contraindicated also in patients known to be
hypersensitive to the drug, in patients with glaucoma,
and in patients with motor tics or with a family history
or diagnosis of Tourette’s syndrome.
 Ritalin is contraindicated during treatment with
monoamine oxidase inhibitors, and also within a
minimum of 14 days following discontinuation of a
monoamine oxidase inhibitor (hypertensive crises
may result).
Warnings
Serious CV events
Sudden death: death, stroke, MI
Preexisting cardiac abnormalities
HTN
Interactions
 CNS stimulants: additive toxicities
 Digoxin: additive toxicities
 MAOIs: increased release of
catecholamines
 TCA: additive toxicities
Drug Dependence
 Ritalinshould be given cautiously to patients with
a history of drug dependence or alcoholism.
Chronic abusive use can lead to marked
tolerance and psychological dependence with
varying degrees of abnormal behavior. Frank
psychotic episodes can occur, especially with
parenteral abuse.
 Careful supervision is required during withdrawal
from abusive use, since severe depression may
occur. Withdrawal following chronic therapeutic
use may unmask symptoms of the underlying
disorder that may require follow-up.
Administration
• Patients who are unable to sleep if
medication is taken late in the day
should take the last dose before 6
p.m.
• Causes insomnia
adderall
ADDERALL
• Combo of Dextroamphetamine and Amphetamine
• Treatment program to control symptoms of attention deficit
hyperactivity disorder (ADHD; more difficulty focusing,
controlling actions, and remaining still or quiet than other
people who are the same age) in adults and children.
• Used to treat narcolepsy (a sleep disorder that causes
excessive daytime sleepiness and sudden attacks of sleep)
 Very popular among nursing students…!!! DANGEROUS
 Side Effects
 nervousness
 stomach pain
 restlessness
 difficulty falling asleep or  nausea
staying asleep  vomiting
 uncontrollable shaking of a
part of the body  diarrhea
 headache  constipation
 changes in sex drive or
 lossof appetite
ability
 dry mouth  weight loss
DANGERS
Heart attack
Seizures
Sudden death
Stroke
Other CNS Stimulants
 Atomoxetine {Strattera]
 Not a controlled substance [lacks additive
properties]
 9/2005: FDA warning: suicidal thinking &
behavior
 Monitor for any behavioral symptoms of
concern
Modafinial [Provigil]
 Improvement of wakefulness in
narcolepsy and shift work sleep disorder
 Less abuse potential
 Schedule IV
Anorexants
 Appetitesuppressant
 Promote weight loss in obesity
 Drugs
 Phentermine [Ionamin]: IV
 Benzphetamine [Didrex]
 Methamphetamine [Desoxyn]
 Phendimetrazine [Bontril]
 Diethylpropion [Tenuate]
 Sibutramine [Meridia]: IV
Drug Profile
 Orlistat [Xenical]: nonstimulant
 Otc agent: Alli
 Binds to gastric and pancreatic enzymes called
lipases
 Reduces fat absorption by 30%
 Restrict dietary intake of fat to less than 30% of
total calories to help reduce GI effects
 Spotting, flatulence and fecal incontinence
 Decreases serum concentration of Vit A, D, E
and beta carotene
 Supplement with fat-soluble vit.
Antimigraine
 Selective Serotonin receptor agonists [SSRAs]
 Used to treat migraine headaches
 Agents: The “Triptan” Family
 Sumatriptan [Imitrex]
 Almotriptan [Maxalt]
 Zolmitriptan [Zomig]
 Eletriptan [Relpax]
 Almotriptan [Axert]
 Naratriptan [Amerge]
 Frovatriptan [Frova]
Antimigraine
 Action: stimulate receptors in cerebral arteries
causing vasoconstriction and normally
reducing or eliminating headache symptoms
 Use: abortive therapy of acute migraine
headache.
 Contra: serious CV disease [vasoconstrictive
potential]
 Adverse effects:
 Vasoconstrictor effects on coronary circulation
 Injectable: local irritation at site
 Tingling sensation, flushing
 Congested feeling in head or chest
 Drug Profile
 Sumatriptan [Imitrex]
 Prototype for acute migraine w/without aura
 Route: PO, Subc., nasal spray
 Onset: 0.5 to 1 h, peak: 2.5 h, half-life: 2.5 h, lasts: 4
h
 Injectable:
 No more than 2 injections in 24-h period & at least 1 h
should be allowed b/w injections
 Inj.: pt. should contact prescriber or emergency
services immediately if
 Swelling around eyes
 Pain or tightness in chest or throat
 Wheezing
 Heart throbbing