Central Nervous System Stimulants

Prototype :
- amphetamines, methylphenidate (Ritalin)
Mechanism of actions :
- increase excitatory CNS neurotransmitter activity and blocks inhibitory impulses.
Indications :
- for obesity (amphetamines)
- attention deficit hyperactivity disorders
- narcolepsy
- drug-induced respiratory depressions.
Adverse effects :
- nervousness, insomnia, restlessness
- hypertension, tachycardia, headache
- anorexia, dry mouth.
Nursing considerations :
1. Should be given at morning.
2. Don’t stop amphetamine abruptly to avoid withdrawal symptoms.
3. Monitor blood pressure and pulse.
4. Ice chips or sugarless gum for dry mouth.
5. Watch out for growth retardation in children taking methylphenidate.






DRUGS AFFECTING MENTAL FUNCTIONING

Sedatives, Hypnotics, and Anxiolytics
Prototype :
a. Benzodiazepines
- diazepam (Valium), lorazipam (Ativan),
alprazolam (Xanax), flurazepam (Dalmane)
b. Barbiturates
- amobarbital, phenobarbital, secobarbital
c. Miscellaneous
- chloral hydrate (Noctec), buspirone (Buspar), paraldehyde (Paral)
Mechanism of actions :
a. Benzodiazepines
- increase the effect of inhibitory neuro transmitter GABA
(gamma-amino butyric acid)
b. Barbiturates and Miscellaneous agents
- depress CNS
Indications :
- induce sleep, sedate and calm clients

Adverse effects :
- hangover-effect, dizziness, CNS depression
- respiratory depression, drug-dependence
Nursing considerations :
1. Warn clients of injuries and falls.
2. Brief period of confusion and excitement upon waking up is common with
benzodiazepines.
3. Warn clients not to discontinue medications abruptly without consulting a physician.
4. Avoid alcohol while taking these drugs.
6. Rotate and don’t shake the ampules of barbiturates. Don’t mix with other drugs.
7. Warn female clients that diazepam is associated with cleft lip.




Antidepressants and Mood Disorder Drugs
Prototype :
a. Tricyclic antidepressants
- amitriptyline (Elavil), protriptyline (Vivactil),
- imipramine (Tofranil), desipramine
b. MAO (monoamine oxidase inhibitors )
- isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Pernate)
c. Second-generation antidepressants
- fluoxetine (Prozac), trazodone (Desyrel)
d. Lithium
Mechanism of actions :
a. Tricyclic antidepressants
- increase receptor sensitivity to serotonin and/or norepinephrine.
b. MAO inhibitors
- inhibit the enzyme MAO that metabolize the neurotransmitters norepinephrine and
serotonin.
c. Second – generation antidepressants
- inhibits the reuptake of serotonin.
d. Lithium
- increase serotonin & norepinephrine uptake
Adverse effects :
- dry mouth, blurred vision, urine retention, constipation (anticholinergic effects)
- orthostatic hypotension, insomnia
- hypertensive crisis (MAO)
- dehydration (Lithium).
Nursing considerations :
1. Caution client to rise slowly to reduce the effects of orthostatic hypotension.
2. Take antidepressant with food to enhance absorption
3. Explain to client that full response may take several weeks (2 weeks).
4. Assess client for constipation resulting from tricyclic antidepressant use.

5. Client taking MAO inhibitors should avoid tyramine-rich foods to avoid
hypertensive crisis.
- aged cheese, sour cream, yogurt, beer, wine, chocolate, soy sauce and yeast
- pentholamine (Regintine) is the drug of choice for hypertensive crisis.
6. Inform physician and withhold fluoxetine if client develop rashes.
7. Take lithium with food to reduce GI effects
- > 1.5 mEq/L blood level may cause toxicity manifested by:
confusion, lethargy, seizures,hyperreflexia.
- maintain salt and adequate fluid intake
- tremors may occur but it is temporary
- monitor white blood cell count (increase).



Antipsychotic drugs (Neuroleptics)
Prototype :
a. Phenothiazines
- chlorpromazine (Thorazine),
- trifluoperazine (Stelazine),
- thioridazine (Mellaril)
b. Other Agents
- clozapine (Clozaril), haloperidol (Haldol)
Mechanism of action :
- block dopamine receptor in the limbic system, hypothalamus, and
other regions of the brain.
Adverse effects :
- Extra pyramidal symptoms such as dystonia, pseudoparkinsonism, and
an irreversible tardive dyskinesia as manifested by :
a. lip smacking
b. fine wormlike tongue movement
c. involuntary movements of arms and leg.
- Neuroleptic malignant syndrome
a. fever, tachycardia, tachypnea, diaphoresis, cardiovascular collapse
b. muscle rigidity, seizures.
- orthostatic hypotension
Nursing considerations :
1. Teach family members the signs of EPS and NMS, and report to physician
immediately.
2. Normalization of symptoms may not occur for several weeks after beginning of
therapy .
3. Avoid administering haloperidol intravenously
4. Watch out of neutropenia with clozapine.
5. Watch out for orthostatic hypotension and photosensitivity with phenothiazine.
6. Be sure that oral doses are swallowed, and not hoarded.