Chapter 13: Central Nervous System Stimulants and Related Drugs

Atomoxetine represents a norepinephrine reuptake inhibitor that offers an alternative mechanism with reduced abuse potential. Nonamphetamine stimulants including modafinil and armodafinil provide wakefulness-promoting effects for narcolepsy and circadian rhythm sleep disorders without the same dependence liability. The chapter addresses weight management pharmacology through anorexiant agents such as phentermine and lipase inhibitors like orlistat, examining their role in obesity treatment alongside lifestyle modifications. Analeptic drugs including caffeine, theophylline, and doxapram are presented for their respiratory stimulation properties in conditions such as neonatal apnea and chronic obstructive pulmonary disease with carbon dioxide retention. Migraine management encompasses both acute and preventive strategies using serotonin receptor agonists known as triptans, ergot-derived vasoconstrictors, and emerging calcitonin gene-related peptide antagonists that represent advances in migraine pathophysiology-based treatment. Critical content includes comprehensive adverse effect profiles such as hypertension, anxiety, tremor, gastrointestinal disturbance, and rebound headache phenomena that require clinical vigilance. Nursing responsibilities form an essential component, emphasizing baseline cardiovascular and neurological assessment, continuous vital sign monitoring, patient education regarding scheduled drug holidays for ADHD medications to prevent tolerance, dietary management to mitigate appetite suppression, sleep hygiene interventions, and substance misuse risk stratification. The chapter integrates pharmacological mechanisms with evidence-based nursing practice to optimize therapeutic outcomes while minimizing complications and supporting patient safety across diverse clinical settings.