50mg vyvanse (lisdexamfetamine) & 20mg dex ir (when needed) for narcolepsy. my bp spikes to 140/100 with chest tightness once in awhile and feels horrible. doc said ok?

Nope: "chest tightness" + "bp spikes" - represents a cardiac event waiting to happen. Not ok. Based on what docs call the "pharmacokinetic curves" of both of your two forms of dextroamphetamine) - you are probably getting a spike at around the 2 - 4 hour mark. I would investigate either Provigil or Nuvigil - both approved for narcolepsy. They are first line + don't typically have cardiac se's.