Cuidados de enfermagem frente ao uso de antipsicóticos

Nursing care regarding the use of antipsychotics

Antipsychotics reduce symptoms of psychosis, such as schizophrenia. Antipsychotics can be considered typical and atypical, as they generate serious adverse effects that alter the lives of health service users. These drugs are also known as antipsychotics and were born out of a serendipitous discovery by Dalay and Deniker, in the early 1950s, with Chlorpromazine, a drug still in use today. In the discovery one can note the sedative and hypnotic effects of the drug. Gradually, new discoveries were made by derivatives of this drug, such as phenothiazines and butyrophenone (haloperidol).

classification

Antipsychotics are classified into typical, also called first-generation antipsychotics, and atypical, known as second-generation antipsychotics. It is characterized by its mechanism of action. Typical antipsychotics block dopamine receptors, especially D2. On the other hand, atypical antipsychotics block both dopamine D2 receptors and serotonergic 5HT2A receptors. The adverse effects of these drugs are determined by the actions of these reaction units.

Typical antipsychotics improve positive psychotic symptoms, but cause more extrapyramidal effects that are classic: tremor, acute dystonia, block movement, akathisia, a combination of these we call parkinsonism, but we can still observe tardive dyskinesia and malignant syndrome. for psychosis. The main representatives of this class are haloperidol and chlorpromazine. Since they are often used to treat positive signs and symptoms, we need to know that these are: hallucinations, delirium, psychomotor agitation, and disorganization of thought.

Read also: Is ketamine an effective alternative to haloperidol in the agitated patient?

On the other hand, antipsychotic drugs that are atypical are characterized as acting on 5HT2A dopamine receptors, which frequently act on negative symptoms such as: social isolation, psychotic syndromes associated with depressive symptoms, emotional suppression, speech poverty, learning and concentration difficulties, and cognitive deficits. . They are less aggressive compared to traditional medicines and can be used for different conditions, such as anxiety and mood disorders such as bipolar disorder. Some of these drugs are: risperidone, olanzapine, quetiapine, clozapine.

Although these medications are widely used in clinic in the treatment of various psychiatric conditions, nursing professionals are often responsible for the care and do not have proper knowledge of the adverse effects of these medications, allowing for better care procedures. First, dehydration and hydro-electrolyte imbalance can be observed in the use of these drugs, the water balance of this patient is important, in addition, the psychomotor effects are most affected in neurotoxicity, in which the user experiences tremor and motor incoordination. Professionals should continually evaluate use, as it is necessary to reduce dosage when effects are adverse.

Extrapyramidal effects are the most severe and should be of constant concern by the nursing staff, including rigidity, bradykinesia, tremor, acathesia, involuntary movements, and facial expression. Weight gain and metabolic effects, as well as anticholinergic effects such as: dry mouth, blurred vision, decreased urination frequency and urinary retention. Other symptoms should be considered, such as drowsiness which causes many patients to fall from their height. Change in prolactin levels.

know more: What are the risks of neurodevelopmental disorders in children exposed to antipsychotics before birth?

Nursing care in the use of antipsychotics:

  • Care in presentation, dosage and method of administration;
  • Care of drug interactions with other classes of drugs, especially anxiolytics or tranquilizers, and guidance when using alcohol and anticonvulsants. Antidiarrheal antacids may alter the effect of the medicine.
  • Attention to the risk of falling, which is very common, due to postural hypotension, possibility of seizure and blurred vision;
  • care with regard to food and hygiene, since impaired motor function can make it difficult to handle tools;
  • take care of physical activity and good nutrition, because weight gain is important;
  • Be aware of any development of motor symptoms, such as stiffness, catatonia, fever, the patient may begin in the form of a neuroleptic malignant syndrome that can lead to death, as it is a condition that leads to rhabdomyolysis and other physiological changes.

Other care can be built by observing the social, active, and emotional life of the health service user. These drugs can alter sexual desire and make erections difficult, requiring care for this condition, in addition to affecting other functions in professional life, and the impact on the user’s life must be analyzed subjectively. In addition, create a unique treatment plan that considers medications, potential adverse effects, and how to provide the most outstanding care.

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