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Transcript
Sedation and
antipsychotics
Rachel Shynn
Clinical Nurse Educator
Community Mental Health
Definition
se·da·tion
1.the calming of mental excitement or abatement
of physiological function, esp. by the
administration of a drug.
2. the state so induced.
http://dictionary.reference.com/
Sedation
Sedation is associated with both newer and
traditional antipsychotics.
Tends to be more pronounced at the initiation of
therapy or upward dose titration.
Starting at low doses and stepping up the dose
slowly can reduce the impact.
Patients should be warned to expect sedation in
the early stages of treatment
Therapeutic guidelines psychotropic, version 5. 2003.
Sedation
Sedation is divided in 3 areas:
Sedation for the acutely disturbed client.
Sedation as a adverse effect.
Sedatives as individual agents
Acutely disturbed client
In most cases the urgent need with acutely
disturbed patient is to achieve sedation to:
Reduce the risk of the pt harming themselves or
others.
Reduce agitation, acute psychotic symptoms.
Allow diagnostic assessment to proceed
Allow transport to an appropriate treatment setting
Sedation as a adverse
effect
All antipsychotic drugs, if given in sufficiently
high doses, have sedative effects.
Antipsychotics can cause sedation within, and
even in some cases below, the optimal
therapeutic range.
These effects are often temporary, Need to
assure the pt that the degree of sedation is likely
to decline over 1-2 weeks.
Therapeutic guidelines psychotropic, version 5. 2003.
Continue
If the degree of sedation is unacceptable- pt
safety and well being, then reduce dose and or
changing to a less sedating drug.
Most sedating
The most sedating of the commonly used drugs
are
Clozapine
chlorpromazine
Olanzepine
Quetiapine
and Zuclopenthixol.
Sedatives as individual
agents.
Anxiolytics and Hypnotics
Benzodiazepines- eg Clonazepam, diazepam,
lorazeapm, nitrazepam, temazepam, alprazolam.
These are mainly effective in relieving anxiety
symptoms and will induce sleep if given in larger
doses.
Drowsiness is a common initial reaction
psychomotor performance may be impaired
also given for drug withdrawal.
Mims online
Nursing implications
After sedation has been achieved (acutely
disturbed and -ve adverse effects) pt may need
to be:
monitored closely (+ Calm and supportive)
Vital signs
monitored for other adverse effects-respiratory
depression, excessive sedation, dystonic reaction
such as choking).
Legal implications- Poisons act etc
Management of mental disorders, Volume 2. WHO: Fourth edition.