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Neuroleptic malignant syndrome

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Nurses’ Role in Controlling Effects of Psychopharmacology For nurses to provide the best medical care for patients suffering from mental problems, they should be aware of the effects of psychopharmacology and also how to manage the side effects once they occur. One of the first side effects is Agranulocytosis. This is a blood disorder characterized by reduction of white blood cell count; this leads to increased risk of contracting diseases. Clozapine is the only anti psychotic drug that is associated with this disorder and may affect up to 3% of all patients using it. Though re-introduced in the ‘90s, Clozapine was once banned in the ‘70s and is now administered under strict supervision from the Clozapine Patient Monitoring Service. Agranulocytosis is hard to detect and is only visible once the symptoms of the infection start to appear. The symptoms include: mucosal ulcers, sore throat and rising temperatures. Nurses should be aware of these signs and should stop administering of Clozapine at the onset of these symptoms. (Keogh & Doyle 2008)
Neuroleptic malignant syndrome is another side effect of psychopharmacology. It is ‘an idiosyncratic reaction to neuroleptic medications’ that may be life threatening (Keogh & Doyle 2008). Though it may occur from using any neuroleptic medication, the main culprit is haloperidol. Many clients start developing symptoms of NMS within a two week time frame. The symptoms include: muscular/lead pipe rigidity, changed autonomic functions like blood pressure, increase in white blood cell count, hyperthermia, tremor and change in the mental status of patients. The nurses should be aware of these signs and immediately stop the medication. Intervention of NMS include: use of dopamine to relax muscles, electroconvulsive therapy to reduce NMS and antipyretics like paracetamol to relax the fever. (Keogh & Doyle 2008)
Special nursing care is also very important for NMS patients aside from the interventions named above. NMS patients are to be closely monitored to evaluate their mental and physical states, so that in case of a symptom breakout, early intervention is done at the initial stages of the attack. There should be routine checkups and documentations and all forms of anomalies should also be recorded and reported to relevant medical practitioners. Serotonin syndrome is also a side effect. It is a life threatening reaction to excess serotonin, although it occurs rarely. This happens when serotonin is administered with other drugs that affect the serotonergic system, for instance the tricyclic medication. Symptoms include: myoclonus, tremors of fingers and tongue, shivering, sweating, high temperatures, euphoria and intoxication, diarrhoea, tachycardia, confusion and restlessness. Nurses should closely monitor these signs and also regularly inspect urine output of the patients. (Keogh & Doyle 2008)
Keogh, B., & Doyle, L. (2008). Psychopharmacological adverse effects. Mental Health Practice, 11(6), 28-30.

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