Sedation and antipsychotics

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Sedation and antipsychotics

• Rachel Shynn
• Clinical Nurse Educator
• Community Mental Health

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Definition

• sedation
• 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/

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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.

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Sedation

• Sedation is divided in 3 areas
• Sedation for the acutely disturbed client.
• Sedation as a adverse effect.
• Sedatives as individual agents

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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

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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.

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Continue

• If the degree of sedation is unacceptable- pt
  safety and well being, then reduce dose and or
  changing to a less sedating drug.

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Most sedating

• The most sedating of the commonly used drugs are
• Clozapine
• chlorpromazine
• Olanzepine
• Quetiapine
• and Zuclopenthixol.

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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

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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.