Lithium, SSRIs, MAOIs ak Ijans Yo Ka Koze

🧠 Poukisa sa enpòtan

LITHIUM: nivo terapetik 0.6 a 1.2 mEq/L; toksisite pi wo pase apeprè 1.5 parèt tankou tranbleman ki gwo, kè plen, vomisman, dyare, ataksi ak konfizyon, epi pi wo pase 2.5 tankou kriz ak aritmi. Kenbe konsomasyon sodyòm ak likid stab: swe, dezidratasyon, rejim ki fèb nan sèl, NSAIDs ak dyiretik tyazid yo tout ogmante nivo lithium. SSRIs yo pran 2 a 4 semèn pou yo travay; konbine medikaman sewotonèjik yo ka koze SENDWOM SEWOTONIN: ajitasyon, ipètèmi, dyafòrez, ipèreflèksi ak klonis. Pa janm sispann SSRIs yo brid sou kou. MAOIs plis manje ki rich an TYRAMINE (fwomaj ki viye, vyann ki trete, diven wouj, sòs soya, manje ki fèrmante) koze yon KRIZ IPÈTANSIF ak gwo maltèt. TRICYCLICS yo se antikolinerjik epi yo letal nan surdozaj, kidonk limite kantite a pou pasyan ki gen ris. ANTIPSYCHOTICS yo koze sentòm ekstrapiramidal (distoni egi, akatizi, pseudoparkinsonis, ak diskinezi tadiv, ki ka pèmanan) ak SENDWOM MALEN NEWOLEPTIK: gwo lafyèv, rigidite miskilè tankou plon, ak enstabilite otonom; sispann medikaman an epi refwadi pasyan an. CLOZAPINE koze agranilositoz, kidonk kontwole kantite absoli netrofil yo epi rapòte gòj fè mal oswa lafyèv. BENZODIAZEPINES yo pa janm sispann brid sou kou akòz kriz sevraj.

LITHIUM: therapeutic level 0.6 to 1.2 mEq/L; toxicity above about 1.5 shows as coarse tremor, nausea, vomiting, diarrhea, ataxia and confusion, and above 2.5 as seizures and arrhythmias. Keep sodium and fluid intake steady: sweating, dehydration, low-salt diets, NSAIDs and thiazide diuretics all raise lithium levels. SSRIs take 2 to 4 weeks to work; combining serotonergic drugs can cause SEROTONIN SYNDROME: agitation, hyperthermia, diaphoresis, hyperreflexia and clonus. Never stop SSRIs abruptly. MAOIs plus TYRAMINE-rich foods (aged cheese, cured meats, red wine, soy sauce, fermented foods) cause a HYPERTENSIVE CRISIS with severe headache. TRICYCLICS are anticholinergic and lethal in overdose, so limit the supply for at-risk clients. ANTIPSYCHOTICS cause extrapyramidal symptoms (acute dystonia, akathisia, pseudoparkinsonism, and tardive dyskinesia, which can be permanent) and NEUROLEPTIC MALIGNANT SYNDROME: high fever, lead-pipe muscle rigidity and autonomic instability; stop the drug and cool the client. CLOZAPINE causes agranulocytosis, so monitor the absolute neutrophil count and report sore throat or fever. BENZODIAZEPINES are never stopped abruptly because of withdrawal seizures.

🏥 Nan lavi reyèl

🌡️ De jou apre yo ajoute yon dezyèm antipsychotic, yon pasyan gen yon tanperati 40.2 °C, li rijid tankou yon planche epi li swe ak yon tansyon ki balanse ant 180/100 ak 90/60. Sa se sendwom malen newoleptik, se pa yon enfeksyon. Enfimyè a kenbe antipsychotic la, li kòmanse mezi refwadisman epi li rele founisè a. Dantrolene ak swen sipò swiv. Yon dosye ki ta di 'lafyèv, antibyotik kòmanse' ta rate li.

🌡️ Two days after a second antipsychotic is added, a client has a temperature of 40.2 °C, is rigid as a board and sweating with a blood pressure swinging between 180/100 and 90/60. This is neuroleptic malignant syndrome, not an infection. The nurse holds the antipsychotic, starts cooling measures and calls for the provider. Dantrolene and supportive care follow. A chart that said 'fever, started antibiotics' would have missed it.

📌 Sa pou retni

• Lithium monte ak dezidratasyon, sodyòm ki ba, NSAIDs ak tyazid yoLithium rises with dehydration, low sodium, NSAIDs and thiazides
• SSRIs: 2 a 4 semèn pou yo travay; veye sendwom sewotoninSSRIs: 2 to 4 weeks to work; watch for serotonin syndrome
• NMS: lafyèv, rigidite, enstabilite otonom; clozapine: kantite netrofilNMS: fever, rigidity, autonomic instability; clozapine: neutrophil counts

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