| MAJOR TRANQUILLISERS (Neuroleptics) General Indications Used in all forms of psychoses especially schizophrenia. Used in controlling disturbed and parnoid behaviour during the acute phase and for maintenance in low doses. General Side-Effects The following side effects apply generally to all neuroleptics: (a) Central Nervous System effects - extrapyramidal movement disorders, including dystonia and oculogyric crises, parkinsonism, alkathisia and tardive dyskinesia. Patients often complain of sluggishness and weight gain, and at higher doses drowsiness. (b) Autonomic effects - dry mouth, blurred vision, constipation and urinary retention. Tachycardia and postural hypotension are often seen. (c) Endocrine Menstrual irregularities and galactorrhoca (lactation) are seen in a significant percentage. (d) Skin and eye - allergic skin reactions and photo toxicity are uncommon. MINOR TRANQUILLISERS General Indications and Comments For the relief of anxiety and tension in neuroses, as a muscle relaxant and as a hypnotic. Used in the treatment of delirium tremors and status epilepticus in the case of Diazepam. Note Well Nitrazepam, Chlordiazepoxide and Diazepam are all slowly metabolised and accumulate with repeated doses, particulaly in the elderly, who can sometimes lapse into a semi-comatose state on a normal adult dose: Lorazepam has a much shorter half-life (3-8 hours) and is preferable for night sedation. PHENYTOIN NOMOGRAM Given a single reliable serum concentration on a given daily dose of phenytoin, the dose required to achieve a desired serum concentration can be predicted. A line is drawn connecting the observed serum concentration (left‑hand scale) with the dose administered (centre scale) and extended to intersect the right-hand vertical line. From this point of intersection, another line is drawn back to the desired serum level (left-hand scale). The dose required to produce this level can be read off the centre scale. Note: This nomogram will give misleading predictions if the serum concentration measurement is inaccurate, if the patient's compliance is in doubt, or if a change in concurrent treatment has been made since measurement of the serum concentration. (Reproduced with permission from Rambeck et al., 1979). |
