Masiqaphele iNeuroleptic Malignant Syndrome, imeko eyingozi ebangelwa ziziyobisi ze-neuroleptic!

Wena okanye umntu omaziyo usenokuba usebenzisa uhlobo lwamayeza abizwa ngokuba yi-neuroleptic, asetyenziselwa ukunyanga ezinye iimeko zempilo yengqondo. Nangona la mayeza enokuba luncedo kakhulu kubantu abaninzi, kukho iimeko ezingaqhelekanga apho la mayeza anokubangela imeko eyingozi, nesongela ubomi. Yiloo nto siyibiza ngokuba yi-Neuroleptic Malignant Syndrome (NMS). Ligama elintsonkothileyo, kodwa kubalulekile ukwazi ngalo.

Yintoni i-Neuroleptic Malignant Syndrome (NMS)? Masiyiqonde ngokulula!

Ngamafutshane, i-neuroleptic malignant syndrome (i-NMS) yindlela engaqhelekanga kakhulu kwaye enokuba yingozi ebomini xa kuziwa kudidi lwamayeza abizwa ngokuba yi-neuroleptics (ekwaziwa ngokuba ngamayeza e-antipsychotic). La mayeza asetyenziselwa ukulawula nokunyanga iimpawu zeengxaki ezininzi zempilo yengqondo.

Iimpawu eziphambili ezininzi zinokubonwa kule meko ye-`NMS`:

• Ukuba nomkhuhlane ophezulu (i-hyperthermia).
• Izihlunu emzimbeni ziyaqina kwaye zibe buhlungu (ukuba oku kuyaqhubeka, izihlunu zinokude ziqhekeke).
• Utshintsho kwisimo sengqondo (njengokudideka, ukulahlekelwa yinkumbulo).
• Ukungasebenzi kakuhle kwenkqubo ye-nervous system okanye i-dysautonomia.

Inkqubo yethu yemithambo-luvo ezimeleyo ifana nenkqubo ezenzekelayo emzimbeni wethu. Ilawula izinto ezifana noxinzelelo lwegazi kunye nesantya sokuphefumla. Xa ingasebenzi kakuhle, uxinzelelo lwegazi lunokunyuka nokuhla ngequbuliso, lubangele ukubila okugqithisileyo (i-hyperhidrosis yesibini), kwaye lubangele ukuqunjelwa kakhulu.

I-NMS yimeko engxamisekileyo yezonyango esongela ubomi, efuna unyango olukhawulezileyo. Ngoko ke, ukuba ufumana ezi mpawu, eyona nto ingcono onokuyenza kukuya esibhedlele ngokukhawuleza.

Zithini ezi ziyobisi ze-neuroleptic?

Amayeza e-neuroleptic, okanye amayeza e-antipsychotic, anokwahlulwa abe ngamacandelo amabini aphambili.

1. Ii-antipsychotics zesizukulwana sokuqala okanye "eziqhelekileyo".

2. Ii-antipsychotics zesizukulwana sesibini okanye "ezingaqhelekanga".

Oogqirha banika la mayeza okubulala iingqondo esizukulwana sokuqala nesesibini kwiimeko ezahlukeneyo zengqondo nezemithambo-luvo. Nazi imizekelo embalwa:

• Iingxaki zokuziphatha ezenzeka kwi-dementia.
• Ukuxhuzula.
• Uxinzelelo.
• Iingxaki zokutya.
• Ingxaki yokuxhalaba ngokubanzi.
• Ukuphazamiseka kwabantu abadala.
• Ukungalali.
• Isifo sokungakhathali (OCD).
• Iingxaki zobuntu.
• Ingxaki yoxinzelelo emva kwesiganeko esibuhlungu (PTSD).
Isifo sokunganyamezelani kakuhle kwengqondo (Schizoaffective disorder). I-Schizophrenia kunye nezifo ezinxulumene nayo.

Ngawaphi amayeza anokubangela i-neuroleptic malignant syndrome (NMS)?

Kukho iintlobo ezahlukeneyo zamayeza anokubangela i-'NMS'. Makhe sijonge ukuba zeziphi.

Amayeza aqhelekileyo e-neuroleptic (antipsychotic):

• I-Bromperidol
• I-Chlorpromazine `(Chlorpromazine)`
• I-Clopenthixol
• I-Fluphenazine `(Fluphenazine)`
• IHaloperidol `(Haloperidol)`
• ILoxapine
• I-Promazine
• I-Thioridazine `(Thioridazine)`
• I-Thiothixene
• I-Trifluoperazine `(Trifluoperazine)`

Amayeza angaqhelekanga e-neuroleptic (antipsychotic):

• I-Amisulpride
• I-Aripiprazole
• I-Clozapine
• I-Olanzapine
• I-Quetiapine
• I-Risperidone
• I-Ziprasidone
• I-Zotepine

Amanye amayeza okulwa nokugabha:

• I-Domperidone
• I-Droperidol `(Droperidol)`
• I-Metoclopramide
• I-Prochlorperazine `(Prochlorperazine)`
• I-Promethazine

Amayeza e-Dopaminergic (Parkinson's) (ngokuyeka la mayeza ngequbuliso):

• I-Amantadine
• Ii-agonists ze-dopamine
• I-Levodopa
• I-Tolcapone

Musa ukothuka lolu luhlu. Asinguye wonke umntu othatha la mayeza oza kuba ne-NMS. Le yimeko engaqhelekanga kakhulu . Kodwa ukuba uthatha la mayeza, kubalulekile ukuba uqaphele oku.

Yintoni umahluko phakathi kwe-NMS kunye ne-malignant hyperthermia?

Usenokuba ukhe weva ngemeko ebizwa ngokuba yi-malignant hyperthermia. Ikwayimpendulo engaqhelekanga neqatha. Kodwa ibangelwa ngamayeza okuthomalalisa imisipha kunye neziphumzi zemisipha .

Inokubangela ukuqina kwemisipha, ukuncipha kwe-reflexes (hyporeflexia), kunye notshintsho lolusu (ubuluhlaza, ukubomvu). Ezi mpawu zinokufana nezo ze-NMS. Nangona kunjalo, oogqirha banokuzihlula zombini ngokujonga imbali yezonyango zesigulana. Oko kukuthi, nokuba basandula ukufumana i-anesthesia okanye bathathe amayeza e-neuroleptic.

Yintoni umahluko phakathi kwe-NMS kunye ne-Serotonin Syndrome?

I-Serotonin syndrome yenye imeko edidayo. Ibangelwa ngamayeza akwiklasi ye-serotonergic, afana nezinye izidambisi-ntlungu, ii-amphetamines, ii-antihistamines, kunye nezinzisa iimvakalelo. Ngamafutshane, yenzeka xa kukho ikhemikhali eninzi emzimbeni ebizwa ngokuba yi-serotonin.

Iimpawu ze-serotonin syndrome ziquka ukuqina kwemisipha, i-hyperreflexia, urhudo, ukubila, ukuxhuzula kwemisipha (myoclonus), kunye notshintsho kwisimo sengqondo. Nangona kunjalo , umkhuhlane kunye nokuqina kwemisipha kudla ngokungaqhelekanga kwi-serotonin syndrome kunakwi-NMS.

Ugqirha wakho uza kwahlula phakathi kwezi meko zimbini ngokuphulaphula iimpawu zakho kunye namayeza owasebenzisayo.

Ngubani ofumana i-neuroleptic malignant syndrome (NMS)?

I-NMS inokwenzeka nakubani na othatha amayeza e-neuroleptic (antipsychotic).

Nangona kucingelwa ukuba malunga nesibini kwisithathu samatyala e-'NMS' ayenzeka kwiveki yokuqala yokuqalisa amayeza e-neuroleptic, kubalulekile ukukhumbula ukuba le meko inokwenzeka nangaliphi na ixesha ngexesha lonyango.

Ixhaphake kangakanani le meko ye-`NMS`?

Enyanisweni, i-neuroleptic malignant syndrome (NMS) yimeko engaqhelekanga kakhulu. Iyenzeka phakathi kwe-0.01% kunye ne-3.2% yabantu abasebenzisa amayeza e-neuroleptic.

Nangona kunjalo, iindaba ezimnandi zezokuba inani leengxelo ze-NMS liyancipha ngenxa yokungeniswa kwamayeza amatsha anomngcipheko omncinci wokubangela i-NMS, kunye nokwaziwa koogqirha kunye nezigulane ngale meko.

Zithini iimpawu ze-neuroleptic malignant syndrome (NMS)?

Iimpawu ze-'NMS' zihlala ziqala ukubonakala kwiintsuku ezi-1 ukuya kwezi-3 . Iimpawu eziphambili zezi:

• Umkhuhlane ophezulu kakhulu (102 ukuya kwi-104 degrees Fahrenheit - 38.9 ukuya kwi-40 degrees Celsius).
• Ukungahambi kakuhle kwesingqisho sentliziyo (arrhythmia).
• Ukunyuka kwesantya sentliziyo (i-tachycardia).
• Ukwanda kwesantya sokuphefumla (i-tachypnea).
• Ukuqina/ukuqina kwemisipha `(ukuqina kwemisipha)`.
• Utshintsho kwisimo sengqondo (njengokudideka, ukuxhalaba, ukulahlekelwa zingqondo).
• Uxinzelelo lwegazi oluphezulu okanye uxinzelelo lwegazi oluphantsi.
• Ukubila okugqithisileyo.

Ukuba unenye okanye ngaphezulu kwezi mpawu, ingakumbi ukuba usela amayeza e-neuroleptic, nceda utsalele umnxeba ku-911 okanye uye esibhedlele esikufutshane ngoko nangoko. Le yingxamiseko yezonyango.

Amayeza e-neuroleptic ayibangela njani i-'NMS'?

Imeko ye-`NMS` ibangelwa liyeza le-neuroleptic (i-antipsychotic).Inokwenzeka ngedosi enye, ngokunyusa idosi, okanye ngokuqhubeka nokusetyenziswa kwedosi enye. Nangona i-NMS inxulunyaniswa kakhulu ne-antipsychotics yesizukulwana sokuqala, inokwenzeka, kancinci, ngokurhoxiswa ngequbuliso kwe-antipsychotics yesizukulwana sesibini, ezinye i-antiemetics, kunye namayeza e-dopaminergic asetyenziselwa isifo sikaParkinson.

Izazinzulu zisazama ukufumanisa ukuba yintoni kanye kanye ebangela i-NMS. Ingcamango yangoku kukuba ibangelwa yi -dopamine D2 receptor antagonism . I-Dopamine yi-neurotransmitter engqondweni yethu. Yikhemikhali ethwala imiyalezo phakathi kweeseli. Amayeza e-neuroleptic asebenza ngokuthintela esi sithunywa se-dopamine ukuba singangeni kwiiseli ngee-receptors ezithile.

Xa ii-dopamine receptors kwi-hypothalamus yakho kunye/okanye kwi-spinal cord zivalekile, uxinzelelo lwemisipha luyanda. Kwakhona, ukuphazamiseka kwee-dopamine receptors kwi-hypothalamus yikona okubangela umkhuhlane ophezulu kunye nokuguquguquka okukhulu koxinzelelo lwegazi olubonwa kwi-NMS.

Ifunyanwa njani i-neuroleptic malignant syndrome (NMS)?

Ukuze oogqirha bakwazi ukuxilonga i-NMS, kufuneka ube nazo zonke ezi mpawu okanye iimeko zilandelayo :

• Usebenzisa amayeza e-neuroleptic okanye ngequbuliso uyeke ukusebenzisa amayeza e-dopaminergic.
• Unemisipha eqinileyo/ukuqina kakhulu (oku kunokubangela nokuqhekeka kwemisipha).
• Unomkhuhlane ophezulu.
• Kukho utshintsho kwimeko yakho yengqondo.

Ukongeza, kufuneka kubekho ubuncinane ezimbini kwezi mpawu zilandelayo :

• Ukubila okugqithisileyo okanye okungaqhelekanga.
• Ubunzima bokuginya.
• Ukungakwazi ukulawula umchamo okanye isitulo (ukungakwazi ukuzibamba).
• Ukunyuka kwesantya sentliziyo (i-tachycardia).
• Ngequbuliso akakwazi ukuthetha.
• Utshintsho olunyukayo okanye oluqhubekayo kuxinzelelo lwegazi.
• Ukwanda kwenani leeseli ezimhlophe zegazi (i-Leukocytosis).
• Amanqanaba aphezulu e-creatine phosphokinase (CPK) ngenxa yokuqhekeka kwemisipha.
• Ukusabela okucothayo okanye okulinganiselweyo (hyporeflexia).

Zeziphi iimvavanyo ezenziwayo ukufumanisa i-'NMS'?

Ukuba ugqirha wakho ukrokrela ukuba une-NMS, unokuyalela iimvavanyo ezifana nezi:

• Iphaneli epheleleyo yemetabolism.
• Uhlalutyo lomchamo.
• Uvavanyo lwegesi yegazi oluvela kwimithambo yegazi okanye kwimithambo yegazi.
• Uvavanyo lwegazi lwe-creatine phosphokinase (CPK).

Iphathwa njani i-neuroleptic malignant syndrome (NMS)?

I-NMS yingxamiseko yezonyango. Ngoko ke kubalulekile ukuyixilonga imeko kwaye uqale unyango ngokukhawuleza. Ukuba une-NMS, kuya kufuneka ulaliswe esibhedlele.Kuya kufuneka ufumane unyango kwiyunithi yokhathalelo olunzulu (ICU).

Kuzo zonke iimeko ze-'NMS', oogqirha baya kuyimisa ngoko nangoko iyeza le-neuroleptic (i-antipsychotic) elibangele i-'NMS'. Ukongeza, baya kunyanga iimpawu ze-'NMS' baze bathathe amanyathelo okuthintela iingxaki ezinokubakho. Olu nyango lungabandakanya:

• Ukugcina uzinzo lwentliziyo kunye nokuphefumla kusetyenziswa umoya ongenisayo ngoomatshini, amayeza okunciphisa ukubetha kwentliziyo, kunye/okanye iipacemaker.
• Ukugcina ibhalansi ye-electrolyte emzimbeni ngokufaka ulwelo olufakwa kwimithambo yegazi (ii-IV fluids).
• Ukunciphisa ubushushu bomzimba kusetyenziswa iingubo zokupholisa, amanzi abandayo, kunye/okanye iipakethe zomkhenkce.
• Ukuba uxinzelelo lwegazi luphezulu, lulawule ngamayeza.
• Ukunika amayeza afana ne-heparin ukuthintela ukujiya kwegazi.
• Ukunika amayeza anokubuyisela amanqanaba aphantsi e-dopamine emzimbeni.
• Ukunika iziphumzi zemisipha okanye zamathambo.

Ziziphi izinto ezibangela umngcipheko wokuphuhlisa i-'NMS'?

Kukho izinto ezininzi ezonyusa umngcipheko wokufumana i-neuroleptic malignant syndrome (NMS):

• Ukuqala iyeza elitsha le-neuroleptic (i-antipsychotic) okanye ukwandisa umthamo.
• Ukusebenzisa amayeza angaphezu kwelinye le-neuroleptic okanye ukusebenzisa iyeza le-lithium.
• Ukuyeka ngequbuliso iziyobisi ze-dopaminergic zesifo sikaParkinson.

Kuza kuthatha ixesha elingakanani ukuchacha kwi-'NMS'? (Ingqikelelo)

Ukuba i-NMS ifunyaniswa kwangethuba kwaye inyangwa ngokukhawuleza nangendlela efanelekileyo, uninzi lwabantu luya kuphila kwiiveki ezimbini ukuya kwiintsuku ezili-14.

Nangona kunjalo, ukuba unyango lulibaziseka, iingxaki ezinzima zinokuvela ezichaphazela izihlunu, izintso, intliziyo, kunye/okanye imiphunga.

Ukuba ayinyangwa ngokukhawuleza, i-NMS inokubulala. Izinga lokufa le-NMS liqala kwi-5% ukuya kwi-20%. Nangona kunjalo, ulwazi olwandisiweyo nge-NMS kunye nokusetyenziswa kwamayeza amatsha okulwa nesifo sengqondo kuye kunciphisa eli zinga lokufa kwiminyaka embalwa edlulileyo.

Abantu abaninzi, phantsi kwesikhokelo sikagqirha, bayakwazi ukuqalisa kwakhona ngempumelelo amayeza e-neuroleptic (antipsychotic).

Zithini iingxaki ze-neuroleptic malignant syndrome (NMS)?

Ngelishwa, iingxaki ze-NMS zixhaphakile kwaye zinzima. Ezinye iingxaki zibangelwa ziimpawu ezibonisa ukuba i-NMS ayisebenzi kakuhle kunye nokungasebenzi kakuhle kwenkqubo yemithambo-luvo, ngelixa ezinye, ingakumbi usulelo, zinokubangelwa kukuhlala ixesha elide kwiyunithi yokhathalelo oluphezulu (ICU).

Ezinye zeengxaki ze-NMS zezi:

• I-Rhabdomyolysis (ukwaphuka kweeseli zemisipha - le yeyona ngxaki ixhaphakileyo).
• Ukuphelelwa ngamanzi emzimbeni.
• Ukungasebenzi kakuhle kwezintso.
• Ukungaphumeleli kokuphefumla ngokukhawuleza.
• Iimeko zokuxhuzula/ ukuxhuzula .
• Imyocardial infarction.
• Ukuqhekeka kwegazi emzimbeni wonke (ukuqhekeka kwegazi ngaphakathi kwemithambo yegazi).
• Ukungasebenzi kakuhle kwesibindi.
• Ukukrala kwemiphunga.
• I-Sepsis (iintsholongwane ezingena egazini).
• Usulelo lomchamo (UTI).
• Ukuxhuzula kwemithambo yegazi.

Ngenxa yokuba ezi ngxaki zinzima kakhulu kwaye zisongela ubomi, kubaluleke kakhulu ukufowunela u-911 ngokukhawuleza kwaye uye esibhedlele esikufutshane ukuze ufumane unyango ukuba uneempawu ze-NMS. Kwakhona, i-NMS yimeko engxamisekileyo esongela ubomi kwaye inokufuna unyango kwiYunithi yoKhathalelo oluPhezulu (ICU).

Ndifanele ndimbone nini ugqirha wam?

Ukuba uthatha iyeza elinye okanye ngaphezulu le-neuroleptics (i-antipsychotics), i-antiemetics, kunye/okanye i-dopaminergic (Parkinson's), kubalulekile ukubona ugqirha wakho rhoqo ukuqinisekisa ukuba zisebenza kakuhle kuwe. Kwakhona, buza ugqirha wakho ngemiphumo emibi yamayeza owasebenzisayo kunye neempawu ekufuneka uzazi.

Ngaba kufuneka ndiye kwiSebe leeNgxamiseko (i-ETU) ukuba ndineempawu ze-'NMS'?

Ukuba uneempawu ze-neuroleptic malignant syndrome (NMS), ezinje ngomkhuhlane ophezulu kakhulu kunye nokuqina kwemisipha, kubalulekile ukufowunela u-911 okanye uye esibhedlele esikufutshane ngoko nangoko. I-NMS ifuna unyango olukhawulezileyo. Ukuba ayinyangwa ngokukhawuleza nangendlela efanelekileyo, inokukhokelela ekufeni.

I-Neuroleptic Malignant Syndrome (NMS) yimeko embi kakhulu nesongela ubomi. Ngoko ke ukuba uneempawu, kubalulekile ukufuna uncedo lwezonyango ngokukhawuleza. I-NMS kulula kakhulu ukuyinyanga ukuba ifunyenwe kwangethuba. Nangona i-NMS ingaqhelekanga, ukuba uthatha amayeza e-neuroleptic (antipsychotic), thetha nogqirha wakho okanye ikhemisti malunga nemiphumo emibi kunye neempawu omele uziqaphele. Bakho ukukunceda.

Ezona zinto zibalulekileyo esizifundileyo kweli nqaku (Umyalezo Wokuya Ekhaya)

Kulungile, masikukhumbuze ngezinye zezona zinto zibalulekileyo ekufuneka uzikhumbule kwizinto esithethe ngazo kule 'NMS':

• I-NMS yimeko engaqhelekanga, kodwa enokuba yingozi ebomini ebangelwa ngamayeza e-neuroleptic.
• Umkhuhlane ophezulu, iintlungu zemisipha, kunye nokudideka kwengqondo zezona mpawu ziphambili.
• Ukuba ubona naziphi na kwezi mpawu, funa ingcebiso kagqirha ngoko nangoko. Musa ukulibazisa.
• Ukuba usebenzisa amayeza e-neuroleptic, thetha nogqirha wakho malunga namayeza kunye nemiphumo yawo. Musa ukoyika ukubuza imibuzo.
• I-NMS inokunyangeka ngokupheleleyo ukuba ifunyaniswe kwaye inyangwa kwangethuba.

Siyathemba ukuba unolwazi oluvela kolu lwazi. Hlala usempilweni!

I- Neuroleptic Malignant Syndrome, i-NMS, amayeza engqondo, iziphumo ebezingalindelekanga, umkhuhlane ophezulu, ukuqina kwemisipha