Parkinsonian side-effects - reduce dose of haloperidol or change to lorazepam.Sedation in 1 hour, peak effect in 2-6 hours (oral).Wait 45-60 minutes and repeat up to four hourly to a maximum dose of 6mg/24 hours: Oral haloperidol 500 micrograms to 1mg single dose (if patient refuses oral treatment consider I/M haloperidol 500 micrograms to 1mg single dose) If any parkinsonism is present avoid haloperidol.ĭo not use haloperidol in neuroleptic-naïve patients or if DLB is suspected. Patients with or at risk of respiratory depression.Lorazepam is not to be used in patients with or at risk of respiratory depression Sedation in 30-45 minutes, peak effect in 1-3 hours.Oral lorazepam 500 micrograms to 1mg single dose (if patient refuses oral treatment consider I/M lorazepam 500 micrograms to 1mg single dose). Dementia with Lewy Bodies (DLB) (see below).Any features of Parkinson's disease or extra-pyramidal side-effects (EPSE).Review all medication at least every 24 hours, medication should usually be discontinued 7-10 days after symptoms resolve.Tailor dose according to age, body size and degree of sedation, titrate dose to effect.Sedation may be used when carrying out essential investigations or treatment, to prevent the patient endangering themselves or to relieve distress in an agitated or hallucinating patient If using any sedatives, tail off any sedation after 24-48 hours if possible.Baseline ECG is recommended prior to treatment with haloperidol in all patients, especially in the elderly and patients with a positive personal or family history of cardiac disease or abnormal findings on cardiac clinical examination.All medication should be reviewed as frequently as possible.Use one drug only if possible, starting with the lowest dose and titrating upwards if necessary.Use of sedatives or major tranquilisers should be kept to a minimum.It is important to remember the following basic principles: In these patients detection is also important because of the high morbidity and mortality of delirium. Some elderly people present with a hypoactive form of delirium where the patient is quiet, withdrawn and may not need sedation. Frequent complications of delirium are:įalls, Pressure sores, Malnutrition, Continence problems, Functional impairment This may include an assessment of risk, remedying any cause of agitation such as thirst, pain, need for toilet or when required trying a distraction technique. Patients who wander require a close observation in a safe environment using as few restrictions as possible acting in the best interest of the patient. Catheterise unless essential, as this can precipitate delirium.Use anticholinergic drugs and keep drug intervention to a minimum.Use physical restraint or argue with patients.For medical inpatients, consider referral to liaison.Encourage visits from family and friends who may help calm the patient down and bring some familiar objects and pictures from home.Encourage mobility and engagement with group activities.Prevent dehydration by encouraging the patient to drink or use intravenous fluids if necessary.Provide pain relief by giving regular paracetamol if needed.Give consistent nursing care with a gentle, calm approach.Ensure use of hearing aids and glasses if needed.Give regular cues to re-orientate, use clocks and calendars.Provide a quiet environment and use adequate lighting levels appropriate for the time of the day.It is commonly associated with medical and physical conditions, and with increasing age. Delirium develops over a short period of time (usually hours to days) tends to fluctuate during the course of the day and worsens at night. 4.13 Miscellaneous nervous system preparationsĭelirium is an acute confusional state characterized by an alteration of consciousness with reduced ability to focus, sustain or shift attention.4.10 Drugs used in substance dependence.4.9 Drugs used in parkinsonism and related disorders.4.5 Drugs used in the treatment of obesity.4.4 CNS stimulants and drugs for attention deficit hyperactivity disorder.4.2 Drugs used in psychoses and related disorders.Chemotherapy Induced Nausea and Vomiting.Treatment of schizophrenia and related psychoses.Management of acute confusion (delirium) in older people.Management of behavioural and psychological symptoms of dementia (BPSD).Treatment of obsessive-compulsive disorder and body dysmorphic disorder.Treatment of anxiety spectrum and related disorders.Adult tension headache treatment guidance.Management of low back pain and sciatica.Management of pain in substance misuse disorders.
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