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Yıl:2018; Cilt: 8; Sayı: 2>> Özet
Psikiyatride Güncel; 2018;8(2):130-136
Nörolojik bulgulara yol açan farmakodinamik etkileşimler ve klinik sonuçlar
H Güleç, H Usta
SBÜ Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi, İstanbul
Şizofreni başta olmak üzere birçok psikiyatrik ve psikiyatri dışı hastalıklarda antipsikotikler tercih edilmeye devam etmektedir. Hal böyle olunca da antipsikotik kullanımına bağlı yan etkiler hala güncelliğini korumaktadır. Bu yan etkiler psikiyatrinin yakın tarihini bir gözden geçirme olarak da ele alınabilir. Tedavi stratejilerinin ve ilaç gelişiminin başlıca nedenlerinden biridir. Yaygın görülmesi ve bazı formlarının hayatı tehdit edici olması nedeniyle uygulamalarda klinisyenin sürekli dikkatinde olması gerekir. İlaçlara bağlı nörolojik yan etkilerin tanı ve ayırıcı tanısının yapılması, devam eden ilaç uygulamalarında önemlilik arz eder, bir o kadar da bu yan etkiyle baş etme yaklaşımında çok önemli olacaktır. Klinik uygulamalarda birden fazla ilaç uygulamalarının artık sık görüldüğü hatta kural olarak görüldüğü daha sık dile getirilmektedir. Birçok psikiyatrik ve tıbbi hastalığın birlikte görülmesi de aynı anda birden fazla ilaç kullanımının diğer nedenlerindendir. Aynı zamanda ilaç-madde kötüye kullanımları, bitkisel amaçlı ürünlerin yaygın kullanımı kişilerde çoklu ilaç kullanımının ne kadar sık karşımıza çıkabileceğini göstermektedir. İlaç etkileşimleri klinik uygulamalarda hatırda tutmamız gereken konumdadır. Tekli tedavilerde görülen yan etkiler çoklu tedavilerde daha düşük dozlarda görülmeye başlayabilir. İlaç uyumunu bozan en önemli etmenlerden biri olan ekstrapiramidal sistem semptomları, tedavi dozlarında karşımıza çıkabilir. Etki düzeneklerine hakim olmak, ciddi boyutlara ulaşabilecek bu soruna yaklaşımda gereklidir. Konvulsiyonlar diğer yan etkilerin bir bulgusu olabileceği gibi tek başına da görülebilmektedir. Daha nadir ancak ölümcül olabilen serotonin sendromu, merkezi sinir sistemi depresyonu ve nöroleptik malign sendrom çoklu ilaç kullanımında görülebilen yan etkilerdendir.
Pharmacodynamic interactions leading to neurological symptoms and clinical outcomes
Antipsychotics continue to be preferred in many psychiatric and non-psychiatric disorders, especially in schizophrenia. However, side effects due to antipsychotic use still remain the current. These side effects can also be considered as a review of the recent history of psychiatry. It is one of the main reasons for treatment strategies and drug development. Because of its common appearance and the fact that some of its forms are life-threatening, the clinician must be constantly careful in practice. Diagnosis and differential diagnosis of neurological side effects due to antipsychotics is important in ongoing drug applications, and it will be very important in approaching coping with this side effect. Frequently, the practice of multiple drug applications is often mentioned as a frequent occurrence or even as a rule in clinical practice. Comorbidities of many psychiatric and medical illnesses are another cause of multiple drug use at the same time. Drug-substance abuse at the same time, the widespread use of herbal products, shows how often people are confronted to multidrug use. Drug interactions are the situation we need to remember in clinical practice. Side effects seen in monotherapy may begin to appear at lower doses in multiple treatments. Extrapyramidal system symptoms as the most important problems of drug compliance may occur at treatment doses. Dominating the mechanisms of action is necessary in approaching the problem that can reach these serious problems. Convulsions can also be seen alone, as they can be a finding of other side effects. Serotonin syndrome, CNS depression, and neuroleptic malignant syndrome, which may be more rare but fatal, are side effects of multiple drug use.

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