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Extrapyramidal Side Effects: (3)
- Acute Dystonia
Treatment of extrapyramidal side effects:
discontinue or anticholinergic
Occurs in first three days.
Acute muscular rigidity and cramping
Stiff or thick tongue with difficulty swallowing
Acute dystonia signs and symptoms
Treatment for acute dystonia:
- IM or IV ANTICHOLINERGIC
- (Cogentin or Benadryl)
Acute dystonia is a medical emergency, take care of ASAP!
Occurs after weeks to months.
Mask like faces
Coarse pill rolling movements
Pseudoparkinsonism signs and symptoms
Treatment of Pseudoparkinsonism
Change medication or use an anticholinergic.
Dopamine agonist for Pseudoparkinsonism symptoms
Occurs in first 10 days.
Intense need to move about
Restless or anxious
Rigid posture or gait
Lack of spontaneous gestures
Treatment for akathisia
betablocker, anticholinergic, or benzo.
Neuroleptic Malignant Syndrome
SEVERE! Potentially fatal reaction!
NMS (neuroleptic malignant syndrome)
SUDDEN high fever
Unstable BP, sweating, pallor
Elevated CPK levels
Confused and mute
Agitation to stupor
Neuroleptic Malignant Syndrome signs and symptoms.
In the 1st two weeks of therapy:
Immediate d/c of meds and supportive medical care.
Treatment for neuroleptic malignant syndrome:
- Treat the symptoms.
- antipyretics, benzo's for anxiety, dantrolene for muscle relaxations
Side affect that is life alterating change.
High serum lipids
Not a life threatening side effect.
This is irreversible and does not go away!
Permanent involuntary movements
Involuntary movements of:
- facial and neck muscles
- upper and lower extremities
- tongue thrusting and protruding; lip smaking
- blinking or grimacing
Test used to check or tardive dyskinesia
Side effect that causes decreased WBC
Agranulocytosis occurs with what medication?
Ulceration of mucous membranes
Agranulocytosis signs and symptoms
Discontinue drug with WBC < _____?
Obtain WBC weekly for 6 months.
Then every two weeks.
If baseline WBC is < ______, do not start clozaril
If WBC drop less than 2000, discontinue medication.
Anticholinergic side effects:
- - Orthostatic hypotension
- - Dry mouth
- - Constipation
- - Urinary hesitance or retention
- - Blurry near vision
- - Dry eyes, photohobia
- - Nasal congestion
- - Decreased memory
The doctor will not usually order any medications for anticholinergic side effects.