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Extrapyramidal Side Effects: (3)
- Acute Dystonia
- Pseudoparkinsonism
- Akathisia
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Treatment of extrapyramidal side effects:
discontinue or anticholinergic
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Occurs in first three days.
Acute dystonia
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Acute muscular rigidity and cramping
Stiff or thick tongue with difficulty swallowing
Laryngospasm
Resp difficulties
Acute dystonia signs and symptoms
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Treatment for acute dystonia:
- IM or IV ANTICHOLINERGIC
- (Cogentin or Benadryl)
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Acute dystonia is a medical emergency, take care of ASAP!
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Occurs after weeks to months.
Pseudoparkinsonism
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Stooped posture
Mask like faces
Shuffling
Cogwheel rigidity
Drooling
Tremors
Coarse pill rolling movements
Pseudoparkinsonism signs and symptoms
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Treatment of Pseudoparkinsonism
Change medication or use an anticholinergic.
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Dopamine agonist for Pseudoparkinsonism symptoms
amantadine
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Occurs in first 10 days.
Akathisia
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Intense need to move about
Restless or anxious
Agitated
Rigid posture or gait
Lack of spontaneous gestures
Akathisia
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Treatment for akathisia
betablocker, anticholinergic, or benzo.
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NMS
Neuroleptic Malignant Syndrome
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SEVERE! Potentially fatal reaction!
NMS (neuroleptic malignant syndrome)
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Rigidity
SUDDEN high fever
Unstable BP, sweating, pallor
Delirium
Elevated CPK levels
Confused and mute
Agitation to stupor
Neuroleptic Malignant Syndrome signs and symptoms.
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In the 1st two weeks of therapy:
Immediate d/c of meds and supportive medical care.
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Treatment for neuroleptic malignant syndrome:
- Treat the symptoms.
- antipyretics, benzo's for anxiety, dantrolene for muscle relaxations
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Side affect that is life alterating change.
Metabolic Syndrome
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Insulin resistance
HTN
High serum lipids
Obesity
Coagulation abnormalities
Metabolic Syndrome
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Not a life threatening side effect.
This is irreversible and does not go away!
Tardive Dyskinesia
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Permanent involuntary movements
Tardive dyskinesia
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Involuntary movements of:
- tongue
- facial and neck muscles
- upper and lower extremities
- tongue thrusting and protruding; lip smaking
- blinking or grimacing
Tardive dyskinesia
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Test used to check or tardive dyskinesia
AIMS test.
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Side effect that causes decreased WBC
Agranulocytosis
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Agranulocytosis occurs with what medication?
Clozaril
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Infection
High fever
Chills
Sore throat
Malaise
Ulceration of mucous membranes
Agranulocytosis signs and symptoms
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Discontinue drug with WBC < _____?
2000
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Obtain WBC weekly for 6 months.
Then every two weeks.
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If baseline WBC is < ______, do not start clozaril
3500
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If WBC drop less than 2000, discontinue medication.
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Anticholinergic side effects:
- - Orthostatic hypotension
- - Dry mouth
- - Constipation
- - Urinary hesitance or retention
- - Blurry near vision
- - Dry eyes, photohobia
- - Nasal congestion
- - Decreased memory
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The doctor will not usually order any medications for anticholinergic side effects.
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