29.2 Medication-Induced Movement Disorders Flashcards
What are the symptoms of neuroleptic-induced Parkinsonism?
Muscle stiffness, cogwheel rigidity, shuffling gait, stooped posture and drooling.
What is Rabbit syndrome?
Perioral tremor that is another parkinsonian effect seen with antipsychotics
When do Parkinsonian symptoms typically occur?
Within 5-90 days of initiation of treatment.
What are some treatments for Parkinsonian symptoms?
Cogent, Amantadine, Benadryl.
How long should anticholinergics be used for parkinsonian symptoms?
They should be withdrawn 4-6 weeks after initiation to assess whether tolerance to the parkinsonian effects has developed.
About half of patients require continued treatment.
How long after withdrawal of antipsychotic do the parkinsonian symptoms last?
Can be a few days up to 3 months, especially in the elderly. Anticholinergics can be continued as needed.
What is the clinical presentation for Neuroleptic malignant syndrome? Lab findings?
The motor and behavioral symptoms include muscular rigidity and dystonia, akinesia, mutism, obtundation, and agitation.
The autonomic symptoms include hyperthermia, diaphoresis, increased pulse and BP.
The labs findings include increased WBC, increased CPK, increased liver enzymes, plasma myoglobin and myoglobinuria, occasionally associated with renal failure.
What is the mortality rate of Neuroleptic malignant syndrome?
Can be up to 10-20%
What is the treatment for neuroleptic malignant syndrome?
Most commonly Dantrolene, Bromocriptine and sometimes Amantadine in addition to supportive medical treatment.
What are dystonias?
Brief or prolonged contractions of muscles that result in obviously abnormal movements or postures.
What is thought to be the mechanism of action in dystonias?
Dopaminergic hyperactivity in the basal ganglia that occurs when CNS levels of the drug begin to fall between doses.
What is Akathisia?
A subjective feeling of restlessness, objective signs of restlessness, or both.
What are the three basic steps in treating akathisia? What drugs are used?
Reducing the dose, attempting treatment with appropriate drugs, and considering changing the medication.
When does tardive dyskinesia usually occur?
It is typically a delayed effect of antipsychotics, rarely occurring until after 6 months of treatment.
Name all the possibly symptoms of Tardive Dyskinesia?
Abnormal, involuntary, irregular choreoathetoid movements of the muscles of the head, limbs, and trunk.
Perioral movements are the most common; darting, twisting, tongue protrusion, chewing and lateral jaw movements, lip puckering and facial grimacing.
Finger movements and hand clenching are also common.
Torticollis, retrocollis, trunk twisting and pelvic thrusting occur in severe cases.
In the most serious cases patients may have breathing and swallowing irregularities that result aerophagia, belching and grunting. Respiratory dyskinesia has also been reported.
