Dystonic / Extrapyramidal Reactions

Question 1

Dystonic / Extrapyramidal reactions are characterized by: (4)

Answer 1

an unusual posture, change in muscle tone, drooling, and uncontrolled movements.

Question 2

These reactions most often occur ____________

Answer 2

shortly after initiation of drug treatment.

Question 3

_________ when administered usually causes marked improvement if not total resolution of symptoms.

Answer 3

Diphenhydramine

Question 4

Signs and symptoms of these reactions include: (6)

Answer 4

eye deviation in all direction, protrusion of tongue, forced jaw opening or spasms, facial grimacing, deviation of the head, difficulty speaking

Question 5

What are 9 differential diagnoses?

Answer 5

conversion disorder, mandible dislocation, hypocalcemia, hypomagnesemia, meningitis, status epi, stroke, tetanus, drug toxicity (anticholinergic, carbamazepine, phenytoin, valproate.)

Question 6

What are the 4 parts of the EMT-B portion of this assessment?

Answer 6

Initial assessment, pulse oximetry w/ oxygen, suction orophraynx if needed, obtain blood glucose sample.

Question 7

What are the 4 parts of the Paramedic portion of this assessment?

Answer 7

place patient on the cardiac monitor, establish an IV, administer diphenhydramine 25-50 mg IV or IM, transport.

Question 8

What are the two common types of dystonia?

Answer 8

spasmodic torticollis and blepharospasm

Question 9

What is spasmodic torticollis and what are the 4 types of it?

Answer 9

Called cervical dystonia, common. Affects the muscles of the neck causing the head to assume unnatural postures or turn uncontrollably. 1) Laterocollis (head turns), 2) Rotational torticollis (head twists to one side) 3) Anterocollis (head tilts forward) 4) Retrocollis (head tilts backward.)

Question 10

What is blepharospasm?

Answer 10

Involuntary contraction of the eyelids, leads to uncontrollable blinking and closure of the eyes.

Question 11

What are the common anti depressant drugs that can cause dystonia? (7)

Answer 11

Amitriptyline, Amoxapine (Asendis), Bupropion, Clomipramide (Anafranil), Doxepin (Sinequan), Trimipramine (Surmontil), Trazondone (Molipaxin.)

Question 12

What are the common neuroleptic agents that can cause dystonia? (7)

Answer 12

Chloropromazine (Largactil), Clozapine (Clozaril), Fluphenazine (Moditen), Haloperidol, Perphenazine (Fentazin), Promazine, Trifluoperazine (Stelazine)

Question 13

What are common miscellaneous drugs that can cause dystonia? (5)

Answer 13

lithium, versed, phenytoin (epanutin), promethazine (phenergen), verapamil (securon)

Question 14

What are the common anti-anxiety agents that can cause dystonia? (2)

Answer 14

alprazolam (xanax), buspirone (buspar)

Question 15

What are the common anti nausea/vomiting agents that can cause dystonia? (2)

Answer 15

metoclopramide (maxolon), prochlorperazine (stemetil)