Medication Related Movement Disorders

Question 1

Akathisia

Answer 1

• characterized by the inability to sit still
• pacing, rocking, repetitive motions
• may be accompanied by feelings of anxiety, jitteriness, inability to relax
• most difficult to relieve, does not respond to anticholinergics

Question 2

Dystonia

Answer 2

• impaired muscle tone
• involuntary muscle spasms
• thick tongue, tight jaw, stiff neck
• protruding tongue, oculogyric crisis, torticollis
• usually the first EPS to occur

Question 3

Parkinsonism

Answer 3

• rigidity, slowed movements, tremor
• loss of spontaneous movements ie swinging arms while walking
• mask-like affect

Question 4

Tardive Dyskinesia

Answer 4

• irregular, repetitive, involuntary movements of mouth, face, and tongue
• chewing, tongue protrusion, lip smacking, puckering lips, rapid blinking
• sometimes abnormal finger, trunk, or limb movements
• later onset - no earlier than after 6 months of treatment or when treatment is reduced or withdrawn
• doesn’t resolve when medication is discontinued

Question 5

Medications used for medication related movement disorders

Answer 5

• Anticholinergics:
  - bentropine (Cogentin) 2-
  6mg/day
• Antihistamines:
  - dimenhydramine (Benadryl)
  25-50mg QID - 400mg daily
• Dopamine Agonists:
  - amantadine (Symmetrel) 100-400mg daily
• Beta Blockers
  - propranolol *must monitor BP and HR
• Benzodiaepines
  - lorazepam
  - diazepam (Valium)
  - clonazepam (Rivotril)