Match each patient's clinical presentation of an antipsychotic-induced adverse effect with the most appropriate specific pharmacological management strategy.
- A 25-year-old man develops severe, sustained torticollis and upward gaze deviation (oculogyric crisis) 12 hours after a dose of intramuscular haloperidol.Administer an anticholinergic (e.g., benztropine) or antihistamine (e.g., diphenhydramine) intravenously or intramuscularly.
- A 32-year-old woman recently started on aripiprazole reports a distressing, constant urge to move and is observed continuously shifting her weight and pacing.Reduce the antipsychotic dose and cautiously add a beta-blocker (e.g., propranolol).
- A 48-year-old man taking perphenazine for several months presents with new-onset generalized psychomotor slowing, a shuffling gait, and resting tremor.Add an oral anticholinergic (e.g., benztropine) or a dopamine agonist (e.g., amantadine).
- A 55-year-old woman on long-term risperidone therapy develops involuntary, repetitive lip-smacking and chewing movements with choreoathetosis of her hands.Taper the offending drug, consider switching to clozapine, or initiate a VMAT2 inhibitor (e.g., valbenazine).
Cevap
Acute dystonia matches with IM/IV anticholinergics or antihistamines. Akathisia matches with dose reduction and a beta-blocker. Drug-induced parkinsonism matches with oral benztropine or amantadine. Tardive dyskinesia matches with tapering the drug, switching to clozapine, or using a VMAT2 inhibitor.
Each extrapyramidal symptom has a specific timeline and treatment protocol. Acute dystonia (muscle spasm within hours) requires immediate anticholinergics. Akathisia (restlessness within days) requires beta-blockers. Parkinsonism (bradykinesia within weeks) requires amantadine or oral anticholinergics. Tardive dyskinesia (choreoathetosis over years) requires VMAT2 inhibitors or switching to clozapine.
Adım Adım Çözüm
Anahtar Kavram
Management of Antipsychotic-Induced Extrapyramidal Symptoms
Tahmini Süre:1m 30s