Dyskinesia

The anainoacridines, tacrine (19) and its 1-hydroxy metaboUte, velnacrine (20), are reversible inhibitors of AChE. Tacrine was synthesi2ed in the 1940s and has been used clinically for the treatment of myasthenia gravis and tardive dyskinesia (115). Placebo-controUed studies have indicated modest efficacy of tacrine to treat AD dementia (122,123) and in 1993 the dmg was recommended for approval by the PDA under the trade name Cognex. Tacrine (19) has been shown to interact with sites other than AChE, such as potassium channels (124) and muscarinic receptors. However, these interactions are comparatively weak and are not thought to contribute to the biological activity of the dmg at therapeutic levels (115). 

Induces dyskinesia/vasodilatation, schizophrenia/4- coordination Vaso constriction/cell proliferation/aldosterone secretion Vaso constriction/cell proliferation/bronchoconstriction 4-memory, sedation/vasodilatation/4 GI motility A blood pressure/4- GI secretion Vagal effects/A blood pressure/tachycardia... 

Dyskinesias are abnormal movements, usually caused by neurological diseases or by diugs used to treat neurological (e.g., levodopa) or psychiatric diseases (e.g., neuroleptics). 

Parkinson s disease (PD) 1. In a non-human primate model of PD endocannabinoid levels are elevated in the basal ganglia and may contribute to the generation of parkinsonian symptoms and/or to expression of levodopa-induced dyskinesia. The cerebrospinal fluid of untreated PD patients contains elevated levels of AEA 1. CB-) antagonists or biosynthesis inhibitors... 

The adverse reactions most often associated with the administration of the COMT inhibitors include disorientation, confusion, light-headedness, dizziness, dyskinesias, hyperkinesias, nausea, vomiting, hallucinations, and fever. Other adverse reactions are orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious and possibly fatal adverse reaction that can occur with the administration of tolcapone is liver failure... 

FIGURE 32-1. A simple method to determine tardive dyskinesia symptoms Abnormal Involuntary Scale examination procedure. (Rom Clayton Sock [1997], Basic phamaoology for nurses] 1 th ed., p. 580, St Louis ... 

Tardive dyskinesia can occur in patients taking the antipsychotics. The nurse must remain alert for any signs and symptoms of tiiis condition. 

Because there is no known treatment for tardive dyskinesia and because it is irreversible in some patients the nurse must immediately report symptoms These indude rhythmic, involuntary movements of the tongue, face, mouth, jaw, or the extremities... 

Immediately report the occurrence of the following adverse reactions restlessness, inability to sit still, muscle spasms, masklike expression, rigidity, tremors, drooling, or involuntary rhythmic movements of the mouth, face, or extremities. Inform all patients about the risks of extrapyramidal symptoms and tardive dyskinesia Avoid exposure to the sun. If exposure is unavoidable, wear sunblock, keep arms and legs covered, and wear a sun hat. 

Which of die following reactions would the nurse expect to see in a patient experiencing tardive dyskinesia ... 

GASTROINTESTINAL STIMULANTS. If drowsiness or dizziness occurs with the administration of metoclo-pramide, the patient will require assistance with ambulatory activities. The nurse observes patients receiving high or prolonged doses of this drug for adverse reactions related to the CNS (extrapyramidal reactions or tardive dyskinesia, see Chap. 32). The nurse reports any... 

Good MI Caiatonia-Iike symptomatology and withdrawal dyskinesias. Am J Psychiatry 133 1454-1456, 1975... 

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