Extrapyramidal

It has been suggested that high affinity for certain 5-HT receptors is a possible method for reducing extrapyramidal side effects observed with antipsychotics. LiabiUty for extrapyramidal side effects has been hypothesi2ed to be related to the ratio of the affinity between dopamine receptor... 

Risperidone (11) is a new type of an atypical antipsychotic with relatively pronounced effects on negative symptoms and low extrapyramidal side... 

Basal ganglia are a group of subcortical nuclei which are essential for the coordination of movements (so-called extrapyramidal system). They include the caudate nucleus, putamen, globus pallidus, and lenti-form nucleus. Damage of the basal ganglia results in involuntary movements, as are observed in Parkinson s disease and Huntington s chorea. 

As early as 1961, the first generation of MAO inhibitors (iproniazid, isocarboxazide) were employed for the treatment of Parkinson s disease (PD). However, because of the severe side effects, such as cheese reaction, they were abandoned. The realization that the basal ganglia (extrapyramidal region) of human brain contained mostly MAO-B, which metabolized... 

Extrapyramidal Side Effects Extrasynaptic Receptors F-actin... 

AMANTADINE The nurse administers this drug for the prevention or treatment of respiratory tract illness caused by influenza A virus. Some patients are prescribed this drug to manage extrapyramidal effects caused by drugp used to treat Parkinsonism (See Chaps. 29 and 32). The nurse should protect the capsules from moisture to prevent deterioration. When the drug is administered for symptoms of influenza, it is important to start therapy within 24 to 48 hours after symptoms begin. 

Among the most significant adverse reactions associated with the antipsychotic dm are the extrapyramidal effects. The term extrapyramidal effects refers to a group of adverse reactions occurring on the extrapyramidal portion of the nervous system as a result of antipsychotic drains. This part of the nervous system affects body posture and promotes smooth and uninterrupted movement of various muscle groups. Antipsychotics disturb the function of the extrapyramidal portion of the nervous system, causing abnormal muscle movement. Extrapyramidal effects include Parkinson-like symptoms (see Chap. 29), akathisia, and dystonia (see Display 32-1). 

Extrapyramidal effects usually diminish with a reduction in the dosage of the antipsychotic drug. The primary health care provider may also prescribe an antiparkinsonism drug, such as benztropine (see Chap. 29) to reduce the incidence of Parkinson-like symptoms. 

Q Impaired Verbal Communication related to drug-induced extrapyramidal effects (eg, dystonia)... 

When administering the antipsychotic drugs, the nurse observes the patient for extrapyramidal effects , which include muscular spasms of the face and neck, the inability to steep or s t still, tremors rigidity, or involuntary rhythmic movements The nurse notifiesthe primary health care provider of the occurrence of these symptoms because they may indicate a need for dosage adjustment. 

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. 

Asa nurse on the psychiatric unit, you are assigned to discuss extrapyramidal effects at a team conference. Discuss how you would present and explain this topic. Describe the points you would stress. 

When ondansetron is administered with rifampin, blood levels of ondansetron may be reduced, decreasing the antiemetic effect. Dimenhydrinate may mask the signs and symptoms of ototoxicity when administered with ototoxic drugp, such as the aminoglycosides (see Chap. 10), causing irreversible hearing damage. When lithium is administered with prochlorperazine, the risk of extrapyramidal reactions increases (see Chap. 32). 

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... 

Antipsychotics are not indicated for the treatment of withdrawal, except when hallucinations or severe agitation are present (Naranjo and Sellers 1986), in which case they should be added to a benzodiazepine. In addition to their potential to produce extrapyramidal side effects, antipsychotics lower the threshold for seizures, which is particularly problematic during alcohol withdrawal. 

Trihexyphenidyl (Artane) and benztropine (Cogentin) are prescription drugs used in the treatment both of Parkinson s disease and the extrapyramidal side effects produced by neuroleptic medication. They are occasionally abused for their mind-altering properties, which occur at toxic doses (Perry et al. 1978). Abusers often try to obtain these drugs by false representation of extrapyramidal symptoms, which are claimed to result from the use of phenothi-azines or other neuroleptics (Rubinstein 1978). 

Ricaurte GA, McCann UD, Szabo Z, et al Toxicodynamics and long-term toxicity of the recreational drug 3,4-methylenedioxy-methamphetamine (MDMA, Ecstasy ). Toxicol Lett 112-113 143-146, 2000 Robinson TN, Killen JD, Taylor CB, et al Perspectives on adolescent substance use a defined population study. JAMA 258 2072-2076, 1987 Rubinstein JS Abuse of antiparkinson drugs feigning of extrapyramidal symptoms to obtain trihexyphenidyl. JAMA 239 2365, 1978 Rumack BH (ed) LSD, in Poisindex, Vol 54. Denver, CO, Micromedex, 1987 Rusyniak DE, Banks ML, Mills EM, et al Dantrolene use in 3,4-methylenedioxymethamphetamine ( ecstasy )-medicated hyperthermia (letter). Anesthesiology 10 263, 2004... 

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