Dyskinesia, tardive

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). 

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... 

Olivera AA, Kiefer MW, Manley NK Tardive dyskinesia in psychiarric parienrs with substance abuse disorders. Am J Drug Alcohol Abuse 16 57-66, 1990 Palatini P, Tedeschi L, Prison G, er al Dose-dependent absorption and eliminarion of gamma-hydroxybutyric acid in healthy volunteers. Eur J Clin Pharmacol 45 3 53— 356, 1993... 

Phenothiazines may cause sedation, orthostatic hypotension, and extrapyramidal symptoms (EPS) such as dystonia (involuntary muscle contractions), tardive dyskinesia (irreversible and permanent involuntary movements), and akathisia (motor restlessness or anxiety).1,21,22 Chronic phenothiazine use has been associated with EPS, but single doses have also caused these effects.23... 

Metoclopramide crosses the BBB and has centrally-mediated adverse effects. Young children and the elderly are especially susceptible to these effects, which include somnolence, reduced mental acuity, anxiety, depression, and EPS (akathisia, dystonia, and tardive dyskinesia).30 The overall incidence of adverse effects is estimated to be 10% to 20%.1... 

Current tardive dyskinesia History of non-adherence Clozapine, quetiapine Long-acting risperidone Risperidone, olanzapine, ziprasidone... 

Tardive dyskinesia A chronic disorder of the nervous system characterized by involuntary jerky or writhing movements of the face, tongue, jaws, trunk, and limbs, usually developing as a late side effect of prolonged treatment with antipsychotic drugs. 

Basile, V. S., Ozdemir, V., Masellis, M. etal. (2000). Afunctional polymorphism ofthe cytochrome P4501A2 (CYP1A2) gene association with tardive dyskinesia in schizophrenia. Mol. Psychiatry, 5, 410-17. 

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