Therapeutic: antipsychotics (conventional)
Pharmacologic: diphenylbutyl piperidines
Suppression of motor and vocal tics in Tourette's disorder with severe, compromising symptoms in patients with an unfavorable response to haloperidol. Second-line treatment after failure with atypical antipsychotics. Unlabeled Use: Psychotic disorders that fail to respond to standard treatment.
Blocks dopamine receptors in the CNS. Increases brain turnover of dopamine, blocks calcium channels, and may antagonize opiate receptors. Therapeutic Effects: Decreased tics in patients with Tourette's disorder.
Adverse Reactions/Side Effects
CNS: NEUROLEPTIC MALIGNANT SYNDROME, mood/behavior effects, weakness, drowsiness. EENT: blurred vision, dry eyes. CV: ARRHYTHMIAS (PROLONGED QTC INTERVAL), hypotension. GI: constipation, dry mouth, ↓ appetite, nausea, vomiting, weight loss. GU: ↓ libido, erectile dysfunction. Derm: skin discoloration. Endo: galactorrhea (women). Hemat: blood dyscrasias. Neuro: akathisia, parkinsonism, dystonic reactions, tardive dyskinesia, akinesia.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician immediately.
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report any rhythm disturbances or symptoms of increased arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
Assess BP periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.
Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:
∘ Tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities, lip smacking or puckering, puffing of cheeks, uncontrolled chewing, rapid or worm-like movements of tongue).
∘ Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).
∘ Akathisia (restlessness or desire to keep moving).
∘ Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).
Monitor unusual weakness and fatigue that might be due to anemia, or other symptoms such as fever, sore throat, mucosal lesions, or signs of infection that might be due to other blood dyscrasias. Notify physician if these signs occur.
Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight loss or decreased body fat.
Guard against falls and trauma (hip fractures, head injury, and so forth) caused by drowsiness, blurred vision, or extrapyramidal symptoms; implement fall prevention strategies (See Appendix E).
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