Molindone

INTRODUCTION

Indications

Schizophrenia. Second-line treatment after failure with atypical antipsychotics. Unlabeled Use: Other psychotic disorders. Bipolar Disorder.

Action

Blocks the effects of dopamine in the reticular-activating and limbic systems in the brain. Therapeutic Effects: Diminished psychoses associated with schizophrenic behavior.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, extrapyramidal reactions, sedation, depression, dizziness, euphoria, headache, insomnia, tardive dyskinesia. EENT: blurred vision, dry eyes, nasal congestion. CV: hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug-induced hepatitis, nausea. Derm: photosensitivity, rashes. Endo: galactorrhea, increased libido, irregular menses. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report 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.

• 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, masklike 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).

• Be alert for depression, euphoria, or other changes in mood and behavior. Notify physician if these changes become problematic.

• Monitor signs of allergic reactions, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or signs of other 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 or syncope.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

• 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).

• Because of the risk of tachycardia and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart ...