Olanzapine

INTRODUCTION

Indications

Psychotic disorders: Acute manic episodes associated with bipolar disorder (may be used with lithium or valproate), long-term maintenance therapy of bipolar disorder, long-term treatment/maintenance of schizophrenia, agitation due to schizophrenia or mania (IM). Unlabeled Use: Management of anorexia nervosa. Treatment of nausea and vomiting related to highly emetogenic chemotherapy.

Action

Antagonizes dopamine and serotonin type 2 in the CNS. Also has anticholinergic, antihistaminic, and anti–alpha₁-adrenergic effects. Therapeutic Effects: Decreased manifestations of psychoses.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, agitation, dizziness, headache, restlessness, sedation, weakness, dystonia, insomnia, mood changes, personality disorder, speech impairment, tardive dyskinesia. EENT: amblyopia, rhinitis, increased salivation, pharyngitis. Resp: cough, dyspnea. CV: orthostatic hypotension, tachycardia, chest pain. GI: constipation, dry mouth, abdominal pain, increased appetite, weight loss or gain, nausea, increased thirst. GU: decreased libido, urinary incontinence. Derm: photosensitivity. Endo: hyperglycemia, goiter. Metab: dyslipidemia. MS: hypertonia, joint pain. Neuro: tremor. Misc: fever, flu-like syndrome.

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.

• Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

• 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).

• 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 pain, shortness of breath, fainting, and fatigue/weakness.

• Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact physician when systolic BP falls >20 mm Hg or diastolic BP falls >10 mm Hg.

• Report any troublesome respiratory problems, including severe or prolonged cough, nasopharyngeal irritation, or difficult/labored breathing.

• Be alert for signs ...