Risperidone

INTRODUCTION

Indications

Schizophrenia in adults and adolescents age 13–17 yr. Bipolar mania (oral only) in adults and children 10–17 yr in adults and children 10–17 yr; can be used with lithium or valproate (adults only). Treatment of irritability associated with autistic disorder in children age 5–16 yr.

Action

May act by antagonizing dopamine and serotonin in the CNS. Therapeutic Effects: Decreased symptoms of psychoses, bipolar mania, or autism.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, aggressive behavior, dizziness, extrapyramidal reactions, headache, increased dreams, increased sleep duration, insomnia, sedation, fatigue, impaired temperature regulation, nervousness, tardive dyskinesia. EENT: pharyngitis, rhinitis, visual disturbances. Resp: cough, dyspnea. CV: arrhythmias, orthostatic hypotension, tachycardia. GI: constipation, diarrhea, dry mouth, nausea, abdominal pain, anorexia, dyspepsia, increased salivation, vomiting, weight gain, weight loss, polydipsia. GU: decreased libido, dysmenorrhea/menorrhagia, difficulty urinating, polyuria. Derm: itching/skin rash, dry skin, increased pigmentation, increased sweating, photosensitivity, seborrhea. Endo: galactorrhea, hyperglycemia. MS: arthralgia, back pain.

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, 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).

• 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 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 of hyperglycemia, including confusion, drowsiness, flushed/dry skin, fruit-like breath odor, rapid/deep breathing, polyuria, loss of appetite, and unusual thirst. Patients with diabetes mellitus should check blood glucose levels ...