Loxapine

INTRODUCTION

Indications

Schizophrenia. Considered second-line treatment after failure of atypical antipsychotic. Unlabeled Use: Other psychotic disorders. Bipolar disorder.

Action

Appears to block dopamine and serotonin at postsynaptic receptor sites in the CNS. Therapeutic Effects: Diminution of psychotic behavior.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, confusion, dizziness, drowsiness, extrapyramidal reactions, headache, insomnia, syncope, tardive dyskinesia, weakness. EENT: blurred vision, lens opacities, nasal congestion. CV: orthostatic hypotension, tachycardia. GI: constipation, drug-induced hepatitis, dry mouth, ileus, nausea, vomiting. GU: urinary retention. Derm: dermatitis, edema, facial photosensitivity, pigment changes, rashes, seborrhea. Endo: galactorrhea. Hemat: AGRANULOCYTOSIS. Neuro: ataxia. 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.

• Watch for signs of agranulocytosis, including fever, sore throat, mucosal lesions, and other signs of infection. Report these signs 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, 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.

• Monitor signs of allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

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

Interventions

• Guard against falls and trauma (hip ...