Lurasidone

INTRODUCTION

Indications

Treatment of schizophrenia.

Action

Effect may mediated via effects on central dopamine type 2 (D₂) and serotonin type 2 (5HT_2A) receptor antagonism. Therapeutic Effects: ↓ schizophrenic behavior.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, akathisia, drowsiness, parkinsonism, agitation, anxiety, cognitive/motor impairment, dizziness, dystonia, tardive dyskinesia. EENT: blurred vision. CV: bradycardia, orthostatic hypotension, syncope, tachycardia. GI: nausea, esophageal dysmotility. Derm: pruritus, rash. Endo: hyperglycemia, hyperprolactinemia. Hemat: AGRANULOCYTOSIS, anemia, leukopenia. Metab: dyslipidemia, weight gain

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• 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 immediately to the physician.

• 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 and leukopenia (fever, sore throat, mucosal lesions, other signs of infection) or unusual weakness and fatigue that might be due to anemia. 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 any rhythm disturbances or symptoms of increased 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 behavioral changes such as anxiety, agitation, and cognitive/motor impairment. Notify physician if these changes become problematic.

• Assess dizziness, drowsiness, and syncope 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.

• Watch for signs of hyperglycemia, including drowsiness, fruity breath, increased urination, and unusual thirst. Patients with ...