Quetiapine

INTRODUCTION

Indications

Schizophrenia. Depressive episodes with bipolar disorder. Acute manic episodes associated with bipolar I disorder (as monotherapy or with lithium or divalproex). Maintenance treatment of bipolar I disorder (with lithium or divalproex).

Action

Probably acts by serving as an antagonist of dopamine and serotonin. Also antagonizes histamine H₁ receptors and alpha₁-adrenergic receptors. Therapeutic Effects: Decreased manifestations of psychoses, depression, or acute mania.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, SEIZURES, dizziness, cognitive impairment, extrapyramidal symptoms, sedation, tardive dyskinesia. EENT: ear pain, rhinitis, pharyngitis. Resp: cough, dyspnea. CV: palpitations, peripheral edema, orthostatic hypotension. GI: anorexia, constipation, dry mouth, dyspepsia. Derm: sweating. Hemat: leukopenia. Metab: weight gain, hyperglycemia. Misc: flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and immediately report signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, decreased cognition, 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 immediately to the physician.

• 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 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 any cardiac palpitations, prolonged cough, or difficult, labored breathing. Report these symptoms if they become problematic.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Watch for signs of leukopenia, including fever, sore throat, mucosal lesions, and other signs of infection. Report these signs to the physician.

• 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 frequently.

• Assess dizziness ...