Therapeutic: antipsychotics, mood stabilizers
Pharmacologic: piperazine derivatives
Schizophrenia; IM form is reserved for control of acutely agitated patients. Bipolar mania (manic and manic/mixed episodes).
Effects probably mediated by antagonism of dopamine type 2 (D2) and serotonin type 2 (5-HT2). Also antagonizes α2-adrenergic receptors. Therapeutic Effects: Diminished schizophrenic behavior.
Adverse Reactions/Side Effects
CNS: NEUROLEPTIC MALIGNANT SYNDROME, seizures, dizziness, drowsiness, restlessness, extrapyramidal reactions, syncope, tardive dyskinesia. Resp: cough/runny nose. CV: PROLONGED QT INTERVAL, orthostatic hypotension. GI: constipation, diarrhea, nausea, dysphagia. Derm: rash, urticaria.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
Be alert for 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. Report these signs to the physician or nursing staff immediately.
Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report arrhythmias (prolonged QT interval, others), or symptoms of rhythm disturbances including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.
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 dizziness and drowsiness 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.
Assess BP, and report a fall in 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.
Guard against falls and trauma (hip fractures, head injury, and so forth) caused by drowsiness, dizziness, syncope, or extrapyramidal symptoms; implement fall prevention strategies (See Appendix E).
Because of the risk of arrhythmias ...