EPS

Question 1

Treatment of acute dystonic reaction

Answer 1

Goal: balancing the disrupted dopaminergic-cholinergic balance in the BG and discontinuation of the offending agent.
Give Benztropine 1-2 mg IV followed by 1 to 2 mg po BID for up to 7 days to prevent recurrence. (UW IV Benadryl or cogentin provide relief w/ in mins, 3-5)
Diphenhydramin: 50 mg IV in adults and 1 mg/kg up to 50mg IV in pediatric patients. Once the acute dystonic reaction is treated and symptoms improve, give PO q6h for 1 to 2 days to prevent recurrence of symptoms.

Question 2

How does an oculogyric crisis present?

Answer 2

forced, sustained elevation of the eyes in an upward position
Eg of acute dystonic rx

Question 3

Parkinsonism features due to AP’s and treatment

Answer 3

Gradual-onset tremor, rigidity & bradykinesia

Benztropine, Amantadine

Question 4

TD treatment

Answer 4

Gradual onset after prolonged therapy (>6 months): dyskinesia of the mouth, face, trunk & extremities

Val-benazine and deutetrabenazine

Question 5

Lyme disease tx in pregnancy (2)

Answer 5

14-21 days of amoxicillin or cefuroxime.

Question 6

Tx for akathasia

Answer 6

First line: propranolol 20-40 mg BID (contraindicated in asthma and diabetes)
Low-dose mirtazapine (15 mg/d) was found to be as effective as propranolol 80 mg/d. But at higher doses mirthzapine itself has been associated w/ akathisia.
klonopin has been shown to be helpful
Insufficient data for use of anticholinergics

Question 7

Which APs have high rates of akathasia? Which have low?

Answer 7

High- aripiprazole and lurasidone

Low- quetiapine, clozapine