Schizophrenia Q 19
A client with schizophrenia who receives fluphenazine (Prolixin) develops pseudoparkinsonism and akinesia. What drug would the nurse administer to minimize extrapyramidal symptoms?
A. benztropine (Cogentin)
B. dantrolene (Dantrium)
C. clonazepam (Klonopin)
D. diazepam (Valium)
Correct Answer: A. benztropine (Cogentin)
Benztropine is an anticholinergic drug administered to reduce extrapyramidal adverse effects in the client taking antipsychotic drugs. It works by restoring the equilibrium between the neurotransmitters acetylcholine and dopamine in the central nervous system (CNS). Thus, benztropine blocks the cholinergic muscarinic receptor in the central nervous system. Therefore, it reduces the cholinergic effects significantly during Parkinson’s disease which becomes more pronounced in the nigrostriatal tract because of reduced dopamine concentrations.
Option B: Dantrolene, a hydantoin drug that reduces the catabolic processes, is administered to alleviate the symptoms of neuroleptic malignant syndrome, a potentially fatal adverse effect of antipsychotic drugs. Dantrolene is used for the treatment of neuroleptic malignant syndrome (given its similarity in presentation and symptoms to malignant hyperthermia) as well as for the overdose of 2,4-dinitrophenol (a banned “fat burner” medication that interrupts ATP synthesis and causes hyperthermia).
Option C: Clonazepam, a benzodiazepine drug that depresses the CNS, is administered to control seizure activity. Clonazepam is a long-acting and high-potency benzodiazepine. It behaves both as a GABA-A receptor agonist and also as a serotonin agonist. Clonazepam has anticonvulsant and anxiolytic effects. It is FDA-approved for the treatment of seizure disorders and panic disorders.
Option D: Diazepam, a benzodiazepine drug, is administered to reduce anxiety. It is a fast-acting, long-lasting benzodiazepine commonly used in the treatment of anxiety disorders, as well as alcohol detoxification, acute recurrent seizures, severe muscle spasm, and spasticity associated with neurologic disorders. In the setting of acute alcohol withdrawal, diazepam is useful for symptomatic relief of agitation, tremor, alcoholic hallucinosis, and acute delirium tremens.