USMLE Forums banner

Diagnosis and Treatment of Prochlorperazine Side Effect!

4K views 12 replies 11 participants last post by  modesty 
#1 ·
A patient who has been treated with prochlorperazine for nausea develops repetitive, involuntary, purposeless movements of her lips and face. Which medication may improve her symptoms?
A. Neosynephrine
B. Amantadine
C. Thioridazine
D. Haloperidol
E. None of the above

:rolleyes:
 
#9 ·
answer

AMANTADINE
Amantadine, an antiviral agent, was by chance found to have antiparkinsonism properties. Its mode of action in parkinsonism is unclear, but it may potentiate dopaminergic function by influencing the synthesis, release, or reuptake of dopamine. It has been reported to antagonize the effects of adenosine at adenosine A2A receptors, which are receptors that may inhibit D2 receptor function. Release of catecholamines from peripheral stores has also been documented.
 
#10 ·
This patient has akathisia, an extrapyramidal disorder, likely as a result of the prochlorperazine. Extrapyramidal symptoms can be difficult to treat; possible therapies include decreasing the dose of the offending medication, switching to another medication, starting beta blockers, or prescribing anti-Parkinsonism drugs. Amantadine, while primarily developed for treatment of influenza, also increases the release of dopamine and is therefore a treatment for Parkinsonism and extrapyramidal symptoms. Because the prochlorperazine was prescribed for nausea, prescribing thioridazine and haloperidol, neither of which have anti-nausea effects, is not appropriate.
 
#13 · (Edited)
ans will be most probably E

anti muscarinic drugs are used in these patients who develope extrapyramidal symptoms (benztropine) from antipsychotic drugs.

using amantadine will increase dopmine levels in brain and might cause psychosis or excarrbate the nausea she was treated for, and according to the symptoms that she is presenting of tardive dysknisia any drug that increases dopamine levels in the brain will make her symptoms even worse (as they think that the tardive dysknesia is caused by hypersensitivity of the dopamine receptors to dopamine) thats why it's such a problematic side effect to treat.
amantadine is an anti Parkinson drug that is used to bring patients out from akinesia, it's given IV and develops fast tolerance that's why it's usually not used chronically.

and ofcourse i forgot to mention that anti muscarinic drugs will be also beneficial for her nausea.
 
This is an older thread, you may not receive a response, and could be reviving an old thread. Please consider creating a new thread.
Top