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Managing Side Effects: Benztropine for Parkinsonism and Drug-Induced Extrapyramidal Disorders

Learn about the clinical indications, physiological actions, side effects, and administration considerations of benztropine (Cogentin) in managing Parkinsonism and drug-induced extrapyramidal disorders.

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Managing Side Effects: Benztropine for Parkinsonism and Drug-Induced Extrapyramidal Disorders

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  1. Benztropine

  2. As we know one of the biggest predictors to compliance with medication is the ability to alleviate side effects. • Due to the potent nature of psychotropic medication the side effects can be not only irritating but greatly effect the quality of life for clients. • There are many anti-cholinergic agents

  3. Clinical indications • All forms of Parkinsonism, as well as drug induced extrapyramidal disorders (except tardivedyskinesia). • Cogentin can be effective at any stage of the disease, even when a patient has become bedridden. • Cogentin is a powerful anticholinergic agent which is mainly effective in relieving tremor and rigidity. • In non drug induced Parkinsonism, partial control of symptoms is usually achieved.

  4. Major subclasses • Benztropine (Cogentin) • Benzhexol (Artane

  5. Physiological actions • When dopamine is deficient in the basal ganglia of the brain there is an increase in acetylcholine leading to EPSE and or Parkinson's symptoms • Benztropine opposes this overactivity • It has both anti-cholinergic and antihistamine effects

  6. Side effects and management • Tachycardia. • Constipation • dry mouth • Nausea • vomiting. • Blurred vision • dilated pupils • Urinary retention • dysuria • allergic reaction, e.g. skin rash, • Heat stroke, hyperthermia, fever

  7. Administration conciderations • When treating extrapyramidal disorders due to CNS drugs such as phenothiazines or reserpine, a dosage of 1 to 4 mg once or twice a day is recommended. • Dosage should be varied to suit the needs of the patient. • After one or two weeks of administration, Cogentin should be withdrawn to determine the continued need for medication. If Parkinsonism recurs, therapy with Cogentin can be reinstituted. • Usually the injection of Cogentin 1 to 2 mL quickly relieves acute dystonic reactions.

  8. Cautions • When given with phenothiazines, haloperidol or other drugs with anticholinergic or anti-dopaminergic activity, patients should be advised to report fever, heat intolerance and gastrointestinal complaints promptly. • Paralytic ileus has occurred in patients taking anticholinergic type anti-parkinsonism drugs when combined with phenothiazines and/or tricyclic antidepressants. • Due to its cumulative action, continued supervision is advisable. Patients with a history of tachycardia or prostatic hypertrophy should be closely observed during treatment.

  9. Toxic Psychosis or Delerium Toxic psychosis, including; • confusion, disorientation, memory impairment, visual hallucinations, exacerbation of pre-existing psychotic symptoms, nervousness, depression, listlessness, numbness in fingers

  10. Mental confusion and excitement may occur with large doses or in susceptible patients. • Getting a ‘buzz’ • Pregnancy risk factor C - • Excretion of breast milk unknown

  11. Common myths regarding cogentin • Cogentin is not indicated for; -Akathesia - Tardive dyskinsia( may make symptoms worse)

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