This PRITE question is bothering me

[Anasazi23]

A patient with schizophrenia is evaluated in the ED after taking an OD of an antipsychotic medication and is experiencing extrapyramidal side effects and urinary retention. Which of the following is the most appropriate immediate pharmacological intervention?

A. Amantadine

B. Benztropine

C. Dihenhydramine

D. Clonazepam

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Ans: A

I understand why this could be a viable option, but the effects take much longer than benztropine, and they're really not describing neuroleptic malignant syndrome. I would normally deal with the EPS, and then the urinary retention separately. Using this medication in this scenario is not my real-world experience. Any other opinions?

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[Poety]

A patient with schizophrenia is evaluated in the ED after taking an OD of an antipsychotic medication and is experiencing extrapyramidal side effects and urinary retention. Which of the following is the most appropriate immediate pharmacological intervention?

A. Amantadine

B. Benztropine

C. Dihenhydramine

D. Clonazepam

.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
.
Ans: A

I understand why this could be a viable option, but the effects take much longer than benztropine, and they're really not describing neuroleptic malignant syndrome. I would normally deal with the EPS, and then the urinary retention separately. Using this medication in this scenario is not my real-world experience. Any other opinions?

Hey Sazi, I must have completely lost my mind because I thought amantadine was an antiviral? for like influenza? Why would you use that at all in this case? I wouldve guessed benztropine for the urinary retention? (and straight cath ofcourse if hes distended) have i gone nuts? that IS what amantadine is right?

I just answered my own question PARKINSONS duh im so dense sometimes

 

[watto]

I have also read that amantadine is useful in conduct disorder and ODD...

 

[Poety]

I have also read that amantadine is useful in conduct disorder and ODD...

wow, thanks for food for thought!

 

[Anasazi23]

Hey Sazi, I must have completely lost my mind because I thought amantadine was an antiviral?

You're right, it also has an indication as an antiviral. It is known to interfere with the function of the transmembrane domain of viral proteins and halt virus assembly. It has specific usefulness in treatment of the Influenza A virus.

The only thing I can think of is that amantadine has no anticholinergic properties...and since the question mentions urinary retention, that this would be a reasonable choice. But still, the onset of action would be much longer, resulting in an unhappy patient for quite a while.

The PDR states that amantadine has an indication for drug-induced extrapyramidal side effects. But, the mean time to plasma peak [ ] is 2.5 - 4hrs. Amantadine usually exerts its effects within 48 hours, and can even be known to have anticholinergic effects in higher doses.

Just more food for thought. How do psychiatry docs usually handle this scenario during their day?

 

[50960]

How can one even answer this question without knowing what drug the per son was taking??? I guess 20 years ago we could all guess etc.... but now this is not the case. Is it trilafon or geodon???? Dumb question I think.

 

[OldPsychDoc]

How can one even answer this question without knowing what drug the per son was taking??? I guess 20 years ago we could all guess etc.... but now this is not the case. Is it trilafon or geodon???? Dumb question I think.

On the prite it sometimes pays to act as though it is 20 years ago.

I'm guessing that amantadine was the "right" answer because the others would be more likely to contribute to the urinary retention.

 

[Poety]

On the prite it sometimes pays to act as though it is 20 years ago.

I'm guessing that amantadine was the "right" answer because the others would be more likely to contribute to the urinary retention.

Benztropine (Cogentin) (2-6 mg once a day) is the most popular treatment and preventive medication used for EPS. Its cost is currently 10 cents a tablet. Unfortunately, as noted below, it causes more side-effects than some other alternatives. Amantadine works just as well for EPS with fewer wide-effects. Its current price is 31 cents a tablet. Propranolol, a beta-blocker high blood pressure medication, works as well or better for akathisia and costs as little as 1 cent a tablet.

i found this on some website just now- u are GOOD oldpsychdoc