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Extrapyramidal Side EffectAka: Extrapyramidal Reaction, Akinesia, Dystonic Reaction, Dyskinesia, Akathesia, Tardive Dyskinesia

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  1. Reversible Extrapyramidal signs and symptoms
    1. Conditions responsive to anti-Parkinsons Agents
      1. Akinesia (lack of movement, Parkinson-like)
      2. Dystonic Reaction (facial muscle spasm, neck, back)
      3. Dyskinesia (Blinking or twitches)
      4. Akathisia (Can not to sit still, inner restlessness)
      5. Perioral Tremor (Rabbit Syndrome)
    2. Neuroleptic Malignant Syndrome
      1. Presents as catatonia, fever, unstable Blood Pressure
      2. Life-threatening; Stop Antipsychotic immediately
  2. Irreversible
    1. Evaluate for these signs monthly while on Antipsychotic
    2. Tardive Dyskinesia
      1. Hyperkinesia (lingual or facial)
        1. Blinking
        2. Lip smacking
        3. Sucking or chewing
        4. Rolls or protrudes Tongue
        5. Grimaces
      2. Choreoathetoid extremity movement
        1. Clonic jerking fingers, ankles, toes
      3. Tonic contractions of neck or back
  3. Management
    1. Reversible Extrapyramidal Effects
      1. Tolerance to affect
      2. Decrease or Increase OR Discontinue drug dose
      3. Shift patient to a non-EPSE side effect
      4. Antihistamine (Benadryl)
    2. Tardive Dyskinesia
      1. Consider Clozapine as alternative Antipsychotic

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