Benztropine PMHNP Exam

Описание: Benztropine in the PMHNP Exam
Benztropine (Cogentin) is an anticholinergic medication used to treat extrapyramidal symptoms (EPS) caused by antipsychotics. The PMHNP-BC exam frequently tests its role in managing drug-induced movement disorders, side effects, and contraindications.

1. Mechanism of Action
✅ Anticholinergic (blocks acetylcholine at muscarinic receptors).✅ Restores dopamine-acetylcholine balance in the nigrostriatal pathway.✅ Reduces rigidity, tremors, and dystonic reactions.
Used primarily to manage EPS from antipsychotics.
Does NOT treat tardive dyskinesia (TD).

2. Indications for Benztropine
Condition Mechanism Clinical Use
Extrapyramidal Symptoms (EPS) from Antipsychotics Blocks excess acetylcholine to counteract dopamine blockade First-line for acute dystonia, reduces parkinsonism symptoms
Drug-Induced Parkinsonism Balances dopamine-acetylcholine activity Reduces tremors, rigidity from antipsychotic use
Acute Dystonia (Severe muscle spasms from EPS) Relaxes muscle contractions Rapid IM/IV administration for acute cases
• Used as prophylaxis in high-risk patients starting FGAs or high-dose SGAs (e.g., Risperidone, Paliperidone).

3. Benztropine & Extrapyramidal Symptoms (EPS)
EPS Type Symptoms Treatment
Acute Dystonia Muscle spasms (neck, tongue, eyes), difficulty breathing Benztropine (IM/IV), Diphenhydramine (IM/IV)
Drug-Induced Parkinsonism Tremors, rigidity, bradykinesia Benztropine (oral)
Akathisia Restlessness, pacing, anxiety Propranolol, Lorazepam (NOT Benztropine)
Tardive Dyskinesia (TD) Involuntary facial & limb movements VMAT-2 inhibitors (Valbenazine, Deutetrabenazine); NOT Benztropine
🚨 Benztropine is NOT used for tardive dyskinesia (TD) and may worsen symptoms.
First-line for acute dystonia (IM/IV) and drug-induced Parkinsonism (oral).
Akathisia is best treated with Beta-blockers (Propranolol) or Benzodiazepines (Lorazepam).

4. Benztropine Side Effects & Contraindications
🚨 Common Side Effects (Anticholinergic Effects):
Dry mouth
Blurred vision
Constipation
Urinary retention
Increased intraocular pressure (worsens glaucoma)
🚨 Serious Risks:
Confusion, delirium (especially in elderly).
Worsening of tardive dyskinesia.
Heat intolerance (impaired sweating).
🚫 Contraindications:
Elderly patients (increased delirium risk).
Glaucoma (raises intraocular pressure).
Urinary retention or BPH (worsens symptoms).
Tardive dyskinesia (can worsen symptoms).
Use with caution in elderly due to increased risk of falls and confusion.
Avoid in patients with history of urinary retention or narrow-angle glaucoma.

5. PMHNP Exam Key Takeaways
Benztropine = First-line for acute dystonia & drug-induced Parkinsonism.
NOT used for akathisia (Propranolol preferred) or tardive dyskinesia (Valbenazine preferred).
Common side effects = Dry mouth, constipation, urinary retention, blurred vision.
Avoid in elderly due to risk of confusion & falls.
IM/IV for acute dystonia, oral for long-term EPS management.
Contraindications: Glaucoma, BPH, tardive dyskinesia.
Best prophylactic option for high-risk patients on FGAs or high-dose SGAs.


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