IGNOU PB. Bsc. Nsg. Entrance-2025
Pharmacology
Easy
One of the following is used to treat dystonia in a client who is on antipsychotics :
Appeared in: IGNOU PB. Bsc. Nsg. Entrance-2025
Explanation
- Diphenhydramine is an antihistamine that possesses strong anticholinergic properties.
- Acute dystonia is an extrapyramidal symptom caused by the dopamine-blocking action of antipsychotics, which leads to a relative excess of acetylcholine.
- The anticholinergic action of diphenhydramine counteracts this excess acetylcholine activity, thereby relieving the involuntary muscle spasms.
- It is considered a first-line, rapid-acting treatment for acute dystonic reactions and is often administered intravenously or intramuscularly for quick relief.
Why Other Options Were Wrong
- Option A: Midazolam is a very short-acting benzodiazepine primarily used for procedural sedation. It is not a standard first-line treatment for acute dystonia.
- Option B: Haloperidol is a high-potency typical antipsychotic. Its mechanism involves strong dopamine D2 receptor blockade, which is a primary cause of acute dystonia and other extrapyramidal symptoms.
- Option C: Prochlorperazine is a phenothiazine that also blocks dopamine receptors. It is known to cause extrapyramidal side effects, including acute dystonia.
Related Visual
Clinical Relevance
- Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Pharmacological management of extrapyramidal side effects (EPS) of antipsychotic medications, specifically acute dystonia as background academic context rather than a clinical decision trigger.
- Nurses must be able to rapidly recognize the signs of acute dystonia (e.g., neck twisting, oculogyric crisis) as it is a medical emergency that is distressing and painful for the patient.
- Prompt nursing action, including notifying the provider and administering an anticholinergic agent like diphenhydramine IM/IV, is critical to prevent complications, such as airway compromise from laryngeal dystonia.
- What if? If the patient was experiencing tardive dyskinesia (another EPS characterized by late-onset, involuntary movements of the face) instead of acute dystonia, giving an anticholinergic like diphenhydramine would be contraindicated as it can worsen the condition. The correct action would be to assess for discontinuation of the antipsychotic and consider medications like valbenazine.
How to Approach the Question
- First, identify the key terms in the question: 'treat dystonia' and 'on antipsychotics'. This tells you the question is about managing a specific side effect of a drug class.
- Recognize that dystonia is an extrapyramidal symptom (EPS), a known side effect of antipsychotics caused by dopamine blockade.
- Recall the primary treatment for acute dystonia involves counteracting the cholinergic overactivity that results from dopamine blockade. This requires an anticholinergic agent.
- Evaluate the options: a) Midazolam (benzodiazepine/sedative), b) Haloperidol (antipsychotic/cause of EPS), c) Prochlorperazine (antipsychotic/cause of EPS), d) Diphenhydramine (antihistamine with strong anticholinergic properties).
- Eliminate Haloperidol and Prochlorperazine because they cause the problem rather than treat it.
- Compare the remaining options. Diphenhydramine is a standard, first-line anticholinergic treatment for acute dystonia. Midazolam is not.
Concept Tested & Keywords
- Concept Tested: Pharmacological management of extrapyramidal side effects (EPS) of antipsychotic medications, specifically acute dystonia.
- Stem keywords: dystonia, antipsychotics, treat
- Lead-in keywords: used to treat
Question ID
Qf3V8lRE5cG0zmTpLwRsmj
Reference Book
E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 1890-1892
E6 Robert Boland, Marcia L. Verduin - Kaplan and Sadock's Comprehensive Text of Psychiatry-Wolters Kluwer Health (2024) (pp 1-16525 of 16525) pp. 7548-7550, 14353-14355
Practise the full IGNOU PB. Bsc. Nsg. Entrance-2025
Attempt every question from this paper in a timed mock, then review the full solution for each one.
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