A patient diagnosed with schizophrenia has been taking haloperidol (Haldol) following an acute psychotic episode. The physical therapist should be alert for which of the following side effects MOST commonly associated with this medication?
 
1.    Facial grimacing and involuntary extremity movements
2.    Significant weight gain and elevated serum lipids
3.    Constipation and urinary retention
4.    Respiratory depression and orthostatic hypotension

Transcript

Welcome back to the Scorebuilders’ Question and Answer Podcast! This podcast provides members of the Scorebuilders’ team with the opportunity to explore challenging multiple-choice examination questions with students actively preparing for the licensing examination. My name is Scott Giles and I will be your host for today’s journey.

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A patient diagnosed with schizophrenia has been taking haloperidol (Haldol) following an acute psychotic episode. The physical therapist should be alert for which of the following side effects MOST commonly associated with this medication?
 
1.    Facial grimacing and involuntary extremity movements
2.    Significant weight gain and elevated serum lipids
3.    Constipation and urinary retention
4.    Respiratory depression and orthostatic hypotension

Haloperidol (Haldol)

Haloperidol (Haldol) is a traditional antipsychotic medication. The most common side effects associated with antipsychotic drugs are extrapyramidal symptoms, which are abnormal movement patterns such as dyskinesia and dystonia. Therapists should be alert for changes in the patient’s posture, balance or movement pattern and notify health care personnel immediately. Early detection of these effects can allow for prompt medical and pharmacological management to help diminish the risk for long-term motor dysfunction.

Let’s explore each of the options:

Option 1 - Facial grimacing and involuntary extremity movements

Facial grimacing and involuntary movements of the extremities are examples of involuntary, repetitive body movements commonly observed in patients taking traditional antipsychotic medications such as haloperidol (Haldol). These extrapyramidal symptoms are characteristic of tardive dyskinesia, one of the most concerning side effects of traditional antipsychotic agents since it may be irreversible. Tardive dyskinesia typically involves the orofacial muscles (e.g., lip smacking, facial grimacing, tongue protrusion), but may also include choreoathetoid movements of the extremities and dystonias of the neck and trunk.

Option 2 – Significant weight gain and elevated serum lipids

Significant weight gain and elevated serum lipids are metabolic side effects associated with the newer, atypical antipsychotic medications such as clozapine (Clorazil), aripiprazole (Abilify), and risperidone (Risperdal). Although these atypical antipsychotic medications have a decreased risk of producing extrapyramidal symptoms such as movement disorders and motor side effects, they can produce side effects that ultimately result in cardiovascular or metabolic disorders.

Option 3 – Constipation and urinary retention

Medications with anticholinergic properties produce side effects that include constipation, urinary retention, confusion, and arrhythmias. Tricyclic antidepressants such as amitriptyline (Elavil) have significant anticholinergic properties. 

Option 4 – Respiratory depression and orthostatic hypotension

Respiratory depression and orthostatic hypotension are side effects associated with opioid analgesics (narcotics). Opioid agents provide analgesia for acute severe pain management. The medication stimulates opioid receptors within the central nervous system to prevent pain impulses from reaching their destination. Respiratory depression can be severe or fatal in patients who are seriously ill, have preexisting pulmonary conditions, or in cases of overdose.

The correct answer is Option 1

Is Life Fair?

Does this question make you ponder the fairness of life? Your exam will include questions that are surprisingly basic and questions that are shockingly specific. This particular question falls into the shockingly specific category.

Be grateful for the basic questions and roll up your sleeves and battle through the shockingly specific questions. Remember, every time you eliminate one or more options, the probability of answering the question correctly dramatically increases.

Let’s explore the all student data:

57% of students selected Option 1 - Facial grimacing and involuntary extremity movements – the correct response
5% of students selected Option 2 - Significant weight gain and elevated serum lipids
8% of students selected Option 3 - Constipation and urinary retention
30% of students selected Option 4 - Respiratory depression and orthostatic hypotension

System Classification
This question is an Other Systems question which represents approximately 21% of all exam items.

Content Outline Classification
This question is a Foundations for Evaluation, Differential Diagnosis, & Prognosis question which represents approximately 33% of all exam items.

Level Classification
This question is a Level 1 question since the question requires students to possess basic foundational academic knowledge. Remediation of Level 1 questions occurs through academic review of entry-level content using textbooks, review books, Basecamp, and flash cards.

Academic Focus Area
Looking to review related academic content?

Check out pages 578-579 in PTEXAM: The Complete Study Guide.

Thanks for joining us on the Scorebuilders Q and A podcast! See you next week!