Fentanyl & extrapyramidal sx

jenrninmi, MSN, RN · Sep 4, 2007

Sorry, feel kind of stupid, but what are "extrapyramidal sx"?

Elvish, BSN, DNP, RN, NP · Sep 4, 2007

The best definition I could find was here:

http://en.wikipedia.org/wiki/Extrapyramidal

It is really freaky. If you've ever seen anyone with tardive dyskinesia from their psych meds, that's an example.

scattycarrot, BSN, RN · Sep 4, 2007

Extrapyramidal sypmtons(EPS) are adverse reactions to antidopaminergic drugs, such as antipsychotic meds, antiemetics, such as metoclopramide or stemetil or to tricyclics. These meds affect the extrapyramidal tract that controls reflexes, coordinated and complex movement, posture control. There are several different types of EPS and these include akathisia(restlessness), acute dystonia(involuntary muscle spasms particularly in face and neck), tardive dyskinesia ( involuntary movements of mouth,lips and tongue) and there are several more. These patients may look like they are having strange seizures and tics, they may be pushing thier tongue out, they may be moving thier head over their shoulder in a strange way ( think Exocist!) and to the uniniated their behaviour is often regarded as bizarre but the patient has no control over it. Anyone adminstering antiemetics should be aware of this reaction. I have seen this many times and once seen you will always(well,maybe not always!!!) recognise it for what it is. Its also easily reversed by giving an anticholinergiine meds such as procyclidine, there are others but I have only ever given this one. Someone else may know more!

Elvish, BSN, DNP, RN, NP · Sep 5, 2007

The weird thing was she had gotten Phenergan but it had been almost 24 hours before she started this. I really think it was the Fentanyl. Either way I d/ced her epidural and she sure as heck didn't get any Phenergan from me.

BabyRN2Be · Sep 6, 2007

From the patient's experience, it's an awful, awful thing to go through. I didn't have the brightest GI doc in the world, so he gave me a very high dose of Reglan along with Compazine to relieve the n/v.

I remember being on O2 while they were trying to figure out what was happening. I also remember I had the uncontrollable urge to "look up", my eyes rolled back into my head with my arms and neck flexed back. My neck hurt for a week afterwards. It was relieved by a 25mg dose of diphenhydramine. After it took effect, I told that it made me feel 200% better.

Something I don't care to repeat... AGAIN.

HappyNurse2005, RN · Sep 9, 2007

Had that happen to a lady to whom I'd given Phenergan.

She began to twitch like mad. her legs and arms were twitching violently. she was tired, had the phenergan,and was on mag, so she was pretty sleepy.

It aws really freaky to watch, esp since i didnt knwo what was wrong, and her husband was watching her do this.

25mg of IV Benadryl solved that quickly.

(and it wasn't from the mag, b/c she stayed on themag and it didnt happen again)

Elvish, BSN, DNP, RN, NP · Sep 9, 2007

I was thinking that mag covered up the sx, not caused them. Mag relaxes everything & she would've had the fentanyl sx sooner had she not had the mag; that was our conjecture, at least.

I've seen it happen with Phenergan, but had never seen it with Fentanyl. Either way it is freaky.

EricJRN, MSN, RN · Sep 10, 2007

I found this article from several years ago where a patient developed EPS symptoms after being under general anesthesia for a surgery in which fentanyl was also given. Physostigmine is what reversed it in this case.

http://www.cja-jca.org/cgi/content/abstract/38/7/919

Belinda-wales, RN · Sep 10, 2007

I have only seen it once- one of our nurses was given an antiemtic for severe morning sickness - she had an EPS reaction she could not stop twitching and moving her legs- I was looking after her she was so unwell - it was very frightening for all.