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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Local Elevator by Kevin MacLeod is licensed under a Creative Commons Attribution 4.0 license. https://creativecommons.org/licenses/by/4.0/

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