A client receiving haloperidol (Haldol) complains of a stiff jaw and difficulty swallowing. The nurse’s first action is to:

Correct Answer: B. Administer as needed dose of benztropine (Cogentin) I.M. as ordered.

The client is most likely suffering from muscle rigidity due to haloperidol. I.M. benztropine should be administered to prevent asphyxia or aspiration. The extrapyramidal symptoms are muscular weakness or rigidity, a generalized or localized tremor that may be characterized by the akinetic or agitation types of movements, respectively. Haloperidol overdose is also associated with ECG changes known as torsade de pointes, which may cause arrhythmia or cardiac arrest.

• Option A: Lorazepam treats anxiety, not extrapyramidal effects. Lorazepam is a benzodiazepine medication developed by DJ Richards. It went on the market in the United States in 1977. Lorazepam has common use as the sedative and anxiolytic of choice in the inpatient setting owing to its fast (1 to 3 minute) onset of action when administered intravenously. Lorazepam is also one of the few sedative-hypnotics with a relatively clean side effect profile. Lorazepam is FDA approved for short-term (4 months) relief of anxiety symptoms related to anxiety disorders, anxiety-associated insomnia, anesthesia premedication in adults to relieve anxiety, or to produce sedation/amnesia, and treatment of status epilepticus.
• Option C: Benztropine belongs to the synthetic class of muscarinic receptor antagonists (anticholinergic drugs). Thus, it has a structure similar to that of diphenhydramine and atropine. However, it is long-acting so that its administration can be with less frequency than diphenhydramine. It also induces less CNS stimulation effect compared to that of trihexyphenidyl, making it a preferable drug of choice for geriatric patients.
• Option D: Another dose of haloperidol would increase the severity of the reaction. Since there is no specific antidote, supportive treatment is the mainstay of haloperidol toxicity. If a patient develops signs and symptoms of toxicities, the clinician should consider gastric lavage or induction of emesis as soon as possible, followed by the administration of activated charcoal. Maintenance of Airway, Breathing, and circulation are the most important factors for survival.