What is the most appropriate med to administer for extrapyramidal symptoms after haloperidol?

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Multiple Choice

What is the most appropriate med to administer for extrapyramidal symptoms after haloperidol?

Extrapyramidal symptoms from haloperidol come from blockade of dopamine in the nigrostriatal pathway, which disrupts normal motor control. The fastest and most effective way to counteract these symptoms is with an anticholinergic agent that restores the balance between acetylcholine and dopamine in the basal ganglia. Diphenhydramine fits this need well. It’s an antihistamine with strong anticholinergic effects, so it quickly reduces dystonia and other EPS when given IV or IM. In the EMS/acute setting, a typical dose is 25–50 mg IM or IV, and it often works within minutes. It directly addresses the underlying imbalance causing the symptoms. Other options don’t target that mechanism as effectively. Lorazepam may help with agitation, but it doesn’t treat the EPS itself as reliably as an anticholinergic. Morphine serves pain relief, not EPS management. Furosemide has no role in EPS.

Extrapyramidal symptoms from haloperidol come from blockade of dopamine in the nigrostriatal pathway, which disrupts normal motor control. The fastest and most effective way to counteract these symptoms is with an anticholinergic agent that restores the balance between acetylcholine and dopamine in the basal ganglia.

Diphenhydramine fits this need well. It’s an antihistamine with strong anticholinergic effects, so it quickly reduces dystonia and other EPS when given IV or IM. In the EMS/acute setting, a typical dose is 25–50 mg IM or IV, and it often works within minutes. It directly addresses the underlying imbalance causing the symptoms.

Other options don’t target that mechanism as effectively. Lorazepam may help with agitation, but it doesn’t treat the EPS itself as reliably as an anticholinergic. Morphine serves pain relief, not EPS management. Furosemide has no role in EPS.

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