Assignment: Medication study guide: Benztropine

Medication study guide:

Medication to review: Benztropine

Create a 3-pages (excluding visual elements, cover page, and references) Medication Study Guide for your assigned psychotropic medication agents that may be utilized by you and colleagues for study. Your medication guide should be in the form of an outline and should include a title page, citations, and references. You should incorporate visual elements, such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative!

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Note: Your Medication Study Guide should not be in the format of an APA paper.

Also Note: Your guide should be informed by the FDA-Approved and Evidenced-Based, Clinical Practice Guidelines Research.

Areas of importance that you should address—but are not limited to—include:

Title page

Description of the psychopharmacological medication agent, including brand and generic names, as well as appropriate FDA indication uses.

Any supporting, valid, and reliable research for non-FDA uses.

Drug classification

The medication mechanism of action

The medication pharmacokinetics

The medication pharmacodynamics

Appropriate dosing, administration route, and any considerations for dosing alterations

Considerations of use and dosing in specific specialty populations, such as children, adolescents, elderly, pregnant people, those exhibiting suicidal behaviors, etc.

Definition of half-life, why half-life is important, and the half-life for your assigned medication.

Side effects/adverse reactions potential

Discuss clinical concerns with EPS and Tardive Dyskinesia

Note: Be sure to include screening tools that would be utilized.

Contraindications for use including significant drug to drug interactions.

Overdose considerations

Diagnostics and labs monitoring comorbidities considerations.

Legal, ethical, and social considerations

Pertinent patient education considerations

References page

Support your rationale with a minimum of three (3) academic resources.

Note: While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing primary and secondary literature.

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Medication study guide: Benztropine
Benztropine
⦁ Brand Names: Cogentin
⦁ Generic Name: Benzatropine
⦁ Benzatropine is an anticholinergic medication used for the treatment of Parkinson’s disease and extrapyramidal symptoms, excluding tardive dyskinesia.
⦁ Benztropine is authorized by the US Food and Drug Administration (FDA) as a supplementary treatment for several types of parkinsonism, such as idiopathic and postencephalitic parkinsonism (Gibbons et al., 2023).
⦁ Benzatropine is often recommended for off-label applications, including the treatment of sialorrhea and akathisia, as well as for preventing extrapyramidal symptoms. However, it is worth noting that some authors advise against using anticholinergics for this reason.
Drug Classification and Medication Mechanism of Action
⦁ Benztropine belongs to a group of medications known as anticholinergics, specifically synthetic muscarinic receptor antagonists.
⦁ Strongly inhibiting dopamine transporters and having an affinity for histamine and muscarine receptors, benztropine is an anti-muscarinic and antihistaminic substance (LeWitt et al., 2024).
⦁ This compound is structurally similar to atropine and exhibits a strong binding affinity for muscarinic receptors M1 in the human brain.
⦁ After being bound, benztropine effectively inhibits the function of these receptors, primarily in the striatum.
⦁ Its benefit is that it counteracts the antagonistic effects of acetylcholine, which helps people living with Parkinson’s with their dopamine and acetylcholine imbalance.

Pharmacokinetics
⦁ Benztropine is absorbed gradually by the gastrointestinal tract, resulting in a peak concentration of 2.5 ng/ml after 7 hours (Gibbons et al., 2023).
⦁ The oral bioavailability is 29%.
⦁ The anticipated distribution range is 12-30 L/kg.
⦁ A significant portion of the administered dose, approximately 95%, is bound to proteins found in the plasma.
⦁ Benztropine is extensively metabolized, yielding four glucuronide conjugates and eight phase-I metabolites.
⦁ The primary route of elimination is through urine, although it may also be detected in fecal matter.
Pharmacodynamics
⦁ Benztropine hinders dopamine reuptake, leading to an elevation in dopamine levels within the dopaminergic system.
⦁ The activity of the substance can be observed following oral and intramuscular administration, with a duration of approximately 24 hours.
⦁ It exhibits a significant sedative effect akin to pyrilamine and an antihistaminic effect comparable to atropine.
⦁ The anticholinergic activity of the substance is equivalent to that of atropine in laboratory conditions and approximately 50% in living organisms (Chepke et al., 2023).
Administration
⦁ Benztropine can be administered orally, intravenously, or intramuscularly, each with distinct advantages.
⦁ The administration of benztropine mesylate through oral routes involves a range of strengths, with initial doses beginning at 0.5 mg and gradually escalating to 6 mg throughout 5 to 6 days (LeWitt et al., 2024). It is recommended to gradually increase the dose until the desired results are achieved while minimizing potential adverse reactions.
⦁ For drug-induced extrapyramidal symptoms or situations where oral and IM administration are not suitable, intravenous routes utilize a 1 mg/mL injection, as intramuscular routes also employ a 1 mg/mL injection.
Special Populations
⦁ Patients with hepatic or renal impairment should avoid using benztropine.
⦁ The effects of this substance on human breastfeeding remain uncertain, while its impact on pregnancy and labor has yet to be determined.
⦁ This medication should not be used in children under three years old, infants, neonates, or older patients with Parkinson’s disease (Chepke et al., 2023).
⦁ It is advisable for elderly patients to steer clear of potent anticholinergic agents.
Half-life
⦁ The half-life is the time it takes for a substance, often a medication, to decrease to half its initial dosage in the body. This concept is useful for determining a drug’s excretion rates and steady-state concentrations. All drugs follow this principle, even though their half-lives may differ (Chepke et al., 2023).
⦁ The elimination half-life of benztropine exhibits considerable variability, with reported values averaging approximately 36 hours.
Side Effects/Adverse Reactions
⦁ The adverse effects of Benztropine can vary in severity, encompassing symptoms such as a rash, chills, weakness, and paraesthesia (Sogawa et al., 2020).
⦁ Some of the effects that can be observed include myasthenia, cardiac arrest, and visual hallucinations.
EPS and Tardive Dyskinesia
⦁ Anticholinergics such as benztropine can effectively mitigate the occurrence of intense muscle spasms that may arise as a result of psychiatric medications. Additionally, they can help alleviate undesirable side effects like muscle stiffness or rigidity, commonly referred to as extrapyramidal symptoms (Gibbons et al., 2023).
⦁ Benztropine can help relieve symptoms of tardive dystonia and parkinsonism. However, it is not recommended for regular use due to the possibility of exacerbating Tardive Dyskinesia and negatively affecting cognitive function and memory.
⦁ The Barnes Akathisia Rating Scale (BARS) is useful for assessing the presence and severity of Akathisia.
⦁ The MIND-TD Questionnaire is a valuable tool for clinicians to facilitate meaningful discussions with patients who may be at risk for tardive dyskinesia.
Contraindications and Drug-to-Drug Interactions
⦁ Benztropine should not be used in patients with hypersensitivity to benztropine mesylate and its components, as well as in children under the age of 3 (Chepke et al., 2023).
⦁ Administering glucagon and anticholinergics together can lead to gastrointestinal side effects. Additionally, using them alongside antipsychotic medications raises the chances of experiencing hypomotility, paralytic ileus, hyperthermia, and heat stroke.
Overdose considerations
⦁ An overdose of Benztropine can result in an anticholinergic toxidrome, which necessitates the provision of supportive care.
⦁ The evaluation of risk takes place 6 hours following ingestion, while the effects of toxicity can range from 12 hours to 5 days (LeWitt et al., 2024).
⦁ Physostigmine is commonly employed as an antidote following the diagnosis of toxicity, although it is important to exercise caution (Chiappini et al., 2022).
⦁ Supportive care typically involves the administration of intravenous benzodiazepines and the use of a catheter along with bladder scans.
Diagnostics and Labs Monitoring
⦁ It is advisable to monitor renal and hepatic function regularly. Regular neurological assessments may be necessary for patients with Parkinson’s disease (Sogawa et al., 2020).
Legal, Ethical, and Social Considerations
⦁ It is important to use benztropine responsibly and strictly following the prescribed instructions, just like any other medication.
⦁ Improper usage may result in the development of dependency and various health complications (Chiappini et al., 2022).

Pertinent patient education considerations
⦁ It is crucial to provide patients with comprehensive information regarding the potential adverse effects of benztropine and emphasize the significance of adhering to the prescribed medication regimen (Chiappini et al., 2022).
⦁ It is recommended that individuals refrain from engaging in mentally demanding tasks until they have a clear understanding of how the medication may impact their cognitive abilities.
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References
Chepke, C., Benning, B., Cicero, S., Hull, M., Giraldo, E., Yeaw, J., Coyle, K., Jen, E., & Bron, M. (2023). Investigating Real-World Benztropine Usage Patterns in Movement Disorders. Primary Care Companion to CNS Disorders/the Primary Care Companion for CNS Disorders, 25(4). https://doi.org/10.4088/pcc.22m03472
Chiappini, S., Mosca, A., Miuli, A., Semeraro, F. M., Mancusi, G., Santovito, M. C., Di Carlo, F., Pettorruso, M., Guirguis, A., Corkery, J. M., Martinotti, G., Schifano, F., & Di Giannantonio, M. (2022). Misuse of Anticholinergic Medications: A Systematic review. Biomedicines, 10(2), 355. https://doi.org/10.3390/biomedicines10020355
Gibbons, R. D., Hur, K., Lavigne, J. E., & Mann, J. J. (2023). Benztropine and suicide attempts and intentional self-harm. Psychiatry Research, p. 320, 115054. https://doi.org/10.1016/j.psychres.2023.115054
LeWitt, P. A., Hong, L., & Moehle, M. S. (2024). Anticholinergic drugs for parkinsonism and other movement disorders. Journal of Neural Transmission. https://doi.org/10.1007/s00702-024-02799-7
Sogawa, C., Eguchi, T., Tran, M. T., Ishige, M., Trin, K., Okusha, Y., Taha, E. A., Lu, Y., Kawai, H., Sogawa, N., Takigawa, M., Calderwood, S. K., Okamoto, K., & Kozaki, K. (2020). Antiparkinson drug Benztropine suppresses tumor growth, circulating tumor cells, and metastasis by acting on SLC6A3/DAT and reducing STAT3. Cancers, 12(2), 523. https://doi.org/10.3390/cancers12020523