A 55-year-old Caucasian male is receiving doxorubicin-based chemotherapy, opioids and anti-emetics for stage IV Hodgkin's lymphoma. He complains of an unstable gait and slowing of movements. Physical examination reveals a bilateral increase in the muscular tone without lateralizing neurologic signs. Which of the following is the best next step in the management of this patient's condition?

Question

A 55-year-old Caucasian male is receiving doxorubicin-based chemotherapy, opioids and anti-emetics for stage IV Hodgkin's lymphoma.  He complains of an unstable gait and slowing of movements.  Physical examination reveals a bilateral increase in the muscular tone without lateralizing neurologic signs.  Which of the following is the best next step in the management of this patient's condition?

Quizplus · Accepted Answer

Explanation: Metoclopromide and some other dopaminergic antagonists are occasionally used for chemotherapy-induced nausea and vomiting. Metoclopramide is a prokinetic agent that acts as a central and peripheral D2-receptor blocker. It is used to treat (and prevent) chemotherapy-induced emesis; however, its use has been associated with extrapyramidal symptoms. The common central nervous system effects include akathisia, dystonia, and parkinsonian-like symptoms. When the drug is used in high doses, the incidence of these side effects may exceed 30%. Metoclopramide has now been largely replaced by 5 HT3 serotonin receptor antagonists (e.g. ondansetron) and aprepitant. (Choice C)Low-dose benzodiazepine is used to reduce anticipation anxiety in patients undergoing chemotherapy. (Choices A, D, and E) Changing the chemotherapy regimen is not correct, because the symptoms are most probably related to the anti-emetic agent, not the chemotherapeutic drugs. Educational objective: Metoclopramide is a central and peripheral D2-receptor blocker. Its use can result in drug-induced extrapyramidal symptoms such as akathisia, dystonia, and parkinsonian-like symptoms.

A 55-Year-Old Caucasian Male Is Receiving Doxorubicin-Based Chemotherapy, Opioids and Anti-Emetics