A client on haloperidol develops acute torticollis and oculo… | MyMerci
Medical EmergenciesPA
Question
A client on haloperidol develops acute torticollis and oculogyric crisis 6 hours after the first dose. The provider orders benztropine 2 mg IM. Which finding most warrants withholding the medication?
1Body mass index of 24
2Mild seasonal allergies
3Documented narrow-angle glaucoma✓ Correct answer
4Hypertension controlled on lisinopril
Explanation
Correct (1): Narrow-angle glaucoma is a contraindication to anticholinergics (benztropine, trihexyphenidyl) because pupil dilation can precipitate acute angle closure with intraocular pressure spike and potential blindness. Other contraindications: paralytic ileus, severe BPH/urinary retention, severe ulcerative colitis, myasthenia gravis. (2,3,4) Not contraindications.
In-depth explanation
Memory Tip Anticholinergic contraindications = "Eye, Ileus, Urine, Muscle" — narrow-angle glaucoma, paralytic ileus, urinary retention/BPH, myasthenia gravis. Acute dystonia first-line: diphenhydramine IM/IV or benztropine if no contraindications.
Clinical scenario
Scenario 32-year-old male just received first haloperidol dose 6 hours ago; now has acute dystonia: neck twisted, upward eye deviation. Benztropine 2 mg IM ordered.
Key concepts
Acute dystonia — Sudden involuntary muscle contraction (torticollis, oculogyric crisis, opisthotonos) early in antipsychotic therapy.