Question

A patient was recently started on Fluphenazine. A few weeks later, he developed tremors, rigidity, bradykinesia, and excessive salivation. The first line of management for this patient is

• A. Selegiline
• B. Trihexyphenidyl
• C. Pramipexole
• D. Amantadine

Answer 1

The Correct Option is B

Pattern recognition: a high-potency antipsychotic plus new tremor, rigidity, and drooling equals drug-induced (pseudo) parkinsonism from D2 blockade, an extrapyramidal side effect.
The fix is not to flood the brain with dopamine, because that would reignite the psychosis the fluphenazine is treating. Instead you tip the dopamine-acetylcholine seesaw back by blocking acetylcholine. Trihexyphenidyl, a central anticholinergic, is the standard first-line choice for these symptoms.
Why not the rest: selegiline, pramipexole, and amantadine are dopaminergic agents reserved for true Parkinson's disease and are inappropriate, even risky, in a psychotic patient. Hence trihexyphenidyl is correct.