Read Mosby's 2014 Nursing Drug Reference Online
Authors: Linda Skidmore-Roth
Mosby's 2014 Nursing Drug Reference (181 page)
Do not confuse:
Prolixin
/Proloid
Depresses cerebral cortex, hypothalamus, limbic system, which control activity and aggression; blocks neurotransmission produced by DOPamine at synapse; exhibits strong α-adrenergic and anticholinergic blocking action; mechanism for antipsychotic effects is unclear
Psychotic disorders, schizophrenia
Hypersensitivity, circulatory collapse, hepatic damage, cerebral arteriosclerosis, coronary disease, severe hypo/hypertension,
blood dyscrasias, coma, brain damage, closed-angle glaucoma, bone marrow depression, alcohol and barbiturate withdrawal
Precautions:
Pregnancy (C), breastfeeding, children <12 yr, geriatric patients, seizure disorders, hypertension, cardiac/hepatic disease
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
Calculator
• Adult and child >16 yr:
IM/SUBCUT
12.5-25 mg q1-3wk, may increase slowly
• Child 12-16 yr:
IM/SUBCUT
6.25-18.75 mg, then repeat q1-3wk, then increase slowly; max 25 mg
• Child 5-12 yr:
IM/SUBCUT
3.125-12.5 mg, then repeat q1-3wk, increase slowly
• Adult:
PO
2.5-10 mg in divided doses q6-8hr, max 40 mg/day;
IM
initially 1.25 mg then 2.5-10 mg in divided doses q6-8hr
• Child:
PO
0.25-3.5 mg/day in divided doses q4-6hr, max 10 mg/day
Available forms:
Decanoate:
inj 25 mg/ml;
HCl:
tabs 1, 2.5, 5, 10 mg; inj 2.5 mg/ml; elixir 2.5 mg/5 ml; oral solution 5 mg/ml
•
Give with food, milk, or a full glass of water to minimize gastric irritation
•
Oral concentrate:
Give using a calibrated measuring device. Dilute just before use with 120–240 ml of water, saline, milk, 7-Up, carbonated orange beverage, or apricot, orange, pineapple, prune, tomato, or V-8 juice. Do not mix with beverages containing caffeine (coffee, cola), tannics (tea), or pectinates (apple juice) or with other liquid medications. Avoid spilling the solution on the skin and clothing
•
Oral elixir:
Give using a calibrated measuring device. Avoid spilling the solution on the skin and clothing
•
Visually inspect for particulate matter and discoloration before use, slight yellow to amber color does not alter potency, markedly discolored solutions should be discarded
•
No dilution necessary; if irritation occurs, subsequent IM doses may be diluted with NS for injection or 2% procaine
•
Inject slowly and deeply into the upper outer quadrant of the gluteal muscle using a dry syringe and needle, aspirate before injection
•
Keep patient in a recumbent position for at least 30 min following injection to minimize hypotensive effects
•
Rotate the site of injection to avoid irritation or sterile abscess formation with repeat use
•
FluPHENAZine decanoate or enanthate injections are administered IM or subcut, do not give IV
•
FluPHENAZine depot injections must be drawn up using a dry syringe and needle of at least 21-G, do not dilute
•
Inject slowly and deeply into the upper outer quadrant of the gluteal muscle, aspirate before injection
•
Keep patient in a recumbent position for at least 30 min following the initial injection to minimize hypotensive effects. Once patient is dose-stabilized on depot formulation, this precaution may be modified. Rotate the site of injection to avoid irritation or sterile abscess formation with repeat administration
•
FluPHENAZine decanoate or enanthate injections are administered via IM or SC injection only, do not administer IV
•
FluPHENAZine depot injection solutions must be drawn up using a dry syringe and a needle of at least 21-G, do not dilute
•
Inject subcut, taking care not to inject intradermally
•
Keep patient in a recumbent position for at least 30 min following the initial injection to minimize hypotensive effects. Once patient is dose-stabilized on depot formulation, this precaution may be modified for ambulatory patients; rotate the injection sites
CNS:
EPS: pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, drowsiness, headache
,
seizures, neuroleptic malignant syndrome
CV:
Orthostatic hypotension
, hypertension,
cardiac arrest,
ECG changes,
tachycardia
EENT:
Blurred vision, glaucoma, dry eyes
GI:
Dry mouth, nausea, vomiting, anorexia, constipation
, diarrhea, jaundice, weight gain,
paralytic ileus, hepatitis,
cholecystic jaundice
GU:
Urinary retention, urinary frequency, enuresis, impotence, amenorrhea, gynecomastia
HEMA:
Anemia,
leukopenia, leukocytosis, agranulocytosis, aplastic anemia, thrombocytopenia
INTEG:
Rash
, photosensitivity, dermatitis
RESP:
Laryngospasm,
dyspnea,
respiratory depression
Metabolized by liver, excreted in urine (metabolites), crosses placenta, enters breast milk, protein binding >90%, not dialyzable
PO/IM (HCl):
Onset 1 hr, peak 2-4 hr, duration 6-8 hr, half-life 3.5-4 days
IM/SUBCUT (decanoate):
Onset 1-3 days; peak 1-2 days, duration over 4 wk, single-dose half-life 6.8-9.6 days, multiple dose 14.3 days
Increase:
serotonin syndrome, neuroleptic malignant syndrome—SSRIs, SNRIs, serotonin-receptor agonists
Increase:
QT prolongation, torsades de pointes (at higher doses)—amiodarone, arsenic trioxide, astemizole, dasatinib, disopyramide, dofetilide, droperidol, erythromycin, flecainide, gatifloxacin, ibutilide, levomethadyl, ondansetron, paliperidone, palonosetron, some antidepressants, vorinostat, ziprasidone, haloperidol
Increase:
sedation—other CNS depressants, alcohol, barbiturate anesthetics, haloperidol, metyrosine, risperiDONE
Increase:
toxicity—EPINEPHrine
Increase:
anticholinergic effects—anticholinergics
Decrease:
effects of levodopa, lithium
Decrease:
fluPHENAZine effects—smoking, barbiturates
Increase:
LFTs, cardiac enzymes, cholesterol, blood glucose, prolactin, bilirubin, cholinesterase
Decrease:
hormones (blood and urine)
False positive:
pregnancy tests, PKU urinary steroids, 17-OHCS
Black Box Warning:
Increased mortality in elderly patients with dementia-related psychosis
•
Serotonin syndrome, neuroleptic malignant syndrome:
severe EPS, increased CPK, altered mental state, sinus tachycardia, change in B/P, sweating, often occurs in young men, heat stress, physical exhaustion, dehydration, organic brain disease
QT prolongation, torsades de pointes:
ECG for changes
•
Bilirubin, CBC, LFTs monthly
•
Urinalysis recommended before and during prolonged therapy
•
Affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances
•
B/P standing and lying; pulse and respirations q4hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg
•
Dizziness, faintness, palpitations, tachycardia on rising
•
EPS
including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of jaw,
mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait)
•
Constipation, urinary retention daily; if these occur, increase bulk, water in diet
•
Supervised ambulation until stabilized on medication; do not involve patient in strenuous exercise; fainting possible; patient should not stand still for long periods
•
Therapeutic response: decrease in emotional excitement, hallucinations, delusions, paranoia, reorganization of patterns of thought, speech
•
That orthostatic hypotension occurs often; to rise from sitting or lying position gradually; to avoid hazardous activities until stabilized on medication
•
To avoid hot tubs, hot showers, tub baths because hypotension may occur; that in hot weather, heat stroke may occur; to take extra precautions to stay cool
To avoid abrupt withdrawal of this product or EPS may result; that product should be withdrawn slowly
•
To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber; that serious product interactions may occur; to avoid use with alcohol, CNS depressants; that increased drowsiness may occur
•
To use a sunscreen to prevent burns
•
About the importance of compliance with product regimen
•
About EPS and the need for meticulous oral hygiene because oral candidiasis may occur
•
To report sore throat, malaise, fever, bleeding, mouth sores; if these occur, CBC should be drawn, product discontinued
•
That urine may turn pink to reddish brown
Lavage; if orally ingested, provide an airway;
do not induce vomiting
Canada only Side effects:
italics
= common;
bold
= life-threatening Nurse Alert