GENERIC/BRAND/ MECHANISM OF CLASSIFICATION ACTION Generic: Alters the effects of Fluphenazine dopamine in CNS.

Anticholinergic and alpha-adrenergic blocking activity. BRAND: Prolixin, Fluphenazine Decanoate

INDICATION Acute and chronic psychoses.

CONTRAINDICATION Hypersensitivity; crosssensitivity with other phenothiazines may exist; subcortical brain damage; severe CNS depression; coma; bone marrow depression; liver disease; hypersensitivity to sesame oil (decanoate salt); some products contain alcohol or tartrazine and should be avoided in clients with known intolerance; concurrent use of drugs that prolong QT interval.

ADVERSE REACTION CNS: NEUROLEPTIC MALIGNANT SYNDROME, extrapyramidal reactions, sedation, tardive dyskinesia. EENT: Blurred vision, dry eyes. CV: Hypertension, hypotension, tachycardia. GI: Anorexia, constipation, druginduced hepatitis, dry mouth, ileus, nausea, weight gain. GU: Urinary retention. Derm: Photosensitivity, pigment changes, rashes. Endo: Galactorrhea. Hemat: AGRANULOCYTOSIS, leukopenia, thrombocytopenia. Misc: Allergic reactions.

DOSAGE Usual: PO (Adults): 0.510 mg/day in divided doses every 68 hr (maximum dose = 40 mg/day). IM (Adults): 12.525 mg initially; may be repeated every 3 wk. Dosage may be slowly as needed (not to exceed 100 mg/dose).

NURSING RESPONSIBILITY Assess patients mental status (orientation, mood, behavior) before and periodically throughout therapy. Monitor blood pressure (sitting, standing, lying), ECG, pulse, and respiratory rate before and frequently during the period of dosage adjustment. May cause Qwave and T-wave changes in ECG. Observe patient carefully when administering oral medication to ensure that medication is actually taken and not hoarded. Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize constipation. Monitor patient for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsoniandifficulty speaking or swallowing, loss of balance control, pill rolling, mask-like face,

RATIONALE

CLASSIFICATION: Antipsychotics

Actual:

Drug Image:

shuffling gait, rigidity, tremors; dystonicmuscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 812 wk after therapy has been discontinued. Reduction in dosage or discontinuation of medication may be necessary. Trihexyphenidyl or diphenhydramine may be used to control these symptoms. Monitor for tardive dyskinesia (uncontrolled rhythmic movement of mouth, face, and extremities; lip smacking or puckering; puffing of cheeks; uncontrolled chewing; rapid or worm-like movements of tongue). Report immediately; may be irreversible. Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report

immediately. Lab Test Considerations: CBC, liver function tests, and ocular examinations should be evaluated periodically during therapy. May cause decreased hematocrit, hemoglobin, leukocytes, granulocytes, and platelets. May cause elevated bilirubin, AST, ALT, and alkaline phosphatase. Agranulocytosis may occur after 410 wk of therapy with recovery 12 wk after discontinuation. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy. May cause false-positive or false-negative pregnancy tests and false-positive urine bilirubin test results.