Drug Study: chlorpromazine (Thorazine)

Generic name:
chlorpromazine

Brand name:
Thorazine

Preparations:
PO 10-25mg 2=4 times daily; may increase every 3-4 days (usual dose is 200ng/day; up to 1g/day)

CLASSIFI-CATION: Antipsychotics

ACTION:
• Block dopamine receptors in the brain; also alter dopamine release and turnover.

• Prevention of seizures

INDICATION / USES:
•Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity. Nausea and vomiting.
• Also used in the treatment of intractable hiccups.

COMMON ADVERSE EFFECTS:
•CNS: neuroleptic malignant syndrome, sedation, extrapyramidal reactions, tardive dyskinesia
•CV: hypotension (increased with IM, IV)
•EENT: blurred vision, dry eyes, lens opacities
• GI: constipation, dry mouth, anorexia, hepatitis, ileus
• GU: urinary retention
• Hematologic: agranulocytosis, leukopenia
• Skin: photosensitivity, pigment changes, rashes

CONTRA-INDICATIONS:
• Hypersensitivity.
•Cross-sensitivity may exist among phenothiazines. Should not be used in narrow-angle glaucoma.
•Should not be used in patients who have CNS depression.

NURSING CONSIDERATIONS:
• Assess mental status prior to and periodically during therapy.
• Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG.
• Observe patient carefully when administering medication, to ensure that medication is actually taken and not hoarded.
•Monitor I&O ratios and daily eight. Assess patient for signs and symptoms of dehydration.
• 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 symptoms immediately. May also cause leukocytosis, elevated liver function tests, elevated CPK.
• Advise patient to take medication as directed. Take missed doses as soon as remembered, witih remaining doses evenly spaced through out the day. May require several weeks to obtain desired effects. Do not increase dose or discontinue medication without consulting health care professional. Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled movements of mouth, tongue or jaw.


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