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02/12/2014 10:37AM
chlorproMAZINE (klor-proe-ma-zeen)
Thorazine
Classification
Therapeutic: antiemetics, antipsychotics
Pharmacologic: phenothiazines
Pregnancy Category C
Indications
Second-line treatment for schizophrenia and psychoses after failure with atypical antipsychotics. Hyperexcitable, combative behavior in children. Nausea and vomiting.
Intractable hiccups. Preoperative sedation. Acute intermittent porphyria. Unlabeled Use: Vascular headache. Bipolar disorder.
Action
Alters the effects of dopamine in the CNS. Has significant anticholinergic/alpha-adrenergic blocking activity. Therapeutic Effects: Diminished signs/symptoms of psychosis. Relief of nausea/vomiting/intractable hiccups. Decreased symptoms of porphyria.
Pharmacokinetics
Absorption: Variable absorption from tablets. Well absorbed following IM administration.
Distribution: Widely distributed; high CNS concentrations. Crosses the placenta;
enters breast milk.
Protein Binding: ⱖ90%.
Metabolism and Excretion: Highly metabolized by the liver and GI mucosa.
Some metabolites are active.
Half-life: 30 hr.
TIME/ACTION PROFILE (antipsychotic activity, antiemetic activity, sedation)
ROUTE
ONSET
PEAK
DURATION
PO
IM
IV
30–60 min
unknown
rapid
unknown
unknown
unknown
4–6 hr
4–8 hr
unknown
⫽ Genetic Implication.
pg 1 # 1
Contraindications/Precautions
Contraindicated in: Hypersensitivity; Hypersensitivity to sulfites (injectable);
1
⫽ Canadian drug name.
Plate # 0-Composite
Cross-sensitivity with other phenothiazines may occur; Angle-closure glaucoma;
Bone marrow depression; Severe liver/cardiovascular disease; Concurrent pimozide
use.
Use Cautiously in: Diabetes; Respiratory disease; Prostatic hyperplasia; CNS tumors; Epilepsy; Intestinal obstruction; OB: Neonates atqrisk for extrapyramidal
symptoms and withdrawal after delivery when exposed during the 3rd trimester; use
only if benefit outweighs risk to fetus; Lactation: Discontinue drug or bottle feed;
Pedi: Children with acute illnesses, infections, gastroenteritis, or dehydration (qrisk
of extrapyramidal reactions); Geri:qrisk of mortality in elderly patients treated for
dementia-related psychosis; Geri: Geriatric/debilitated patients (pinitial dose).
Adverse Reactions/Side Effects
CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, extrapyramidal reactions, tardive
dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: hypotension (qwith
IM, IV), tachycardia. GI: constipation, dry mouth, anorexia, hepatitis, ileus, priapism. GU: urinary retention. Derm: photosensitivity, pigment changes, rash.
Endo: galactorrhea, amenorrhea. Hemat: AGRANULOCYTOSIS, leukopenia. Metab:
hyperthermia. Misc: allergic reactions.
Interactions
Drug-Drug: Pimozideqthe risk of potentially serious cardiovascular reactions;
concurrent use contraindicated. May alter serum phenytoin levels.ppressor effect
of norepinephrine and eliminates bradycardia. Antagonizes peripheral vasoconstriction from epinephrine and may reverse some of its actions. Maypelimination
andqeffects of valproic acid. Maypthe pharmacologic effects of amphetamine
and related compounds. Maypthe effectiveness of bromocriptine. Mayqblood
levels and effects of tricyclic antidepressants. Antacids or adsorbent antidiarrheals maypadsorption; administer 1 hr before or 2 hr after chlorpromazine.q
risk of anticholinergic effects with antihistamines, tricyclic antidepressants,
quinidine, or disopyramide. Premedication with chlorpromazineqthe risk of
neuromuscular excitation and hypotension when followed by barbiturate anesthesia. Barbiturates mayqmetabolism andpeffectiveness. Chlorpromazine mayp
barbiturate levels. Additive hypotension with antihypertensives. Additive CNS depression with alcohol, antidepressants, antihistamines, MAO inhibitors,
opioid analgesics, sedative/hypnotics, or general anesthetics. Concurrent use
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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Plate # 0-Composite
pg 2 # 2
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● Assess weight and BMI initially and throughout therapy. Refer as appropriate for
with lithium may produce disorientation, unconsciousness, or extrapyramidal
symptoms. Concurrent use with meperidine may produce excessive sedation and
hypotension. Concurrent use with propranololqblood levels of both drugs.
Drug-Natural Products: Concomitant use of kava-kava, valerian, chamomile, or hops canqCNS depression.qanticholinergic effects with angel’s trumpet, jimson weed, and scopolia.
● Assess positive (hallucinations, delusions, agitation) and negative (social with-
nutritional/weight and medical management.
Route/Dosage
●
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PO (Adults): Psychoses— 10– 25 mg 2– 4 times daily; mayqevery 3– 4 days
(usual dose is 200 mg/day; up to 1 g/day). Nausea and vomiting— 10– 25 mg q 4
hr as needed. Preoperative sedation— 25– 50 mg 2– 3 hr before surgery. Hiccups/porphyria— 25– 50 mg 3– 4 times daily.
PO (Children): Psychoses/nausea and vomiting— 0.55 mg/kg (15 mg/m2) q 4–
6 hr as needed. Preoperative sedation— 0.55 mg/kg (15 mg/m2) 2– 3 hr before
surgery.
IM (Adults): Severe psychoses— 25– 50 mg initially, may be repeated in 1 hr;qto
maximum of 400 mg q 3– 12 hr if needed (up to 1 g/day). Nausea/vomiting— 25
mg initially, may repeat with 25– 50 mg q 3– 4 hr as needed. Nausea/vomiting during surgery— 12.5 mg, may be repeated in 30 min as needed. Preoperative sedation— 12.5– 25 mg 1– 2 hr prior to surgery. Hiccups/tetanus— 25– 50 mg 3– 4
times daily. Porphyria— 25 mg q 6– 8 hr until patient can take PO.
IM (Children 6 mo): Psychoses/nausea and vomiting— 0.55 mg/kg (15 mg/m2)
q 6– 8 hr (not to exceed 40 mg/day in children 6 mo– 5 yr, or 75 mg/day in children
5– 12 yr). Nausea/vomiting during surgery— 0.275 mg/kg, may repeat in 30 min
as needed. Preoperative sedation— 0.55 mg/kg 1– 2 hr prior to surgery. Tetanus— 0.55 mg/kg q 6– 8 hr.
IV (Adults): Nausea/vomiting during surgery— up to 25 mg. Hiccups/tetanus— 25– 50 mg. Porphyria— 25 mg q 8 hr.
IV (Children): Nausea/vomiting during surgery— 0.275 mg/kg. Tetanus—
0.55 mg/kg.
●
NURSING IMPLICATIONS
Assessment
●
● Assess mental status (orientation, mood, behavior) prior to and periodically dur-
ing therapy.
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drawal) symptoms of schizophrenia.
Monitor BP (sitting, standing, lying), pulse, and respiratory rate prior to and frequently during the period of dose adjustment.
Observe patient carefully when administering medication to ensure medication is
actually taken and not hoarded.
Assess fluid intake and bowel function. Increased bulk and fluids in the diet may
help minimize constipation.
Monitor patient for onset of akathisia (restlessness or desire to keep moving) and
ex-trapyramidal side effects (parkinsonian— difficulty speaking or swallowing,
loss of balance control, pill rolling of hands, mask-like face, shuffling gait, rigidity,
tremors; and dystonic— muscle spasms, twisting motions, twitching, inability to
move eyes, weakness of arms or legs) every 2 mo during therapy and 8– 12 wk
after therapy has been discontinued. Notify health care professional if these symptoms occur; reduction in dose or discontinuation may be necessary. Trihexyphenidyl, diphenhydramine, or benzotropine may be used to control these symptoms.
Benzodiazepines may alleviate symptoms of akathisia.
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, excessive eye blinking). Report these symptoms immediately; may be irreversible.
Monitor for development of neuroleptic malignant syndrome (fever,
respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of
bladder control). Report these symptoms immediately.
Monitor for symptoms related to hyperprolactinemia (menstrual abnormalities,
galactorrhea, sexual dysfunction).
Preoperative Sedation: Assess level of anxiety prior to and following administration.
Vascular Headache: Assess type, location, intensity, and duration of pain and accompanying symptoms.
Lab Test Considerations: Monitor CBC, liver function tests, and ocular
exams periodically throughout therapy. May causephematocrit, hemoglobin, leukocytes, granulocytes, platelets. May causeqbilirubin, AST,
ALT, and alkaline phosphatase. Agranulocytosis occurs 4– 10 wk after
䉷 2015 F.A. Davis Company
CONTINUED
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Name /bks_53161_deglins_md_disk/chlorpromazine
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pg 3 # 3
● Y-Site Compatibility: alemtuzumab, alfentanyl, amikacin, amphotericin B lipid
3
CONTINUED
chlorproMAZINE
initiation of therapy, with recovery 1– 2 wk following 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.
● Assess fasting blood glucose and cholesterol levels initially and periodically
throughout therapy.
● May causeqserum prolactin levels.
Potential Nursing Diagnoses
Disturbed thought process (Indications)
Imbalanced nutrition: risk for more than body requirements (Side Effects)
Implementation
● Do not confuse chlorpromazine with chlorpropamide, chlordiazepox-
ide, or prochlorperazine.
● Keep patient recumbent for at least 30 min following parenteral administration to
minimize hypotensive effects.
● Hiccups: Initial treatment is with oral doses. If hiccups persist 2– 3 days, IM in-
jection may be used, followed by IV infusion.
● PO: Administer oral doses with food, milk, or a full glass of water to minimize gas-
tric irritation. Tablets may be crushed.
● IM: Do not inject subcut. Inject slowly into deep, well-developed muscle. May be
diluted with 0.9% NaCl or 2% procaine. Lemon-yellow color does not alter potency of solution. Do not administer solution that is markedly discolored or contains a precipitate.
IV Administration
● pH: 3.4– 5.4.
● Direct IV: Diluent: Dilute with 0.9% NaCl. Concentration: Do not exceed 1
mg/mL. Rate: Inject slowly at a rate of at least 1 mg/min for adults and 0.5 mg/
min for children.
● Continuous Infusion: Diluent: May further dilute 25– 50 mg in 500– 1000
mL of D5W, D10W, 0.45% NaCl, 0.9% NaCl, Ringer’s or lactated Ringer’s injection, dextrose/Ringer’s or dextrose/lactated Ringer’s combinations.
⫽ Canadian drug name.
⫽ Genetic Implication.
complex, amsacrine, anidulafungin, argatroban, ascorbic acid, atracurium, atropine, benztropine, bleomycin, buprenorphine, butorphanol, calcium chloride,
calcium gluconate, carmustine, caspofungin, cisatracurium, cisplatin, cladribine,
cyanocobalamin, cyclophosphamide, cyclosporine, cytarabine, dactinomycin,
daptomycin, dexmedetomidine, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dopamine, doxacurium, doxorubicin, doxorubicin liposome,
doxycycline, enalaprilat, ephedrine, epinephrine, epirubicin, erythromycin, esmolol, etoposide, famotidine, fenoldopam, fentanyl, filgrastim, fluconazole, gemcitabine, gentamicin, glycopyrrolate, granisetron, hetastarch, hydrocortisone, hydromorphone, idarubicin, ifosfamide, isoproterenol, labetalol, levofloxacin,
lidocaine, lorazepam, magnesium sulfate, mannitol, mechlorethamine, meperidine, methoxamine, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, miconazole, midazolam, milrinone, mitoxantrone, morphine, multivitamins, mycophenolate, nafcillin, nalbuphine, naloxone,
nitroglycerin, norepinephrine, octreotide, ondansetron, oxacillin, oxaliplatin, palonosetron, pamidronate, pancuronium, papaverine, penicillin G potassium, pentamidine, pentazocine, phentolamine, phytonadione, potassium acetate, potassium chloride, procainamide, prochlorperazine, promethazine, propofol,
propranolol, protamine, pyridoxime, quinupristin/dalfopristin, ranitidine, rituximab, rocuronium, sodium acetate, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiamine, thiotepa, tirofiban, tolazoline, trimetaphan, vancomycin, vasopressin, vecuronium, verapamil, vincristine, vinorelbine, vitamin B
complex with C, voriconazole, zoledronic acid.
● Y-Site Incompatibility: acetaminophen, acyclovir, allopurinol, amifostine, aminophylline, amphotericin B cholesteryl, amphotericin B colloidal, amphotericin
B liposome, ampicillin, ampicillin/sulbactam, azathioprine, aztreonam, bivalirudin, bumetanide, carboplatin, cefazolin, cefepime, cefoperazone, cefotaxime, cefotetan, cefoxitin, ceftriaxone, cefuroxime, chloramphenicol, clindamycin, dantrolene, dexamethasone, diazepam, diazoxide, epoetin alfa, eptifibatide, ertapenem,
etoposide phosphate, fludarabine, fluorouracil, folic acid, furosemide, gancilovir,
hydralazine, imipenem/cilastatin, indomethacin, insulin, irinotecan, ketorolac, linezolid, melphalan, methotrexate, nitroprusside, paclitaxel, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phenytoin, piperacillin/tazobactam, sargramostim, sodium bicarbonate, streptokinase, ticarcillin/clavulante, tigecycline,
trastuzumab, trimethoprim/sulfamethoxazole.
Patient/Family Teaching
● Advise patient to take medication as directed and not to skip doses or double up
on missed doses. If a dose is missed, take within 1 hr or omit dose and return to
CAPITALS indicate life-threatening, underlines indicate most frequent.
Strikethrough ⫽ Discontinued.
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regular schedule. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia.
Instruct patient to report these symptoms immediately to health care professional.
Advise patient to change positions slowly to minimize orthostatic hypotension.
May cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to the medication is known.
Caution patient to avoid taking alcohol or other CNS depressants concurrently with
this medication.
Advise patient to use sunscreen and protective clothing when exposed to the sun.
Exposed surfaces may develop a temporary pigment change (ranging from yellowbrown to grayish purple). Extremes of temperature (exercise, hot weather, hot
baths or showers) should also be avoided, because this drug impairs body temperature regulation.
Instruct patient to use frequent mouth rinses, good oral hygiene, and sugarless
gum or candy to minimize dry mouth. Consult health care professional if dry
mouth continues for 2 wk.
Advise patient not to take chlorpromazine within 2 hr of antacids or antidiarrheal
medication.
Inform patient that this medication may turn urine a pink-to-reddish-brown color.
Advise patient to notify health care professional of medication regimen prior to
treatment or surgery.
Instruct patient to notify health care professional promptly if sore
throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.
Advise female patients to notify health care professional if pregnancy is planned or
suspected or if breast feeding.
Emphasize the importance of routine follow-up exams to monitor response to
medication and detect side effects. Encourage continued participation in psychotherapy as indicated.
Treatment is not a cure; symptoms may recur after discontinuation of medication.
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Plate # 0-Composite
pg 4 # 4
Relief of nausea and vomiting.
Relief of hiccups.
Preoperative sedation.
Management of porphyria.
Relief of vascular headache.
Decrease in positive (hallucinations, delusions, agitation) symptoms of schizophrenia.
Why was this drug prescribed for your patient?
Evaluation/Desired Outcomes
● Decrease in excitable, manic behavior. Therapeutic effects may not be seen for 7–
8 wk.
䉷 2015 F.A. Davis Company
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