C15_nonphenothiazine.qxd

CHAPTER 15
Nervous System Drugs
Nonphenothiazine
Half-life: Onset:
Duration:
IM: 15–30 min IM: 30–45 min IM: 4–8 h IM: Decanoate IM: Decanoate IM: Decanoate behavioral problems in children, short-term treatment of hyperactivity in children; treatment of infantile autism, Huntington’s chorea, nausea/vomiting associated with cancer therapy.
Pregnancy Pharmacokinetic: PB: 80–90%;
category: C
readily absorbed from GI tract;extensively metabolizedin liver,excreted in urine; not removedby hemodialysis.
• Competitively blocks postsynaptic dopamine receptors, interrupts impulse movement and increases turnover of braindopamine,producing tranquilizing effect. Strong extrapyramidal,antiemetic effects, weak anticholinergic, sedative effects.
• PO: 0.5–5 mg 2–3 times/day. Maximum 100 mg/day.
• IM (lactate) 2–5 mg q4–8 h as needed.
• IM (decanoate) 10–15 times stabilized oral dose given at • IV: only lactate is given IV; IV push at rate of 5 mg/min; infuse piggy back over 30 min; up to 25 mg/hr has been used titratedto patient response.
• Obtain medical and drug history.
• Assess mental status, cardiac, eye, and respiratory disorders CHAPTER 15
Nervous System Drugs
Nonphenothiazine
• PO: give without regarad to meals.
• PO: scored tablets may be crushed.
• Prepare Decanoate IM injection with 21 gauge needle; do not exceed maximum volume of 3 ml per IM site; inject slowly,deep IM into upper outer quardant of gluteus maximus.
• IV may given undiluted; flush with at least 2 mL 0.9% NaCl before and after administration; may add to 30–50 mL mostsolutions (D5W preferred).
• IM: Patient must remain recumbent for 30–60 min in head-low position with legs raised to minimize hypotensive effect.
• Monitor blood pressure for hypotension.
• Assess for extrapyramidal symptoms.
• Monitor WBC, differential count for blood dyscrasias.
• Monitor for fine tongue movement (may be early sign of • Place on suicide precautions if necessary.
• Coma, alcohol ingestion, Parkinson’s disease, thyrotoxicosis.
• Caution: impaired respiratory/hepatic/cardiovascular function, alcohol withdrawal, history of seizures, urinary retention,glaucoma, prostatic hypertrophy, elderly.
• Frequent: blurred vision, constipation, orthostatic hypotension, dry mouth, swelling or soreness of female breasts, peripheraledema.
• Occasional: allergic reaction, difficulty urinating, decreased thirst, dizziness, decreased sexual ability, drowsiness, nausea,vomiting, photosensitivity, lethargy.
• Extrapyramidal symptoms appear to be dose related and may be noted in first few days of therapy; Marked drowsiness andlethargy, excessive salivation, fixed stare may be mild to severein intensity. Less frequently seen are severe akathisia and acutedystonias. Tardive dyskinesia may occur with long-term therapyand is more common in female geriatric patients. This may beirreversible. Abrupt withdrawal following long-term therapymay provoke transient dyskinesia signs.
• Toxic blood serum level >1 mcg/mL.
CHAPTER 15
Nervous System Drugs
Nonphenothiazine
• May take up to 6 weeks or longer to achieve full clinical effect • Do not consume alcohol or other CNS depressants such as • Do not abruptly discontinue the drug.
• Read labels on OTC and herbal preparations. Some are contraindicated when taking antipsychotics.
• Advise health care provider if you smoke. The dose may need to be adjusted as smoking increases metabolism of some antipsychotics.
• Maintain good oral hygiene by frequent brushing and flossing.
• Effects of antipsychotics on the fetus are unknown; discuss family planning with health care provider.
• Drug passes into breast milk which could cause drowsiness and • Maintain routine follow-up appointments with health care • Obtain laboratory tests as scheduled. • Wear an ID bracelet indicating medication taken.
• Tolerance to sedative effect develops over a period of days • Avoid potentially dangerous situations such as driving until • Be aware of EPS and report them immediately to provider.
• Avoid direct sunlight or use a sun block and protective clothing.
• Avoid arising from a lying or sitting position quickly as

Source: http://books.mcgraw-hill.com/authors/kamienski/ch_15/c15_Nonphenothiazine.pdf