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Cebu Normal University College of Nursing Osmea Boulevard, Cebu City DRUG STUDY





CONTRAINDICATIONS Contraindications Blood dyscrasias, bone marrow depression, cerebral arteriosclerosis, coma, concomitant use of large amounts of another CNS depressant, coronary artery disease, hepatic dysfunction, hypersensitivity to phenothiazines, myeloproliferative disorders, severe CNS depression, severe hypertension or hypotension, subcortical brain damage Precautions Cardiovascular diseases, Parkinsons disease, angle-closure glaucoma, myasthenia gravis, prostatic hyperplasia; seizure disorders; OB, Lactation: safety not established; enters breat milk, not

CNS: Ataxia, cerebral edema, dizziness, drowsiness, headache, insomnia, lightheadedness, nervousness, seizures, slurred speech, syncope, worsening psychotic symptoms CV: AV conduction disorders, bradycardia, cardiac arrest, hypercholesterolemia, hypertension, orthostatic hypotension, QT-interval prolongation, shock, STsegment depression, tachycardia EENT: Blurred vision, dry mouth, glaucoma, increased salivation, laryngeal edema, laryngospasm, miosis, mydriasis, nasal congestion, papillary hypertrophy of the tongue, parotid gland enlargement, photophobia, pigmentary retinopathy, ptosis ENDO: Breast

Generic Name Therapeutic Fluphenazine Antipsychotic, hydrochloride/Fluphenazine decanoate Pharmacologic Phenothiazines Trade Name Modecate (CAN), Modecate Pregnancy Concentrate (CAN), Prolixin Category Decanoate C Patients Dose N/A Minimum Dose 2.5 to 10 mg/day in divided doses every 6 to 8 hr. PO Maximum Dose 20 mg/dose with caution PO in divided doses Contents Fluphenazine decanoate/ Fluphenazine hydrochloride Availability Injection, tablets, concentrates,

Pharmacokinetics General Absorption: Acute and Well-absorbed after PO/IM chronic administration, deconoate salt pyschoses in in sesame oil has delayed onset and prolonged action Patients because of delayed release Actual from oil vehicle and Indication subsequent release from fatty N/A tissues Distribution Widely distributed; crosses blood-brain barrier; crosses placenta; enters breast milk Metabolism and Excretion Mostly metabolized by liver ; undergo enterohepatic recirculation Onset PO- 1 hour IM- 24-72 hours Peak PO- unknown IM- 48-96 hours Duration PO- 6-8 hours IM- >4 weeks Half-life: 33 hours; 6.8-9.6 days Action: May block postsynaptic

NURSING RESPONSIBILITIES Before 1. Monitor patients blood pressure routinely. 2. Assess mental status (mood, behavior, orientation). 3. Assess weight and BMI. 4. Assess positive and negative symptoms of schizophrenia. 5. Assess fluid intake and bowel function 6. Prepare drug aseptically and verify the right dose. Render health teaching as appropriate. During 1. Verify patients identity using the chart and other patient and nurses confirmation. 2. Administer oral doses with food, milk, or a full glass of water. 3. For I.M. and subcutaneous injection, use at least a 21G needle.


Routes of Administration


dopamine receptor sites in the CNS. This action may depress areas of the brain that control activity and aggression, including the cerebral cortex, hypothalamus, and limbic system. Therapeutic Effects Diminished signs and symptoms of psychoses

recommended; Geri: dosage reduction Drug Interactions Drug-Drug

magnesium-containing antacids: Possibly inhibited absorption of fluphenazine amantadine, anticholinergics: Possibly intensified adverse effects of both drugs amphetamines: Possibly decreased therapeutic effects of both drugs antihypertensives: Possibly severe hypotension antithyroid drugs: Increased risk of agranulocytosis beta blockers: Possibly increased blood levels and risk of adverse effects of both drugs bromocriptine: Decreased bromocriptine effects CNS depressants: Possibly prolonged and intensified CNS depression erythromycin: Possibly inhibited fluphenazine metabolism guanethidine: Decreased hypotensive effect of guanethidine levodopa: Possibly decreased antidyskinetic effect of levodopa

engorgement (females), galactorrhea, hyperglycemia, hypoglycemia, mastalgia, syndrome of inappropriate ADH secretion GI: Anorexia, constipation, diarrhea, fecal impaction, ileus, increased appetite, nausea, vomiting GU: Amenorrhea, bladder paralysis, decreased libido, enuresis, menstrual irregularities, polyuria, urinary frequency, urinary incontinence, urine retention HEME: Anemia, aplastic anemia, eosinophilia, leukopenia, thrombocytopenia, thrombocytopenic or nonthrombocytopenic purpura RESP: Bronchospasm, dyspnea, increased respiratory depth SKIN: Contact dermatitis, dry skin, eczema, erythema, jaundice, photosensitivity, pruritus, seborrhea Other: Heatstroke, hyponatremia, lupuslike symptoms, weight gain

4. To prevent contact dermatitis, avoid getting solution ion hands. 5. Advise patient not to mix oral solution with beverages that contain caffeine (coffee, cola), tannins (tea), or pectins (apple juice). 6. Observe patient carefully when administering medication to ensure that medication is taken not hoarded or cheeked. After 1. Document medication given. 2. Dont let patient sit or stand up until blood pressure and heart rate have returned to baseline. 3. Notify prescriber if patient develops tardive dyskinesia or urinary incontinence. 4. Instruct to frequently do good oral hygiene. 5. Be alert for and immediately report signs of neuroleptic malignant syndrome. 6. Notify prescriber

lithium: Possibly neurotoxicity (disorientation, extrapyramidal reactions, unconsciousness) meperidine: Excessive sedation and hypotension metrizamide: Increased risk of seizures when injected in subarachnoid area during fluphenazine therapy oral anticoagulants: Possibly decreased anticoagulant effects pimozide, other drugs that prolong QT interval: Prolonged QT interval and risk of arrhythmias thiazide diuretics: Increased risk of hyponatremia, hypotension, and water intoxication tricyclic antidepressants: Possibly prolonged and intensified sedation

about worsening psychotic symptoms: agitation, catatonic state, confusion, depression, hallucinations, lethargy, paranoid reactions. 7. Monitor temperature; a significant, unexplained rise can indicate intolerance and a need to discontinue drug. Notify prescriber immediately if this occurs.

Drug- Activities
alcohol use: Possibly increased CNS depression and increased risk of heatstroke

SOURCE: Deglin, J.H., Vallerand, A.H. (2009). Daviss Drug Guide for Nurses. Ed.11. Philadelphia: F.A. Davis Company pp. 568-570 Lippincotts Nurses Drug Handbook , ed. 10. 2011, pp. 451-453