This action might not be possible to undo. Are you sure you want to continue?
: Initially, 25-50 mg 3-4 times daily for 2-3 days; if unresponsive, may admin 25-50 mg via IM inj. If still necessary, 25-50 mg in 500-1000 ml of normal saline may be given via slow IV infusion. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Elderly: Initially, 1/3-½ the normal adult dose. Oral Psychoses Adult: 25 mg tid; may be given as a single 75 mg dose at night. Maintenance: 25-100 mg tid increased to ≥1 g daily as required in psychotic patients. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Elderly: Initially, 1/3-½ the normal adult dose. Intramuscular Psychoses Adult: 25-50 mg repeated every 6-8 hr. Substitute with oral therapy as soon as possible. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Elderly: Initially, 1/3-½ the normal adult dose. Intramuscular Nausea and vomiting Adult: Initially, 25 mg via IM inj, followed by 25-50 mg every 3-4 hr until vomiting stops. Child: 1-12 yr: 500 mcg/kg every 4-6 hr. Max: >5 yr: 75 mg daily; 1-5 yr: 40 mg daily. Elderly: Initially, 1/3-½ the normal adult dose. Rectal
Psychoses Adult: 100 mg every 6-8 hr as suppositories. MODE OF ACTION: Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic dopamine receptor in the mesolimbic dopaminergic system and inhibits the release of hypothalamic and hypophyseal hormones. It has antiemetic, serotonin-blocking, and weak antihistaminic properties and slight ganglion-blocking activity. Onset: 15 min (IM); 30-60 min (oral). Absorption: Readily but sometimes erratically absorbed from the GI tract (oral); peak plasma concentrations after 2-4 hr. Distribution: Widely distributed; crosses the blood-brain barrier and placenta; enters breast milk. Metabolism: Extensively hepatic by hydroxylation and conjugation with glucuronic acid, N-oxidation, oxidation of a sulfur atom and dealkylation. Excretion: Urine and faeces (as active and inactive metabolites); 30 hr (elimination halflife). • Block dopamine receptors in the brain; also alter dopamine release and turnover. • Prevention of seizures INDICATIONS: Chlorpromazine is used virtually in all types of psychoses. It can be combined with other anti-psychotics. Chlorpromazine is also used to control anxiety or agitation in certain patients,to relieve a wide range of drug or disease induced vomiting, and in severe hiccups. Chlorpromazine is also used in the treatment of tetanus in combination with other drugs. •Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity. Nausea and vomiting. • Also used in the treatment of intractable hiccups.
CONTRAINDICATIONS: • • • • • • • Hypersensitivity. Cross-sensitivity may exist among phenothiazines. Should not be used in narrowangle glaucoma. Should not be used in patients who have CNS depression. Coma bone-marrow suppression phaeochromocytoma lactation.
DRUG INTERACTIONS: Potentiation of anticholinergic effects of antiparkinson agents and TCAs may lead to an anticholinergic crisis. Additive orthostatic hypotensive effect in combination with MAOIs. Reverses antihypertensive effect of guanethidine, methyldopa and clonidine. Potentially Fatal: Additive depressant effect with sedatives, hypnotics, antihistamines, general anaesthetics, opiates and alcohol. Chorpromazine has additive depressant effect with sedatives, hypnotics, antihistamines, opiates and with alcohol. It potentiates the anti-cholinergic effects of antiparkinson agents and tricyclic-antidepressants, which may lead to a anti-cholinergic crisis. It has additive orthostatic hypotensive effect in combination with MAO inhibitors. SIDE EFFECTS: Blurred vision; constipation; dizziness; drowsiness; dry mouth; light sensitivity; nasal congestion.Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest or throat; swelling of the mouth, face, lips, or tongue); changes in breasts; changes in menstrual period; changes in vision; chest pain; chills; confusion; difficulty swallowing; difficulty urinating; drooling; extreme tiredness; fever; inability to move eyes; involuntary movements of the face, mouth, tongue, or jaw; jitteriness; lip smacking or puckering; mask-like face; muscle spasms of the face, neck, or back; prolonged or painful erection; puffing of cheeks; rigid muscles; seizures; shuffling walk; skin
discoloration; sleeplessness; sore throat; stiff arms or legs; tremors of hands; twitching or twisting movements; weakness of arms or legs; yellowing of the skin or eyes. ADVERSE EFFECTS: Tardive dyskinesia (on long-term therapy). Involuntary movements of extremities may also occur. Dry mouth, constipation, urinary retention, mydriasis, agitation, insomnia, depression and convulsions; postural hypotension, ECG changes. Allergic skin reaction, amenorrhoea, gynaecomastia, weight gain. Hyperglycaemia and raised serum cholesterol. Potentially Fatal: Agranulocytosis. Instantaneous deaths associated with ventricular tachyarrhythmias. Marked elevation of body temperature with heat stroke. Neuroleptic malignant syndrome, extrapyramidal dysfunction. 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 NURSING RESPONSIBILITIES: 1. Assess mental status prior to and periodically during therapy. R: So that the nurse can determine major or minor changes after drug has been taken. 2. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May cause QT interval changes on ECG. R: to observe for any changes relevant. 3. The drug may be taken with or without food. R: May be taken w/ meals to reduce GI discomfort.
4. Observe patient carefully when administering medication. R: to ensure that medication is actually taken and not hoarded. 5. Monitor I&O ratios and daily weight. R: Assess patient for signs and symptoms of dehydration. 6. 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. R: to be able to watch out for any changes, and report to physician these changes 7. Advise patient to take medication as directed. Take missed doses as soon as remembered, with remaining doses evenly spaced through out the day. R: Missed doses may require several weeks to obtain desired effects. 8. Do not increase dose or discontinue medication without consulting health care professional. R: Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled movements of mouth, tongue or jaw. 9. Instruct patient to report significant changes in neurological status, such as seizures, extreme lethargy, slurred speech, disorientation or ataxia. R: To report to the physician and to be able to do some precautions. 10. Monitor kidney and liver function of the patient. R: Observe for signs of hepatic toxicity. Monitor laboratory blood work such as platelets, PT, PTT, and liver enzymes 11. Monitor cardiovascular status of the patient. R: To be able to observe for hypertensive crisis and signs of impending stroke or M.I.: severe headache, dizziness, paresthesias, bradycardia, tachycardia, nausea/vomiting, diaphoresis. 12. Watch out for somnolence, coma, hypotension and extrapyramidal symptoms, agitation and restlessness, convulsions, fever, autonomic reactions such as dry mouth and ileus, EKG changes and cardiac arrhythmias.
R: These are signs of over dosage of Chlorpromazine. Treatment is symptomatic and supportive. Early gastric lavage may be helpful. Observe patient and maintain an open airway. 13. Store Intramuscular injections of Chlorpromazine at 15-30°C and oral dosages at 1530°C. R: To maintain potency and effectivity of Chlorpromazine. 14. Take special precautions with patients with Parkinson's disease, CV disease, renal or hepatic impairment, cerebrovascular and respiratory disease, jaundice, DM, hypothyroidism; paralytic ileus. Prostatic hyperplasia or urinary retention; epilepsy or history of seizures; myasthenia gravis; pregnancy; elderly (especially with dementia),and debilitated patients. Instruct the patients to avoid direct sunlight. R: Side and adverse effects of Chlorpromazine occur severely with these patients. Sunlight can cause an allergic reaction to the patient. BIBLIOGRAPHY: http://www.webhealthcentre.com/drugix/Chlorpromazine_DI0035.aspx http://www.mims.com/Page.aspx? menuid=mng&name=chlorpromazine&brief=false#Storage http://www.drugs.com/sfx/chlorpromazine-side-effects.html http://www.nursing-nurse.com/drug-study-chlorpromazine-2-162/
Criteria: Promptness- 5 Format- 5 Drawing- 10 Content- 45 Nursing Responsibility- 35
ATENEO DE DAVAO UNIVERSITY COLLEGE OF NURSING
Submitted to: Zenaida Lagrosa, RN Clinical Instructor
Submitted by: Jenna Christy C. Matalam On January 28, 2010
This action might not be possible to undo. Are you sure you want to continue?