fluPHENAZine decanoate (Rx)

Assessment - SSRIs, SNRIs, serotonin-receptor agonists: increased serotonin syndrome, malignant neuroleptic syndrome

BLACK BOX WARNING: Increased mortality in elderly patients with dementia-related psychosis; not approved for this use - Serotonin syndrome, neuroleptic malignant syndrome: severe EPS, increased CPK, altered mental state, sinus tachycardia, change in B/P; sweating often occurs in young men; heat stress, physical exhaustion, dehydration, organic brain disease - QT prolongation, torsades de pointes: ECG for changes - Assess mental status: orientation, mood, behavior, presence and type of hallucinations before initial administration and monthly; this product should significantly reduce psychotic behavior - Monitor bilirubin, CBC, liver function tests monthly; ophthalmic exams periodically - Assess affect, orientation, LOC, reflexes, gait, coordination, sleep pattern disturbances - Monitor B/P with patient sitting, standing, and lying down; take pulse and respirations q4 hr during initial treatment; establish baseline before starting treatment; report drops of 30 mm Hg; obtain baseline ECG, Q-wave and T-wave changes - Check for dizziness, faintness, palpitations, tachycardia on rising; severe orthostatic hypotension is common - Assess for EPS including akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait); an antiparkinson product should be prescribed - Assess for constipation, urinary retention daily; if these occur, increase bulk, water in diet

Patient/family education - Caution patient to avoid hazardous activities until product response is determined; dizziness, blurred vision may occur - Inform patient that orthostatic hypotension occurs often and to rise from sitting or lying position gradually; tell patient to avoid hot tubs, hot showers, tub baths because hypotension may occur; tell patient that in hot weather, heat stroke may occur; extra precautions are necessary to stay cool - Instruct patient to avoid abrupt withdrawal of this product, or EPS may result; product should be withdrawn slowly - Advise patient that follow-up lab and ophthalmic exams are needed - Teach patient to avoid OTC preparations (cough, hay fever, cold) unless approved by physician because serious product interactions may occur; avoid use with alcohol, CNS depressants; increased drowsiness may occur - Instruct patient to use a sunscreen and sunglasses to prevent burns - Teach patient about EPS and necessity of meticulous oral hygiene because oral candidiasis may occur - Instruct patient to take antacids 2 hr before or after this product - Advise patient to report sore throat, malaise, fever, bleeding, mouth sores; if these occur, CBC should be performed and product discontinued

Evaluation

Positive therapeutic outcome: Decrease in emotional excitement, hallucinations, delusions, paranoia; Reorganization of patterns of thought, speech TREATMENT OF

OVERDOSE: Lavage if orally ingested; provide airway; do not induce vomiting or use EPINEPHrine