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INTRODUCTION

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chlorpromazine (klor-proe-ma-zeen)

Chlorpromanyl, Largactil, Novo-Chlorpromazine, Thorazine, Thor-Prom

Classification

Therapeutic: antiemetics, antipsychotics

Pharmacologic: phenothiazines

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Indications
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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.

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Action
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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.

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Adverse Reactions/Side Effects
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CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, extrapyramidal reactions, tardive dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: hypotension (↑ with IM, IV), tachycardia. GI: constipation, dry mouth, anorexia, hepatitis, ileus, priapism. GU: urinary retention. Derm: photosensitivity, pigment changes, rashes. Endo: galactorrhea, amenorrhea. Hemat: AGRANULOCYTOSIS, leukopenia. Metab: hyperthermia. Misc: allergic reactions.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor and report signs of neuroleptic malignant syndrome (hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure [BP], incontinence). Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use.

  • Watch for signs of agranulocytosis and leucopenia, including fever, sore throat, mucosal lesions, and other signs of infection. Report these signs to the physician immediately.

  • Assess motor function, and be alert for extrapyramidal symptoms. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

    • 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).

    • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

    • Akathisia (restlessness or desire to keep moving).

    • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

  • Assess BP periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

  • Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report a rapid heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

  • Monitor signs of allergic reactions, including pulmonary symptoms (laryngeal edema, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

  • If used to control behavioral problems in children, document any changes in combative or hyperactive behavior to help determine drug efficacy and appropriate dosing.

  • If used to control vascular headache, monitor the frequency, severity, and duration of attacks to help document the effects of drug therapy.

  • If used to control nausea and vomiting, monitor the frequency, severity, and duration of GI problems to help document drug effectiveness.

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