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INTRODUCTION

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perphenazine (per-fen-a-zeen)

Apo-Perphenazine, PMS Perphenazine, Trilafon

Classification

Therapeutic: antiemetics, antipsychotics (conventional)

Pharmacologic: phenothiazines

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Indications
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Schizophrenia. Nausea and vomiting. Unlabeled Use: Other psychotic disorders, bipolar disorder. Treatment of intractable hiccups (IV only).

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Action
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Alters the effects of dopamine in the CNS. Possesses significant anticholinergic and alpha-adrenergic blocking activity. Blocks dopamine in the chemoreceptor trigger zone (CTZ). Therapeutic Effects: Diminished signs and symptoms of psychoses. Decreased nausea, vomiting, or hiccups.

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Adverse Reactions/Side Effects
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CNS: NEUROLEPTIC MALIGNANT SYNDROME, extrapyramidal reactions, sedation, tardive dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: hypotension, tachycardia. GI: constipation, dry mouth, anorexia, ileus, weight gain. GU: discoloration of urine, 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 leukopenia, including fever, sore throat, mucosal lesions, and other signs of infection. Report these signs to the physician or nursing staff 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).

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

  • 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 signs of other arrhythmias, including palpitations, chest discomfort, shortness of breath, fainting, and fatigue/weakness.

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

  • Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth) caused by ...

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