Apo-Perphenazine, PMS Perphenazine, Trilafon
Therapeutic: antiemetics, antipsychotics (conventional)
Schizophrenia. Nausea and vomiting. Unlabeled Use: Other psychotic disorders, bipolar disorder. Treatment of intractable hiccups (IV only).
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.
Adverse Reactions/Side Effects
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.
PHYSICAL THERAPY IMPLICATIONS
Examination and Evaluation
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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