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INTRODUCTION

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thiethylperazine (thye-eth-il-per-a-zeen)

Norzine, Torecan

Classification

Therapeutic: antiemetics

Pharmacologic: phenothiazines

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Indications
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Management of nausea and vomiting.

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Action
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Alters the effects of dopamine in the CNS. Depresses the chemoreceptive trigger zone (CTZ) and vomiting center in the CNS. Therapeutic Effects: Diminished nausea and vomiting.

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Adverse Reactions/Side Effects
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CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, cerebral vascular spasm, extrapyramidal reactions, headache, restlessness, tardive dyskinesia. EENT: dry eyes, blurred vision, lens opacities, tinnitus. CV: hypotension (following IM use), peripheral edema. GI: constipation, dry mouth, altered taste, anorexia, drug-induced hepatitis, ileus. GU: urinary retention. Derm: photosensitivity, pigment changes, rashes. Endo: galactorrhea. Hemat: AGRANULOCYTOSIS, leukopenia. Metab: hyperthermia. Neuro: trigeminal neuralgia. 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.

  • Monitor signs of agranulocytosis and leukopenia including fever, sore throat, mucosal lesions, signs of infection, and bruising. Report these signs to the physician immediately.

  • Monitor the frequency, severity, and duration of GI problems (nausea, vomiting) to help document drug effectiveness in controlling these symptoms.

  • Assess motor function, and be alert for extrapyramidal reactions. 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, fatigue, or other symptoms.

  • Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor any facial pain consistent with trigeminal neuralgia; that is, sharp or electric-like pain radiating into the cheek, jaw, teeth, gums, lips, and sometimes the eye and forehead. Notify physician and discuss possible physical interventions to control this pain.

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Interventions
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  • Guard against falls and trauma (hip fractures, head injury, and so forth) caused by drowsiness, blurred vision, or extrapyramidal symptoms; implement fall prevention strategies (See Appendix E).

  • Because of an increased risk of hyperthermia, use caution during aerobic exercise, especially in hot environments. Carefully monitor the patient's exercise tolerance and terminate ...

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