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INTRODUCTION

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thioridazine (thye-oh-rid-a-zeen)

Apo-Thioridazine, Mellaril, Mellaril-S, Novo-Ridazine, PMS Thioridazine

Classification

Therapeutic: antipsychotics

Pharmacologic: phenothiazines

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Indications
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Treatment of refractory schizophrenia. Considered 2nd-line treatment after failure with atypical antipsychotics.

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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. Therapeutic Effects: Diminished signs and symptoms of psychoses.

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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, pigmentary retinopathy (high doses). CV: ARRHYTHMIAS, QTC PROLONGATION, hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug-induced hepatitis, ileus, weight gain. GU: urinary retention, priapism. 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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  • Watch for signs of neuroleptic malignant syndrome, including hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure (BP), and incontinence. Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use. Report these signs to the physician or nursing staff immediately.

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

  • Monitor 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 allergic 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.

  • 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 drowsiness, blurred vision, or extrapyramidal symptoms; implement fall-prevention strategies (See Appendix E).

  • Because of the risk of arrhythmias and abnormal BP ...

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