Perphenazine

INTRODUCTION

Indications

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

Action

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.

Interventions

• Guard against falls and trauma (hip fractures, ...