Prochlorperazine

INTRODUCTION

Indications

Management of nausea and vomiting. Treatment of psychoses. Treatment of anxiety.

Action

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

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, extrapyramidal reactions, sedation, tardive dyskinesia. EENT: blurred vision, dry eyes, lens opacities. CV: ECG changes, hypotension, tachycardia. GI: constipation, dry mouth, anorexia, drug-induced hepatitis, ileus. GU: pink or reddish brown discoloration of urine, urinary retention. Derm: photosensitivity, pigment changes, rashes. Endo: galactorrhea. Hemat: AGRANULOCYTOSIS, leukopenia. Metab: hyperthermia. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report immediately 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.

• 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 allergic reactions, including pulmonary symptoms (tightness in the throat and chest, wheezing, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician or nursing staff immediately if these reactions occur.

• 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.

• Assess BP periodically, and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness or syncope.

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

Interventions

• 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...