Prolixin

fluPHENAZine

Modecate Concentrate

Prolixin

Prolixin Decanoate

Indications

Action

Pharmacokinetics

Time/action profile (antipsychotic activity)

Contraindications/Precautions

Adverse Reactions/Side Effects

Central nervous system

• neuroleptic malignant syndrome (life-threatening)
• extrapyramidal reactions (most frequent)
• sedation
• tardive dyskinesia

Ear, Eye, Nose, Throat

• blurred vision
• dry eyes

Cardiovascular

• hypertension
• hypotension
• tachycardia

Gastrointestinal

• anorexia
• constipation
• drug-induced hepatitis
• dry mouth
• ileus
• nausea
• weight gain

Genitourinary

• urinary retention

Dermatologic

• photosensitivity (most frequent)
• pigment changes
• rashes

Endocrinologic

• galactorrhea

Hematologic

• agranulocytosis (life-threatening)
• leukopenia
• thrombocytopenia

Miscellaneous

• allergic reactions

Interactions

Drug-Drug interaction

Route/Dosage

Fluphenazine Decanoate

Fluphenazine Hydrochloride

Availability (generic available)

Nursing implications

Nursing assessment

• Assess mental status (orientation, mood, behavior) before and periodically during therapy.
• Monitor BP (sitting, standing, lying), ECG, pulse, and respiratory rate before and frequently during the period of dose adjustment. May cause Q-wave and T-wave changes in ECG.
• Observe carefully when administering oral medication to ensure that medication is actually taken and not hoarded.
• Assess fluid intake and bowel function. Increased bulk and fluids in the diet help minimize constipation.
• Monitor for onset of akathisia (restlessness or desire to keep moving) and extrapyramidal side effects (parkinsonian—difficulty speaking or swallowing, loss of balance control, pill rolling, mask-like face, shuffling gait, rigidity, tremors; dystonic—muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs) every 2 mo during therapy and 8–12 wk after therapy has been discontinued. Reduction in dose or discontinuation of medication may be necessary. Benztropine or diphenhydramine may be used to control these symptoms.
• Monitor for 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). Report immediately; may be irreversible.
• Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, seizures, diaphoresis, arrhythmias, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report immediately.
• Lab Test Considerations: Evaluate CBC, liver function tests, and ocular examinations periodically during therapy. May cause ↓ hematocrit, hemoglobin, leukocytes, granulocytes, and platelets. May cause ↑ bilirubin, AST, ALT, and alkaline phosphatase. Agranulocytosis may occur after 4–10 wk of therapy with recovery 1–2 wk after discontinuation. May recur if medication is restarted. Liver function abnormalities may require discontinuation of therapy.

Potential Nursing Diagnoses

Implementation

• Do not confuse fluphenazine with fluvoxamine.
• Slight yellow to amber color does not alter potency.
  • To prevent contact dermatitis, avoid getting liquid preparations on hands and wash hands thoroughly if spillage occurs.
  • Injectable forms must be drawn up with a dry syringe and dry 21-gauge needle to prevent clouding of the solution.
• Oral: Dilute concentrate just before administration in 120–240 mL of water, milk, carbonated beverage, soup, or tomato or fruit juice. Do not mix with beverages containing caffeine (cola, coffee), tannics (tea), or pectinates (apple juice).
• Subcutaneous: Fluphenazine decanoate is dissolved in sesame oil for long duration of action. It may be administered subcut or IM. 12.5 mg of fluphenazine decanoate given every 3 wk is approximately equivalent to 10 mg/day orally of fluphenazine hydrochloride.
• Intramuscular: IM dose of fluphenazine hydrochloride is usually 30–50% of oral dose. Because fluphenazine hydrochloride has a shorter duration of action, it is used initially to determine the patient’s response to the drug and to treat the acutely agitated patient.
  • Administer deep IM, using a dry syringe and 21-gauge needle, into dorsal gluteal site. Instruct patient to remain recumbent for 30 min to prevent hypotension.
• Syringe Compatibility: Fluphenazine hydrocholride is compatible in syringe with.benztropine, diphenhydramine, hydroxyzine

Patient/Family Teaching

• Advise patient to take medication as directed and not to skip doses or double up on missed doses. If a dose is missed, take within 1 hr or skip dose and return to regular schedule if taking more than 1 dose/day; take as soon as possible unless almost time for next dose if taking 1 dose/day. Abrupt withdrawal may lead to gastritis, nausea, vomiting, dizziness, headache, tachycardia, and insomnia.
• Inform patient of possibility of extrapyramidal symptoms and tardive dyskinesia. Caution patient to report these symptoms immediately to health care professional.
• Advise patient to change positions slowly to minimize orthostatic hypotension.
• Medication may cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Caution patient to avoid taking alcohol or other CNS depressants concurrently with this medication.
• Advise patient to use sunscreen and protective clothing when exposed to the sun. Exposed surfaces may develop a blue-gray pigmentation, which may fade after discontinuation of the medication. Extremes of temperature should also be avoided because this drug impairs body temperature regulation.
• Advise patient that good oral hygiene, frequent rinsing of mouth with water, and sugarless gum or candy may help relieve dry mouth. Health care professional should be notified if dry mouth persists beyond 2 wk.
• Instruct patient to notify health care professional promptly if sore throat, fever, unusual bleeding or bruising, rash, weakness, tremors, visual disturbances, dark-colored urine, or clay-colored stools occur.
• Advise patient to notify health care professional of medication regimen before treatment or surgery.
• Emphasize the importance of routine follow-up exams, including ocular exams, with long-term therapy and continued participation in psychotherapy.

Evaluation/Desired Outcomes

• Decrease in excitable, paranoiac, or withdrawn behavior.