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Chlorpromazine Medication outline
Pharmacology for Professional Nursing (NUR2474)
Rasmussen University
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ACTIVE LEARNING TEMPLATES THERAPEUTIC PROCEDURE A
Medication
STUDENT NAME _____________________________________
MEDICATION __________________________________________________________________________ REVIEW MODULE CHAPTER ___________
CATEGORY CL A SS ______________________________________________________________________
ACTIVE LEARNING TEMPLATE:
PURPOSE OF MEDICATION
Expected Pharmacological Action
Complications
Contraindications/Precautions
Interactions
Medication Administration
Evaluation of Medication Effectiveness
Therapeutic Use
Nursing Interventions
Client Education
Chlorpromazine
Antipsychotic/antiemetic
ACTION: Depresses cerebral cortex, hypothalamus, limbic
system, which control activity, aggression; blocks
neurotransmission produced by DOPamine at synapse;
exhibits a strongadrenergic, anticholinergic blocking action;
mechanism for antipsychotic effects is unclear
Psychosis
Adult: PO 10-50 mg q1-4hr initially then increase
up to 2 g/day if necessary
IM 1050 mg q1-4hr, usual dose 300-800 mg/day
Geriatric: PO 10-25 mg daily-bid, increase by
10-25 mg/day q4-7days, max 800 mg/day
Nausea and vomiting
Adult: PO 10-25 mg q4-6hr prn;
IM 12-25 mg q3hr prn, then 25-50 mg q6-8 hr
prn if no hypotension, max 400 mg/day; IV 25-
mg daily-qid
Increase: CNS depression other CNS depressants, alcohol, barbiturate anesthetics, antihistamines, sedatives/hypnotics, antidepressants Increase: toxicity EPINEPHrine Increase: agranulocystosis antithyroid agents Increase: effects of both products β -adrenergic blockers, alcohol Increase: anticholinergic effects anticholinergics, antidepressants, antiparkinsonian agents, MAOIs Increase: valproic acid level Decrease: seizure threshold anticon - vulsants Decrease: absorption aluminum hydroxEENT: ide, magnesium hydroxide antacids, cimetidine Decrease: antiparkinson activity levodopa, bromocriptine Decrease: serum chlorproMAZINE lithium, barbiturates Decrease: anticoagulant effect warfarin Drug/Herb: Increase: CNS depression kava, chamomile, hops, valerian Increase: anticholinergic effect jimson weed, scopolia Drug/Lab Test Increase: hepatic studies Decrease: WBC, platelets, Hgb/Hct False positive: pregnancy tests, PKU False negative: urinary steroids, 17-OHCS
CONTRAINDICATIONS: Children <6 mo, hypersensitivity, circulatory collapse, liver damage, cerebral
arteriosclerosis, coronary disease, coma
Precautions: Pregnancy, breastfeeding, geriatric patients, seizure disorders, hyper - tension, hepatic/cardiac disease,
prostatic enlargement, Parkinson s disease, pulmonary disease, severe hypo/hypertension, blood dyscrasias, brain
damage, bone marrow depression, alcohol/barbiturate withdrawal, closed-angle glaucoma
Black Box Warning: Dementia; increased mortality in geriatric patients with dementia-related psychosis
####### SIDE EFFECTS
CNS: EPS: pseudoparkinsonism, akathisia, dystonia, tardive dyskinesia, seizures, headache, neuroleptic malignant syndrome, dizziness CV: Orthostatic hypotension, hypertension, cardiac arrest, ECG changes, tachycardia Blurred vision, glaucoma, dry eyes ENDO: SIADH GI: Dry mouth, nausea, vomiting, anorexia, constipation, diarrhea, cholestatic jaundice, weight gain GU: Urinary retention, enuresis, impotence, amenorrhea, gynecomastia, breast engorgement HEMA: Anemia, leukopenia, leukocytosis, agranulocytosis INTEG: Rash, photosensitivity, dermatitis RESP: Laryngospasm, dyspnea, respiratory depression SYST: Death in geriatric patients with dementia
USES: Psychotic disorders, mania, schizophrenia, anxiety,
intractable hiccups in adults, nausea, vomiting;
preoperatively for relaxation; acute intermittent porphyria,
behavioral problems in children, nonpsychotic, demented
patients, Tourette's syndrome
Assess: Black Box Warning: Beers: avoid in older adults except in schizophrenia, bipolar disorder, or short-term use as antiemetic in chemotherapy; increased risk for stroke and greater rate of cognitive decline and mortality in dementia Mental status: AIMS assessment, orientation, mood, behavior, presence and type of hallucinations before initial administration and monthly Any potentially reversible causes of behavioral problems in geriatric patients before and during therapy I&O ratio; palpate bladder if low uri - nary output occurs, especially in geriatric patients Monitor B/P, pulse, lying, sitting Bilirubin, CBC, LFTs, ocular exam; agranulocytosis, glaucoma, cholestatic jaundice may occur Respirations q4hr during initial treat - ment; establish baseline before starting treatment; report drops of 30 mm Hg; obtain baseline ECG; Q-wave and T-wave changes Dizziness, faintness, palpitations, tachycardia on rising Neuroleptic malignant syndrome: hyperpyrexia, muscle rigidity, increased CPK, altered mental status, for acute dystonia (check chewing, swallowing, eyes, pill rolling) Extrapyramidal symptoms: akathisia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (rigidity, tremors, pill rolling, shuffling gait) Constipation, urinary retention daily; increase bulk, water in diet Supervised ambulation until stabilized on medication; do not involve in strenuous exercise program because fainting is possible; patient should not stand still for long periods Increased fluids, roughage to prevent constipation Candy, gum, sips of water for dry mouth
Therapeutic response: decrease in emotional excitement,
hallucinations, delusions, paranoia; reorganization of
patterns of thought, speech; increase in target behaviors
To use good oral hygiene; to use frequent rinsing of mouth, sugarless gum, candy, ice chips for dry mouth To avoid hazardous activities until product response is determined That orthostatic hypotension occurs often; to rise gradually from sitting or lying position To remain lying down for at least 30 min after IM inj To avoid hot tubs, hot showers, tub baths because hypotension may occur; that during hot weather, heat stroke may occur; to take extra precautions to stay cool To avoid abrupt withdrawal of product or EPS may result; product should be withdrawn slowly To avoid OTC preparations (cough, hay fever, cold) unless approved by prescriber since serious product interactions may occur; avoid use with alcohol, increased drowsiness may occur To use a sunscreen and sunglasses to prevent burns and photophobia To take antacids 2 hr before or after this product To report sore throat, malaise, fever, bleeding, mouth sores; CBC should be drawn and product discontinued To employ contraceptive measures That urine may turn pink or reddish brown
Chlorpromazine Medication outline
Course: Pharmacology for Professional Nursing (NUR2474)
University: Rasmussen University
