Post by annar on Feb 28, 2015 9:46:58 GMT
CHLORPROMAZINE
a) Chlorpromazine is a typical (first generation) antipsychotic medication
b) Common brand names: Largactil
c) Normal oral dose range:
Chronic psychosis (adult):
25 – 100mg
3 to 4 times daily
Maximum daily dose = 1000mg
Acute psychosis and severe behaviour disturbance (adult):
50 – 100mg
Upto every 2 hrs (as needed)
Maximum daily dose = 500mg
Agitation, anxiety, behaviour disturbance (adult):
25 – 50mg
Upto 3 times daily
Behaviour disorder (child > 5yrs):
0.5 – 1 mg/kg
Every 4 – 6 hrs
Maximum daily dose = 75mg
d) Common side effects of Chlorpromazine are:
- Weight gain (high chance)
- Sedation and drowsiness (high chance)
- Extra pyramidal symptoms (moderate chance)
(more likely to occur if dose is > 600mg)
- Orthostatic hypotension (high chance)
- Anti-cholinergic effects (moderate chance)
eg. restlessness, constipation
- Anti-muscarinic effects eg. blurred vision, dry mouth, urinary retention
- Impaired temperature regulation
- Reduced seizure threshold
- Increased BGL
- Photosensitivity
- Skin reactions
- Neuroleptic malignant syndrome (NMS) when combined with anaesthesia
e) Contraindications:
- Moderate / severe hepatic dysfunction
f) Special monitoring/ nursing care requirements:
The nurse should monitor:
- the patient to establish if the medication is effective
- the patient for any of the adverse effects listed above
- the patient’s vital signs – esp HR, BP (postural), TEMP
- the patient’s BGL
- the patient’s weight
The nurse should provide:
- education to the patient, their family and carers about possible adverse effects and what to do if they do occur
- education to the patient about taking their medication on time, every time
- An environment that protects against falls
- Regular mouth care
The nurse should document:
- The presence and degree of any side effects if they occur, as well as who was informed about these and the action taken.
- A bowel chart can be kept to monitor for constipation
- A fluid balance chart can be kept to monitor hydration
- A falls risk chart
g) Education requirements:
The patient should be advised:
- About the importance of taking the correct dose of medication on time, every time
- about any side effects that may occur and to inform the nurse/ doctor about these
- to eat a high fibre diet to prevent constipation
- to monitor their diet and exercise regularly to offset weight gain
- to limit alcohol intake to prevent increased sedation
- to avoid tasks that require them to be alert if Chlorpromazine makes them drowsy
- to avoid prolonged exposure to sunlight, apply sunscreen when going out and wear clothing that provides a barrier from the sun.
In case of orthostatic hypotension:
The patient should be advised:
- to move from a supine position into a sitting or standing position slowly
- to move from a sitting position into a standing position slowly
- to maintain an adequate fluid intake
Family:
The family should be advised:
- about the importance of the patient taking the correct dose of medication on time, every time
- about possible side effects and how to monitor their family member for these.
- when to seek medical help
Carers:
Carers should be advised:
- about the importance of the patient taking the correct dose of medication on time, every time
- about which side effects may occur and how to monitor the patient for these.
- when to seek medical help
REFERENCES:
Australian Medicines Handbook 2014, Australian Medicines Handbook Pty Ltd; Adelaide.
Berman, A. Snyder, S. J. Krozier, B. Erb, G. Levett-Jones, T. Dwyer, T. Hales, M. Harvey, N. Luxford, Y. Moxham, L. Park, T. Parker, B. Reid-Searl, B & Stanley, D (eds) 2012 Kozier and Erb's fundamentals of nursing (2nd Australian edition), Pearson, Frenchs Forest, Australia.
a) Chlorpromazine is a typical (first generation) antipsychotic medication
b) Common brand names: Largactil
c) Normal oral dose range:
Chronic psychosis (adult):
25 – 100mg
3 to 4 times daily
Maximum daily dose = 1000mg
Acute psychosis and severe behaviour disturbance (adult):
50 – 100mg
Upto every 2 hrs (as needed)
Maximum daily dose = 500mg
Agitation, anxiety, behaviour disturbance (adult):
25 – 50mg
Upto 3 times daily
Behaviour disorder (child > 5yrs):
0.5 – 1 mg/kg
Every 4 – 6 hrs
Maximum daily dose = 75mg
d) Common side effects of Chlorpromazine are:
- Weight gain (high chance)
- Sedation and drowsiness (high chance)
- Extra pyramidal symptoms (moderate chance)
(more likely to occur if dose is > 600mg)
- Orthostatic hypotension (high chance)
- Anti-cholinergic effects (moderate chance)
eg. restlessness, constipation
- Anti-muscarinic effects eg. blurred vision, dry mouth, urinary retention
- Impaired temperature regulation
- Reduced seizure threshold
- Increased BGL
- Photosensitivity
- Skin reactions
- Neuroleptic malignant syndrome (NMS) when combined with anaesthesia
e) Contraindications:
- Moderate / severe hepatic dysfunction
f) Special monitoring/ nursing care requirements:
The nurse should monitor:
- the patient to establish if the medication is effective
- the patient for any of the adverse effects listed above
- the patient’s vital signs – esp HR, BP (postural), TEMP
- the patient’s BGL
- the patient’s weight
The nurse should provide:
- education to the patient, their family and carers about possible adverse effects and what to do if they do occur
- education to the patient about taking their medication on time, every time
- An environment that protects against falls
- Regular mouth care
The nurse should document:
- The presence and degree of any side effects if they occur, as well as who was informed about these and the action taken.
- A bowel chart can be kept to monitor for constipation
- A fluid balance chart can be kept to monitor hydration
- A falls risk chart
g) Education requirements:
The patient should be advised:
- About the importance of taking the correct dose of medication on time, every time
- about any side effects that may occur and to inform the nurse/ doctor about these
- to eat a high fibre diet to prevent constipation
- to monitor their diet and exercise regularly to offset weight gain
- to limit alcohol intake to prevent increased sedation
- to avoid tasks that require them to be alert if Chlorpromazine makes them drowsy
- to avoid prolonged exposure to sunlight, apply sunscreen when going out and wear clothing that provides a barrier from the sun.
In case of orthostatic hypotension:
The patient should be advised:
- to move from a supine position into a sitting or standing position slowly
- to move from a sitting position into a standing position slowly
- to maintain an adequate fluid intake
Family:
The family should be advised:
- about the importance of the patient taking the correct dose of medication on time, every time
- about possible side effects and how to monitor their family member for these.
- when to seek medical help
Carers:
Carers should be advised:
- about the importance of the patient taking the correct dose of medication on time, every time
- about which side effects may occur and how to monitor the patient for these.
- when to seek medical help
REFERENCES:
Australian Medicines Handbook 2014, Australian Medicines Handbook Pty Ltd; Adelaide.
Berman, A. Snyder, S. J. Krozier, B. Erb, G. Levett-Jones, T. Dwyer, T. Hales, M. Harvey, N. Luxford, Y. Moxham, L. Park, T. Parker, B. Reid-Searl, B & Stanley, D (eds) 2012 Kozier and Erb's fundamentals of nursing (2nd Australian edition), Pearson, Frenchs Forest, Australia.