Pastor James S.

Pacadaljen Drug Study

BSN 137 GROUP 146B

GENERIC NAME: Chlorpromazine

BRAND NAME: Thorazine

CLASSIFICATION: Antipsychotics, Antiemetics

SUGGESTED DOSE:
Oral
Psychoses
Adult: 25 mg tid; may be given as a single 75 mg dose at night. Maintenance: 25-100 mg tid
increased to ≥1 g daily as required in psychotic patients.
Elderly: Initially, 1/3-½ the normal adult dose.

MODE OF ACTION:
Chlorpromazine is a neuroleptic that acts by blocking the postsynaptic dopamine receptor in the
mesolimbic dopaminergic system and inhibits the release of hypothalamic and hypophyseal
hormones. It has antiemetic, serotonin-blocking, and weak antihistaminic properties and slight
ganglion-blocking activity.

INDICATIONS:
Chlorpromazine is used virtually in all types of psychoses. It can be combined with other anti-
psychotics. Chlorpromazine is also used to control anxiety or agitation in certain patients,to
relieve a wide range of drug or disease induced vomiting, and in severe hiccups. Chlorpromazine
is also used in the treatment of tetanus in combination with other drugs.

•Acute and chronic psychoses, particularly when accompanied by increased psychomotor activity.
Nausea and vomiting.
• Also used in the treatment of intractable hiccups.

CONTRAINDICATIONS:

• Hypersensitivity.
• Cross-sensitivity may exist among phenothiazines. Should not be used in narrow-angle
glaucoma.
• Should not be used in patients who have CNS depression.
• Coma
• bone-marrow suppression
• phaeochromocytoma
Pastor James S. Pacadaljen Drug Study
BSN 137 GROUP 146B
• lactation.

SIDE EFFECTS:
Blurred vision; constipation; dizziness; drowsiness; dry mouth; light sensitivity; nasal
congestion.Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the
chest or throat; swelling of the mouth, face, lips, or tongue); changes in breasts; changes in
menstrual period; changes in vision; chest pain; chills; confusion; difficulty swallowing; difficulty
urinating; drooling; extreme tiredness; fever; inability to move eyes; involuntary movements of the
face, mouth, tongue, or jaw; jitteriness; lip smacking or puckering; mask-like face; muscle spasms
of the face, neck, or back; prolonged or painful erection; puffing of cheeks; rigid muscles;
seizures; shuffling walk; skin discoloration; sleeplessness; sore throat; stiff arms or legs; tremors
of hands; twitching or twisting movements; weakness of arms or legs; yellowing of the skin or
eyes.

COMMON ADVERSE EFFECTS:

•CNS: neuroleptic malignant syndrome, sedation, extrapyramidal reactions, tardive dyskinesia
•CV: hypotension (increased with IM, IV)
•EENT: blurred vision, dry eyes, lens opacities
• GI: constipation, dry mouth, anorexia, hepatitis, ileus
• GU: urinary retention
• Hematologic: agranulocytosis, leukopenia
• Skin: photosensitivity, pigment changes, rashes

NURSING RESPONSIBILITIES:

1. Assess mental status prior to and periodically during therapy.

R: So that the nurse can determine major or minor changes after drug has been taken.
2. Monitor BP and pulse prior to and frequently during the period of dosage adjustment. May
cause QT interval changes on ECG.
R: to observe for any changes relevant.
3. The drug may be taken with or without food.
R: May be taken w/ meals to reduce GI discomfort.
4. Observe patient carefully when administering medication.
R: to ensure that medication is actually taken and not hoarded.
5. Monitor I&O ratios and daily weight.
R: Assess patient for signs and symptoms of dehydration.
6. Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress,
tachycardia, seizures, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle
Pastor James S. Pacadaljen Drug Study
BSN 137 GROUP 146B
stiffness, loss of bladder control. Report symptoms immediately. May also cause leukocytosis,
elevated liver function tests, elevated CPK.
R: to be able to watch out for any changes, and report to physician these changes
7. Advise patient to take medication as directed. Take missed doses as soon as remembered,
with remaining doses evenly spaced through out the day.
R: Missed doses may require several weeks to obtain desired effects.
8. Do not increase dose or discontinue medication without consulting health care professional.
R: Abrupt withdrawal may cause dizziness, nausea, vomiting, GI upset, trembling, or uncontrolled
movements of mouth, tongue or jaw.
9. Instruct patient to report significant changes in neurological status, such as seizures, extreme
lethargy, slurred speech, disorientation or ataxia.
R: To report to the physician and to be able to do some precautions.
10. Monitor kidney and liver function of the patient.
R: Observe for signs of hepatic toxicity. Monitor laboratory blood work such as platelets, PT, PTT,
and liver enzymes
11. Monitor cardiovascular status of the patient.
R: To be able to observe for hypertensive crisis and signs of impending stroke or M.I.: severe
headache, dizziness, paresthesias, bradycardia, tachycardia, nausea/vomiting, diaphoresis.
12. Watch out for somnolence, coma, hypotension and extrapyramidal symptoms, agitation and
restlessness, convulsions, fever, autonomic reactions such as dry mouth and ileus, EKG changes
and cardiac arrhythmias.
R: These are signs of over dosage of Chlorpromazine. Treatment is symptomatic and supportive.
Early gastric lavage may be helpful. Observe patient and maintain an open airway.
13. Store Intramuscular injections of Chlorpromazine at 15-30°C and oral dosages at 15-30°C.
R: To maintain potency and effectivity of Chlorpromazine.
14. Take special precautions with patients with Parkinson's disease, CV disease, renal or hepatic
impairment, cerebrovascular and respiratory disease, jaundice, DM, hypothyroidism; paralytic
ileus. Prostatic hyperplasia or urinary retention; epilepsy or history of seizures; myasthenia gravis;
pregnancy; elderly (especially with dementia),and debilitated patients. Instruct the patients to
avoid direct sunlight.
R: Side and adverse effects of Chlorpromazine occur severely with these patients. Sunlight can
cause an allergic reaction to the patient.

BIBLIOGRAPHY:
http://www.webhealthcentre.com/drugix/Chlorpromazine_DI0035.aspx
http://www.mims.com/Page.aspx?menuid=mng&name=chlorpromazine&brief=false#Storage
http://www.drugs.com/sfx/chlorpromazine-side-effects.html
http://www.nursing-nurse.com/drug-study-chlorpromazine-2-162/