Comprehensive exams for Mental Health Q 87
A client has a history of chronic undifferentiated schizophrenia. Because she has a history of noncompliance with antipsychotic therapy, she’ll receive fluphenazine decanoate (Prolixin Decanoate) injections every 4 weeks. Before discharge, what should the nurse include in her teaching plan?
A. Asking the physician for droperidol (Inapsine) to control any extrapyramidal symptoms that occur.
B. Sitting up for a few minutes before standing to minimize orthostatic hypotension.
C. Notifying the physician if her thoughts don’t normalize within 1 week.
D. Expecting symptoms of tardive dyskinesia to occur and to be transient.
Correct Answer: B. Sitting up for a few minutes before standing to minimize orthostatic hypotension
The nurse should teach the client how to manage common adverse reactions, such as orthostatic hypotension and anticholinergic effects. Fluphenazine has an adverse effect profile similar to other first-generation or typical antipsychotics, which is due to its dopamine receptor antagonism as well as its anticholinergic, antihistaminic, and alpha-adrenergic antagonistic properties. Common side effects include sedation, dry mouth, constipation, dry eyes, blurred vision, constipation, orthostasis, dizziness, hypotension, and urinary retention.
Option A: Droperidol increases the risk of extrapyramidal effects when given in conjunction with phenothiazines such as fluphenazine. The most common behavioral adverse effects of INAPSINE (droperidol) include dysphoria, postoperative drowsiness, restlessness, hyperactivity and anxiety, which can either be the result of an inadequate dosage (lack of adequate treatment effect) or of an adverse drug reaction (part of the symptom complex of akathisia). Care should be taken to search for extrapyramidal signs and symptoms (dystonia, akathisia, oculogyric crisis) to differentiate these different clinical conditions. When extrapyramidal symptoms are the cause, they can usually be controlled with anticholinergic agents.
Options C: Antipsychotic effects of the drug may take several weeks to appear. Oral fluphenazine has a half-life of 14 to 16 hours. Intramuscular (IM) formulation for acute administration is typically a 1.25 mg initial dose with options ranging from 2.5 mg to 10 mg per day. IM, short-acting formulations can be administered every 6 to 8 hours as needed for acute agitation in patients with psychosis. The half-life of the intramuscular formulation of fluphenazine is 6 to 10 days. The long-acting intramuscular or subcutaneous formulation is dosed initially 12.5 mg to 25 mg, and typical dosing is every 28 days.
Option D: Tardive dyskinesia is a possible adverse reaction and should be reported immediately. Tardive dyskinesia is caused due to long-term exposure to first and second-generation neuroleptics, certain antidepressants, lithium, and some antiemetic medications. Typically, the first-generation antipsychotics with increased dopamine D2 receptor affinity are affiliated with a higher risk of causing permanent abnormal involuntary movements.