Assessment

• Assess mental status (orientation, mood, behavior) prior to and periodically during therapy

» Assess weight and BMI initially and throughout therapy

» Asses fasting blood glucose and cholesterol levels initially and periodically throughout therapy. Refer as appropriate for nutritional/weight and medical management

» Assess positive (hallucinations, delusions, agitation) and negative (social withdrawal) symptoms of schizophrenia

» Monitor blood pressure (sitting, standing, lying), pulse, and respiratory rate prior to and frequently during the period of dose adjustment

» Observe patient carefully when administering medication to ensure medication is actually taken and not hoarded

» Assess fluid intake and bowel function. Increased bulk and fluids in the diet may help minimize constipation

» Monitor patient 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 of hands, mask-like face, shuffling gait, rigidity, tremors; and 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. Notify health care professional if these symptoms occur; reduction in dose or discontinuation may be necessary. Trihexyphenidyl, diphenhydramine, or benzotropine may be used to control these symptoms. Benzodiazepines may alleviate symptoms of akathisia

» 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, excessive eye blinking). Report these symptoms immediately; may be irreversible

» Monitor for development of neuroleptic malignant syndrome (fever, respiratory distress, tachycardia, convulsions, diaphoresis, hypertension or hypotension, pallor, tiredness, severe muscle stiffness, loss of bladder control). Report these symptoms immediately

• Assess level of anxiety prior to and following administration

• Assess type, location, intensity, and duration of pain and accompanying symptoms

• Monitor CBC, liver function tests, and ocular exams periodically throughout therapy. May cause hematocrit, hemoglobin, leukocytes, granulocytes, platelets. May cause bilirubin, AST, ALT, and alkaline phosphatase. Agranulocytosis occurs 4–10 wk after initiation of therapy, with recovery 1–2 wk following discontinuation. May recur if medication is restarted Liver function abnormalities may require discontinuation of therapy. May cause false-positive or false-negative pregnancy tests and false-positive urine bilirubin test results

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