NUR203 Chlorpromazine Study Guide Essay

NUR203 Chlorpromazine Study Guide Essay

NUR203 Chlorpromazine Study Guide Essay

Study Guide for Medication Treatment Schizophrenia Spectrum and Other Psychosis

Description of the Psychopharmacological medication agent

• Chlorpromazine is an antipsychotic medication. The debut of chlorpromazine back in 1952, a dopamine inhibitor and phenothiazine antipsychotic, marked the beginning of pharmacological therapy for schizophrenia. It is regarded as an innovative breakthrough that revolutionized psychiatry.
• brand and generic names: Thorazine, Largatctil

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Appropriate FDA indication uses

• Schizophrenia
• Mania
• Hypomania
• Other psychoses
• Psychomotor agitation excitement in anxiety
• Short-term management of violent or dangerously impulsive behavior
• Intractable hiccup
• Childhood schizophrenia and autism
• Nausea and vomiting

Non-FDA uses

• Migraine Headache
• Acute Intermittent Porphyria
• Preoperative Apprehension (Harbell et al., 2021)
• Intraoperative Sedation (Shimada et al., 2022)
• Adjunctive treatment of tetanus

Drug classification

• Atypical antipsychotic medication/first-generation antipsychotic
• Phenothiazine

The medication mechanism of action

• Chlorpromazine is a dopamine blocker that works by inhibiting the release of prolactin, which is believed to be controlled by dopamine. This results in increased levels of prolactin and an increase in dopamine turnover within the brain. The drug’s effectiveness in treating psychotic disorders may be related to its ability to block central dopaminergic function. The medication pharmacokinetics
• This drug’s other characteristics of this substance encompass the reduction of feelings such as anxiousness, stress, and restlessness. It enhances the effect of central nervous system depressants such as pain relievers, drugs that relieve discomfort, or sedatives. Additionally, it possesses anti-nausea properties.

The medication pharmacodynamics

• Alpha-adrenergic inhibition caused by chlorpromazine may result in hypotension.
• Additionally, the drug chlorpromazine frequently results in raised blood cholesterol and glucose levels.

Appropriate dosing and administration route – for schizophrenia (adults)

• Available as a tablet and injectable forms
• Tabs: 10mg,25mg, 50mg, 100mg, and 200mg
• Injection: 25mg/mL ampoules
• Start doses: up to 7mg/day per oral; 25mg IV/IM
• Maintenance doses: from 200mg and 800mg per day per oral and 300-800 mg/day IV/IM

Considerations for dosing alterations

• IV doses for adjunctive treatment of tetanus
• For nausea and vomiting best use parenteral doses
• Slow IV infusions in normal saline 0.5L
• For direct IV injection do not exceed 1mg/mL
• The dosage may need to be reduced in patients with hepatic or renal impairment

Considerations of use and dosing in specific specialty populations

Children with SCHIZOPHRENIA, PSYCHOSES, ANXIETY, AND AGITATION

• Do not use in children under one year unless the need is life-saving
• Do not exceed 40 mg daily in children between 1 and 5 years

Adolescents

• Use a third to half the adult dose in children between 5 years and 12 years

Elderly

• Start with one-third to one-half the typical adult dose and raise the amount more gradually.

 Pregnancy

• Category C

Suicidal behaviors

• Schizophrenia and bipolar disease both have a risk of a suicide attempt; thus therapy should be combined with constant patient monitoring for those who are at high risk.

Lactation

• It is not advised for nursing women to use chlorpromazine unless the anticipated advantages outweigh any possible risks because it has been observed to be excreted in breast milk in varying concentrations.

Half-life why half-life is important

• Half-life is the amount of time needed for a substance’s concentration in the body to drop to half of its initial dose (Andrade, 2022)
• Half-lives determine dosing frequencies
• For example, medications with short half-lives are more likely to be associated with withdrawal or discontinuation syndromes
• Chlorpromazine has a half-life of about 30 hours
• However, elimination is carried out in phases through urine
• Early phase – 2-3 hours
• Intermediate phase – 15 hours
• Late phase – up to 60 days
• When medicines exhibit this biphasic elimination pattern, the clinically significant half-life corresponds to the second phase (Andrade, 2022).

Side effects/adverse reaction potentials

Contraindications for use

• Previous hypersensitivity – anaphylaxis reaction
• Bone marrow depression – the risk of further agranulocytosis and leucopenia
• Pheochromocytoma – catecholamine secretion leading to pheochromocytoma multisystem crisis (Wang et al., 2021a) recent controversies reported (Wang et al., 2021b)
• Hepatic failure or active hepatic disease – risk of liver dysfunction
• Circulatory collapse – the risk of further hypotension
• CNS depression – can cause further coma and increase drug intoxication

SIGNIFICANT DRUG-TO-DRUG INTERACTIONS

• Antacids – slow absorption
• Lithium – increased clearance
• Tricyclic antidepressants – Increased chlorpromazine levels
• Ciprofloxacin and fluvoxamine – Increased chlorpromazine levels
• Antiarrhythmic agents – the risk of QT prolongation
• Anticonvulsants – chlorpromazine lower the convulsive threshold
• Desferrioxamine and prochlorperazine – transient metabolic encephalopathy
• Thiazide diuretics – increase the risk of the orthostatic hypotension

Overdose Considerations

• Toxic effects appear when serum levels reach 750ng/mL
• Symptoms of overdose: restlessness, confusion, excitement, drowsiness, coma, areflexia; hypotension, tachycardia, hypothermia, pupillary constriction, tremor, muscle twitching, spasm or rigidity, convulsions, muscular hypotonia, dysphagia and difficulty in breathing, sudden apnea, cyanosis, and respiratory and/or vasomotor collapse
• Treatment: supportive management
• Avoid emetics – the risk of aspiration from extrapyramidal effects
• Avoid adrenaline – the risk of further hypotension
• Use benztropine for severe extrapyramidal effects
• Antibiotics for suspected respiratory infections

Diagnostics and labs monitoring

• Monitoring for symptoms and signs of neuroleptic malignant syndrome
• Perform appropriate glycemic monitoring during treatment with chlorpromazine
• Serum chlorpromazine levels are not necessary unless in neonates born to mothers on chlorpromazine

Neuroleptic malignant syndrome

Comorbidities considerations

• Lactation – secreted in breast milk
• Hypertensive patients on antihypertensive

Legal and ethical considerations

• Suicidal risk in schizophrenic and bipolar patients
• Beware of intentional overdose for suicidal intentions
• Patient awareness of adverse effects and dosing schedule
• Patient-centered Care and family engagement in Treatment
• Administration to lactating mother – the risk of adverse effects on the neonate

Pertinent patient education considerations

• Reason for treatment
• Dose, frequency, and timing
• Intake with meals – Food, and alcohol can reduce the absorption
• Time for the onset of clinical benefits – not specific, as early as 2-4 weeks
• Duration of treatment varies with each patient response; usually 6 months

References

Andrade, C. (2022). The practical importance of half-life in psychopharmacology. The Journal of Clinical Psychiatry, 83(4). https://doi.org/10.4088/JCP.22f14584

Harbell, M. W., Dumitrascu, C., Bettini, L., Yu, S., Thiele, C. M., & Koyyalamudi, V. (2021). Anesthetic considerations for patients on psychotropic drug therapies. Neurology International, 13(4), 640–658. https://doi.org/10.3390/neurolint13040062

Shimada, K., Inokuchi, R., Tominaga, K., Yagihashi, S., Yamada, M., & Ishitsuka, S. (2022). Effective treatment of intraoperative hiccups with chlorpromazine under general anesthesia without muscle relaxants: A case report. A&A Practice, 16(6), e01597. https://doi.org/10.1213/XAA.0000000000001597

Stip, E., Rizvi, T. A., Mustafa, F., Javaid, S., Aburuz, S., Ahmed, N. N., Abdel Aziz, K., Arnone, D., Subbarayan, A., Al Mugaddam, F., & Khan, G. (2020). The large action of chlorpromazine: Translational and transdisciplinary considerations in the face of COVID-19. Frontiers in Pharmacology, 11, 577678. https://doi.org/10.3389/fphar.2020.577678

Wang, J. J., He, Z., Yang, Y., Yu, B., Wang, H., Ding, H., Cui, G., Wang, L., Wang, D. W., & Jiang, J. (2021a). Chlorpromazine efficiently treats the crisis of pheochromocytoma: Four case reports and literature review. Frontiers in Cardiovascular Medicine, 8, 762371. https://doi.org/10.3389/fcvm.2021.762371

Wang, J. J., He, Z., Yang, Y., Yu, B., Wang, H., Ding, H., Cui, G., Wang, L., Wang, D. W., & Jiang, J. (2021b). Chlorpromazine efficiently treats the crisis of pheochromocytoma: Four case reports and literature review. Frontiers in Cardiovascular Medicine, 8, 762371. https://doi.org/10.3389/fcvm.2021.762371

Xu, H., & Zhuang, X. (2019). Atypical antipsychotics-induced metabolic syndrome and nonalcoholic fatty liver disease: a critical review. Neuropsychiatric Disease and Treatment, 15, 2087–2099. https://doi.org/10.2147/NDT.S208061

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Assigned medication: Chlorpromazine

Create a study guide for your assigned psychotropic medication agents. Your study guide should be in the form of an outline with references, and you should incorporate visual elements such as concept maps, charts, diagrams, images, color coding, mnemonics, and/or flashcards. Be creative! It should not be in the format of an APA paper. Your guide should be informed by the FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also supported by at least three other scholarly resources.

Areas of importance you should address, but are not limited to, are:

Title page

Description of the Psychopharmacological medication agent including brand and generic names and appropriate FDA indication uses

Any supporting, valid and reliable research for non-FDA uses

Drug classification

The medication mechanism of action

The medication pharmacokinetics

The medication pharmacodynamics

Mechanism of Action

Appropriate dosing, administration route, and any considerations for dosing alterations

Considerations of use and dosing in specific specialty populations to consider children, adolescents, elderly, pregnancy, suicidal behaviors, etc.

Definition of Half-life, why half-life is important, and the half-life for your assigned medication

Side effects/adverse reaction potentials

Contraindications for use including significant drug to drug interactions

Overdose Considerations

Diagnostics and labs monitoring

Comorbidities considerations

Legal and ethical considerations

Pertinent patient education considerations

Reference Page

Note: Support your rationale with a minimum of five academic resources. While you may use the course text to support your rationale, it will not count toward the resource requirement. You should be utilizing the primary and secondary literature.

For the Medication Study Guide:

Each student will be assigned an antipsychotic to research and create a study guide for this medication to be submitted by day 7 by Sunday by 11:59 p.m. Mountain Time MT/ 1:59 a.m. Eastern Time the next day.

Please see below table for your assigned medication. You must complete the medication study guide for your assigned medication-not a medication of your choice.

Use an outline format with references not paper format and include tables/graphics- the more the better. This should not be in the format of an APA paper other than your title page and reference page.

The instructions include a list of all required elements and pages. Include everything exactly as explained in the assignment instructions. Any required elements or pages (including the title page and reference page) not included will result in point deductions.

Be specific and concise but complete.

Be sure to research, cite anytime a source is used, and reference.

For references: you must use FDA-approved and Evidenced-Based, Clinical Practice Guidelines Research but also use at least three other scholarly resources. There is a minimum of 5 academic resources. The textbook may be used but will not count as 1 of the 5 resources.

For guidance on this assignment, please see- https://www.usu.edu/academic-support/test/creating_study_guides