Classification: Antipsychotic – Butyrophenones
Action: Competitively blocks dopamine receptors to cause sedation and also causes alpha-adrenergic and anticholinergic blockade. It depresses cerebral cortex and hypothalamus and limbic system, which control activity and agression but also cause significant extrapyramidal effects. The mechanism for antipsychotic effects are unclear.
Indication: Management of Tourette disorders; control of adults; management of severe behavioral problems in children and adults; management of severe behavioral problems in children; short-term treatment of hyperactive children. Long-term antipsychotic therapy (haloperidol decanoate).
- Assess patient’s disorder and mental status before drug therapy and reassess regularly thereafter; affect, orientation, mood, behavior, sleep pattern, presence and type of hallucinations.
- Monitor for possible adverse reactions:
- CNS: severe extrapyramidal reactions, tardive dyskinesia, sedation, seizures, neuroleptic malignant syndrome.
- Cardiovascular: tachycardia, ECG changes, hypotension, hypertension, bradycardia.
- EENT: blurred vision.
- GU: urine retention, menstrual irregularities.
- Hematologic: transient leukopenia and leukocytosis.
- Hepatic: jaundice.
- Skin: rash, gynecomastia.
- Monitor swallowing of oral administration medication and check for hoarding or giving of medication to other patients.
- Monitor vital signs during initial treatment (sitting, standing and lying blood pressure). Check for dizziness, faintness, palpitations, tachycardia on rising and severe orthostatic hypotension. Obtain baseline ECG, Q-wave and T-wave changes.
- Assess for constipation and urinary retention daily. Monitor input-output ratio and palpate bladder if low urinary output s observed. Increase bulk and water in the diet.
- Monitor CBC, liver function and bilirubin monthly.
- Assess for neuroleptic malignant syndrome (hyperpyrexia, muscle rigidity, CPK increase and altered mental status. If these occur, drug should be discontinued.
- Assess for reflexes, gait, coordination and EPS including akathasia (inability to sit still, no pattern to movements), tardive dyskinesia (bizarre movements of the jaw, mouth, tongue, extremities), pseudoparkinsonism (ragged tremors, pill rolling, shuffling gait), for prescription of an antiparkinsonism drug.
- Assess patient’s and family’s knowledge of drug therapy.
- Disturbed thought process related to underlying condition
- Impaired physical activity related to extrapyramidal symptoms
- Ineffective coping related to underlying condition
- PO route
- Give drug in liquid form mixed in glass of juice or caffeine-free cola if hoarding is suspected; do not mix in caffeine drinks, tannics, pectins
- Give decreased dosage in elderly because of slower metabolism
- Give oral administration with full glass of water, milk, or give with food to decrease GI upset
- Store in tight, ligh-resistant container, oral solution in amber bottle
- IM route
- Inject in deep muscle mass, do not give SC; use 21-G 2-in needle; do not administer solution with a precipitate; give <3 mL per injection site; give slowly, may be painful.
- IV route
- Give undiluted for psychotic episode at 5mg/min
- Give by intermittent infusion after dilution in 30-50 mL of D5W, run over 1/2 hour
- Instruct patient to take drug exactly as prescribed, not to double dose to compensate for missed ones and to avoid abrupt withdrawal of this drug to minimize risk of EPS
- Instruct patient to take antacids 2 hours before or after this drug
- Advice patient to avoid hazardous activities until drug response is determined because dizziness and blurred vision are common. Remind patient to avoid OTC preparations because serious drug interactions may occur; avoid also the use of alcohol and other CNS depressants since increased drowsiness may occur
- Advice patient to shift positions slowly because orthostatic hypotension may occur. Due to the danger of hypotension, tell patient to avoid hot tubs, hot showers, tub baths and to take extra precautions during hot weather to prevent heat stroke.
- Tell patient to report sore throat, malaise, fever, bleeding, mouth sores and other adverse reactions
- Teach patient to use good oral hygiene, frequent rinsing of mouth to prevent candidiasis. Sugarless gum may be used for dry mouth.
- Advice patient to use a sunscreen and sunglasses to prevent burns.
- Patient demonstrates decreased psychotic behavior and agitation
- Patient maintains physical mobility
- Patient and family state understanding of drug therapy