Medication Name/Class

  • Generic/Brand: Fluphenazine / Prolixin Decanoate
  • Class: First-Generation Antipsychotic (Phenothiazine)

2. Mechanism of Action

  • Blocks postsynaptic D2 (dopamine) receptors in the mesolimbic system.
  • Possesses weak anticholinergic and alpha1-adrenergic blocking effects.
  • Strong D2 blockade reduces psychosis but directly causes extrapyramidal symptoms (EPS).

3. Expected Action/Therapeutic Effect

  • Decreases dopamine neurotransmission to control psychotic symptoms.
  • Provides antiemetic effects by blocking the chemoreceptor trigger zone.

4. Indications

  • Priority Uses: Schizophrenia (maintenance and acute management).
  • Acute agitation in psychotic disorders.
  • Off-Label: Severe behavioral/psychological symptoms of dementia (strictly regulated by OBRA).

5. Pharmacokinetics

  • Onset/Peak: Oral peaks in 2 hrs. Immediate IM peaks in 1.5-2 hrs. Depot IM/SubQ peaks in 8-10 hrs.
  • Duration: Immediate IM lasts 6-8 hrs; Depot lasts 2-4 weeks.
  • Metabolism: Liver; major CYP2D6 substrate and inhibitor.

6. Drug-Drug Interactions

  • CNS depressants: Increase sedation and fall risk in the elderly.
  • CYP2D6 substrates: Metabolism may be inhibited by fluphenazine.
  • Food/Liquid Interaction: Oral concentrate MUST NOT be mixed with caffeine (coffee, cola), tannics (tea), or pectinates (apple juice).

7. Side Effects vs Adverse Effects

  • Common: EPS (pseudoparkinsonism, akathisia, dystonia), sedation, anticholinergic effects (dry mouth), orthostatic hypotension.
  • Severe/Life-Threatening: Neuroleptic Malignant Syndrome (NMS), Tardive Dyskinesia (TD), prolonged QT/Torsade de pointes, agranulocytosis, seizures.

8. Contraindications/Precautions

  • Contraindicated: Hepatic impairment or liver damage.
  • Precautions: Geriatric patients (Beers Criteria) due to high risk of falls, fractures, and anticholinergic effects.

9. Nursing Interventions

  • Admin: Inject deeply into upper outer gluteal muscle; rotate sites. Do NOT dilute depot injections.
  • Safety: Keep patient recumbent for 30 mins post-injection to minimize severe hypotension.
  • Monitor: Sodium levels for SIADH risk.

10. Patient Education

  • Take oral doses with food if GI upset occurs.
  • Avoid spilling liquid preparations on skin/clothing.
  • Rise slowly from sitting or lying down to manage orthostatic hypotension.

11. Black Box Warning/Antidote

  • BBW: Increased mortality in elderly patients with dementia-related psychosis (deaths usually from heart failure, infections, or stroke).

12. Nursing School Priority Summary

  • Must Know: Keep the patient flat for 30 minutes after injection to prevent severe hypotensive effects.
  • Nice to Know: 10 mg of daily oral fluphenazine converts to ~12.5 mg of depot every 3 weeks.
  • Test Trap: The oral concentrate has strict mixing rules—never mix with coffee, tea, or apple juice.
  • Clinical Red Flag: Watch for potentially fatal NMS, TD, and blood dyscrasias.

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