Thiethylperazine

INTRODUCTION

Indications

Management of nausea and vomiting.

Action

Alters the effects of dopamine in the CNS. Depresses the chemoreceptive trigger zone (CTZ) and vomiting center in the CNS. Therapeutic Effects: Diminished nausea and vomiting.

Adverse Reactions/Side Effects

CNS: NEUROLEPTIC MALIGNANT SYNDROME, sedation, cerebral vascular spasm, extrapyramidal reactions, headache, restlessness, tardive dyskinesia. EENT: dry eyes, blurred vision, lens opacities, tinnitus. CV: hypotension (following IM use), peripheral edema. GI: constipation, dry mouth, altered taste, anorexia, drug-induced hepatitis, ileus. GU: urinary retention. Derm: photosensitivity, pigment changes, rashes. Endo: galactorrhea. Hemat: AGRANULOCYTOSIS, leukopenia. Metab: hyperthermia. Neuro: trigeminal neuralgia. Misc: allergic reactions.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor and report signs of neuroleptic malignant syndrome (hyperthermia, diaphoresis, generalized muscle rigidity, altered mental status, tachycardia, changes in blood pressure [BP], incontinence). Symptoms typically occur within 4–14 days after initiation of drug therapy, but can occur at any time during drug use.

• Monitor signs of agranulocytosis and leukopenia including fever, sore throat, mucosal lesions, signs of infection, and bruising. Report these signs to the physician immediately.

• Monitor the frequency, severity, and duration of GI problems (nausea, vomiting) to help document drug effectiveness in controlling these symptoms.

• Assess motor function, and be alert for extrapyramidal reactions. Report these symptoms immediately, especially tardive dyskinesia, because this problem may be irreversible. Common extrapyramidal symptoms include:

  • 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).

  • Pseudoparkinsonism (shuffling gait, rigidity, tremor, pill-rolling motion, loss of balance control, difficulty speaking or swallowing, mask-like face).

  • Akathisia (restlessness or desire to keep moving).

  • Other dystonias and dyskinesias (dystonic muscle spasms, twisting motions, twitching, inability to move eyes, weakness of arms or legs).

• Assess BP periodically and compare to normal values (See Appendix F). Report low BP (hypotension), especially if patient experiences dizziness, fatigue, or other symptoms.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

• Monitor any facial pain consistent with trigeminal neuralgia; that is, sharp or electric-like pain radiating into the cheek, jaw, teeth, gums, lips, and sometimes the eye and forehead. Notify physician and discuss possible physical interventions to control this pain.

Interventions

• Guard against falls and trauma (hip fractures, head injury, and so forth) caused by drowsiness, blurred vision, or extrapyramidal symptoms; implement fall prevention strategies (See Appendix E).

• Because of an increased risk of hyperthermia, use caution during aerobic exercise, especially in hot environments. Carefully ...