MH PHARM | Perphenazine [Trilafon]

1. Medication Name/Class Trilafon (perphenazine). Class: First-Generation Antipsychotic (FGA); Phenothiazine Antiemetic.2. Mechanism of Action Blocks postsynaptic dopamine D2 receptors in the mesolimbic system (reducing psychosis) and the chemoreceptor trigger zone (stopping emesis). It also causes alpha-1 adrenergic and moderate anticholinergic blockade.3. Expected Action/Therapeutic Effect Decreased psychotic symptoms and resolution of severe nausea or vomiting.4. Indications Common: Schizophrenia, severe nausea and vomiting. Off-Label: Severe behavioral or psychological symptoms of dementia (BPSD).5. Pharmacokinetics Extensively metabolized in the liver (CYP2D6); contraindicated in significant hepatic impairment. It is highly protein-bound with a half-life of 9-12 hours.6. Drug-Drug Interactions It acts as a relatively potent inhibitor of CYP2D6. Crucial administration rule: Do NOT mix oral concentrate with caffeine (coffee/cola), tannics (tea), or pectinates (apple juice). Dilute just prior to administration using only approved liquids like water, milk, or orange/tomato juice.7. Side Effects vs Adverse Effects Common: Drowsiness, dry mouth, orthostatic hypotension, constipation, urinary retention. Adverse: Extrapyramidal symptoms (EPS - dystonia, pseudoparkinsonism, akathisia), tardive dyskinesia, QT prolongation. Life-Threatening: Neuroleptic Malignant Syndrome (NMS), agranulocytosis, seizures, stroke, cardiac arrest.8. Contraindications/Precautions Avoid in geriatric patients with Parkinson's, delirium, dementia, or benign prostatic hyperplasia. Use cautiously in fall-risk patients due to CNS depression and hypotension.9. Nursing Interventions Monitor sodium levels closely upon initiation/dose changes due to the risk of SIADH and hyponatremia. In long-term care, follow OBRA regulations requiring gradual dose reduction (GDR) attempts and documented medical necessity. Avoid spilling liquid on skin to prevent contact dermatitis.10. Patient Education May take with food for stomach upset. Change positions slowly to avoid fainting. Immediately report muscle rigidity, high fever (NMS), abnormal involuntary movements (EPS), or signs of infection like a sore throat (agranulocytosis).11. Black Box Warning BBW: Increased risk of death (typically heart failure or infection) and cerebrovascular events (stroke) in elderly patients treated for dementia-related psychosis.12. Nursing School Priority SummaryMust Know: Blocks dopamine, causing a high risk for EPS, tardive dyskinesia, and NMS.Nice to Know: Liquid concentrate has strict mixing rules; never mix with apple juice, coffee, or tea.Test Trap: Administering to a geriatric dementia patient without attempting non-pharmacologic interventions violates OBRA guidelines and triggers the Black Box Warning.Clinical Red Flag: Watch for sudden fever, sore throat (agranulocytosis), or muscle rigidity (NMS).One-Sentence Memory Hook: Perphenazine powerfully prevents psychosis and puking, but provokes parkinsonism and poses perils for the aging.