MH PHARM | Prolixin [Fluphenazine]

Medication Name/ClassGeneric/Brand: Fluphenazine / Prolixin DecanoateClass: First-Generation Antipsychotic (Phenothiazine)2. Mechanism of ActionBlocks 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 EffectDecreases dopamine neurotransmission to control psychotic symptoms.Provides antiemetic effects by blocking the chemoreceptor trigger zone.4. IndicationsPriority Uses: Schizophrenia (maintenance and acute management).Acute agitation in psychotic disorders.Off-Label: Severe behavioral/psychological symptoms of dementia (strictly regulated by OBRA).5. PharmacokineticsOnset/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 InteractionsCNS 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 EffectsCommon: 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/PrecautionsContraindicated: Hepatic impairment or liver damage.Precautions: Geriatric patients (Beers Criteria) due to high risk of falls, fractures, and anticholinergic effects.9. Nursing InterventionsAdmin: 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 EducationTake 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/AntidoteBBW: Increased mortality in elderly patients with dementia-related psychosis (deaths usually from heart failure, infections, or stroke).12. Nursing School Priority SummaryMust 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.