Nursing Implications for Trihexyphenidyl Hydrochloride

Trihexyphenidyl Hydrochloride

(trye-hex-ee-fen′i-dill)

Aparkane A, Apo-Trihex A, Novohexidyl A

Classifications: CENTRALLY ACTING CHOLINERGIC RECEPTOR ANTAGONIST; ANTIPARKINSON; ANTISPASMODIC

Therapeutic: ANTIPARKINSON; ANTISPASMODIC

Prototype: Benztropine

Pregnancy Category: C

AVAILABILITY

Tablet; elixir

ACTION & THERAPEUTIC EFFECT

Thought to act by blocking excess of acetylcholine at certain cerebral synaptic sites. Relaxes smooth muscle by direct effect and by atropinelike blocking action on the

parasympathetic nervous system. Diminishes the characteristic tremor of Parkinson’s disease.

USES

Symptomatic treatment of all forms of parkinsonism (arteriosclerotic, idiopathic, postencephalitic). Also to prevent or control drug-induced extrapyramidal disorders.

UNLABELED USES

Huntington’s chorea, spasmodic torticollis.

CONTRAINDICATIONS

Narrowangle glaucoma; tardive dyskinesia; lactation.

CAUTIOUS USE

History of drug hypersensitivities; arteriosclerosis; hypertension; cardiac disease, kidney or liver disorders; myasthenia gravis; alcoholism; obstructive diseases of GI or genitourinary tracts; older adults with prostatic hypertrophy; pregnancy (category C). Safe use in children is not established.

Nursing Implications for Trihexyphenidyl Hydrochloride

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ROUTE & DOSAGE

Parkinsonism

Adult: PO 1 mg day 1, 2 mg day 2, then increase by 2 mg q3–5days up to 6–10 mg/day in 3 or more divided doses (max: 15 mg/day)

Extrapyramidal Effects

Adult: PO 5–15 mg/day in divided doses

ADMINISTRATION

Oral

• Give before or after meals, depending on how patient reacts. Older adults and patients prone to excessive salivation (e.g., postencephalitic parkinsonism) may prefer to take drug after meals. If drug causes excessive mouth dryness, it may be better given before meals, unless it causes nausea.
• Do not crush or chew sustained release capsules. These must be swallowed whole.
• Store at 15°–30° C (59°–86° F) in tight container unless otherwise directed.

ADVERSE EFFECTS (≥1%)

GI: Dry mouth, nausea, constipation. Special Senses: Blurred vision, mydriasis, photophobia, angle-closure glaucoma. Urogenital: Urinary hesitancy or retention. CNS: Dizziness, nervousness, insomnia, drowsiness, confusion, agitation, delirium, psychotic manifestations, euphoria. CV: Tachycardia, palpitations, hypotension, orthostatic hypotension. Body as a Whole: Hypersensitivity reactions.

INTERACTIONS

Drug: Reduces therapeutic effects of chlorpromazine, haloperidol, PHENOTHIAZINES; increases bioavailability of digoxin; MAO INHIBITORS potentiate actions of trihexyphenidyl. Herbal: Betel nut may increase risk of extrapyramidal symptoms.

PHARMACOKINETICS

Absorption: Readily from GI tract. Onset: Within 1 h. Peak: 2–3 h. Duration: 6–12 h. Elimination: In urine.

NURSING IMPLICATIONS

Assessment & Drug Effects

• Be aware that incidence and severity of adverse effects are usually dose related and may be minimized by dosage reduction. Older adults appear more sensitive to usual adult doses.
• Monitor vital signs. Pulse is a particularly sensitive indicator of response to drug. Report tachycardia, palpitations, paradoxical bradycardia, or fall in BP.
• Assess for and report severe CNS stimulation (see ADVERSE EFFECTS) that occurs with high doses, and in patients with arteriosclerosis, or those with history of hypersensitivity to other drugs.
• In patients with severe rigidity, tremors may appear to be accentuated during therapy as rigidity diminishes.
• Monitor daily I&O if patient develops urinary hesitancy or retention. Voiding before taking drug may relieve problem.
• Check for abdominal distention and bowel sounds if constipation is a problem.

Patient & Family Education

• Learn measures to relieve druginduced dry mouth; rinse mouth frequently with water and suck ice chips, sugarless gum, or hard candy. Maintain adequate total daily fluid intake.
• Avoid excessive heat because drug suppresses perspiration and, therefore, heat loss.
• Do not to engage in potentially hazardous activities requiring alertness and skill. Drug causes dizziness, drowsiness, and blurred vision. Help walking may be indicated.

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Ditulis oleh Unknown pada tanggal Tuesday, September 15, 2015