An antipsychotic agent, fluphenazine (Prolixin), is ordered for a patient with psychosis. The nurse understands that this agent can lead to extrapyramidal symptoms that may be treated with which medication?

Many antipsychotic medications, such as fluphenazine, have anticholinergic side effects due to their blockade of muscarinic receptors. These effects—dry mouth, blurred vision, constipation, and urinary retention—can significantly impact comfort and adherence. Nurses play a key role in teaching clients self-care strategies to reduce these symptoms and maintain compliance with therapy.

Rationale for correct answer:

B. Chew sugarless gum to moisten the mouth – Dry mouth is a common anticholinergic effect of fluphenazine. Chewing sugarless gum stimulates salivary flow, helping to moisten the oral mucosa and prevent dental problems. This is an effective, nonpharmacologic coping strategy.

Rationale for incorrect answer:

A. Take the medication in the morning to prevent insomnia – Fluphenazine is more likely to cause sedation than insomnia. Adjusting the time of administration does not address anticholinergic effects such as dry mouth.

C. Use cooling measures to decrease fever – While anticholinergic drugs can reduce sweating and theoretically contribute to heat intolerance, fever is not the most common issue. Cooling measures are not a primary intervention for typical anticholinergic effects in this context.

D. Take an antacid to relieve nausea – Antacids are not indicated for anticholinergic effects. In addition, they can interfere with the absorption of some oral medications, including certain antipsychotics.

Take-home points:

• Anticholinergic effects of fluphenazine include dry mouth, constipation, urinary retention, and blurred vision.
• Nonpharmacologic interventions, such as chewing sugarless gum or sipping water, can improve comfort and adherence.
• Client education should focus on practical, daily strategies to manage side effects without introducing unnecessary medications.

Phenothiazines, a class of first-generation antipsychotics, can cause acute dystonia early in treatment. This is a type of extrapyramidal symptom (EPS) characterized by severe, involuntary muscle spasms that may affect the neck, face, tongue, or back, and require prompt medical attention.

Rationale for correct answer:

B. Severe muscle spasms may occur early in therapy.
Acute dystonic reactions are a known early adverse effect, often appearing within hours to days of starting phenothiazines. Education should stress reporting these symptoms immediately, as they can compromise breathing or swallowing.

Rationale for incorrect answer:

A. The client may experience withdrawal and slowed activity.
Phenothiazines more commonly cause sedation, not withdrawal-like symptoms, and this is not the most urgent teaching point before discharge.

C. Tardive dyskinesia is likely early in therapy.
Tardive dyskinesia usually develops after months to years of therapy, not in the early stages.

D. Medications should be taken as prescribed to prevent adverse effects.
While adherence is important, this statement does not address a specific high-priority side effect for early treatment.

Take-home points:

• Acute dystonia can occur within the first days of phenothiazine use.
• Early recognition and reporting of muscle spasms is critical to prevent complications.
• Tardive dyskinesia develops later, not at the start of therapy.