Which side effects would the nurse most likely observe with fluphenazine decanoate (Prolixin)?

• A. High extrapyramidal effects, low anticholinergic effects
• B. High anticholinergic effects, low extrapyramidal effects
• C. Risk for agranulocytosis, fever, and elevated blood pressure
• D. Blood dyscrasias such as thrombocytopenia

Answer: (A)

The key idea is that high-potency typical antipsychotics, like fluphenazine decanoate, produce more movement-related side effects (extrapyramidal symptoms) and have relatively little anticholinergic activity. Fluphenazine decanoate strongly blocks dopamine D2 receptors in the nigrostriatal pathway, which drives EPS such as dystonia, parkinsonism, akathisia, and tardive dyskinesia. Because its receptor profile has limited anticholinergic effects, you would expect fewer anticholinergic symptoms (dry mouth, blurred vision, constipation, urinary retention, etc.). A long-acting injectable maintains this risk because the drug is released steadily over time, keeping EPS potential high.

The other options describe side effects more typical of other profiles (for example, agranulocytosis or fever with clozapine, or widespread anticholinergic effects seen with some low-potency agents), which is why they don’t fit fluphenazine decanoate as well.