Apomorphine

INTRODUCTION

Indications

Acute, intermittent treatment of hypomotility; “off” episodes due to advanced Parkinson's disease.

Action

Stimulation of specific dopamine receptors improves motor function. Therapeutic Effects: Improved motor function.

Adverse Reactions/Side Effects

CNS: dizziness, hallucinations, somnolence, confusion, sudden drowsiness, headache. EENT: rhinorrhea. CV: CARDIAC ARREST, chest pain, hypotension, angina, CHF, QTc prolongation. GI: nausea, vomiting. GU: priapism. Derm: flushing, pallor, sweating. Local: injection site pain. MS: arthralgia, back pain, limb pain. Neuro: aggravation of Parkinson's disease, dyskinesia. Misc: yawning.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of cardiac arrest, and seek immediate medical assistance if the patient collapses, loses consciousness, stops breathing, and lacks a pulse.

• Assess gait and motor function to help document anti-Parkinson effects, especially when treating severe hypomobility or akinetic episodes (“off” periods).

• Document increased side effects such as involuntary movements (dyskinesias) or fluctuations in response (on-off phenomenon, end-of-dose akinesia). Notify physician because increased side effects might require dose adjustment or a change in medication regimen.

• Monitor confusion, hallucinations, and other psychologic problems. Repeated or excessive symptoms may require change in dose or medication.

• Assess blood pressure periodically, and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences increased dizziness, fainting, or other symptoms.

• Assess signs of congestive heart failure, including dyspnea, rales/crackles, peripheral edema, jugular venous distention, and exercise intolerance. Report these signs to the physician.

• Assess dizziness and drowsiness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Assess any back, joint, or limb pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Monitor injection site for pain, swelling, and irritation. Report prolonged or excessive injection site reactions to the physician.

Interventions

• Implement therapeutic exercises (coordination exercises, gait training, cardiovascular conditioning) to complement the effects of drug therapy and help achieve optimal function.

• Guard against falls and trauma (hip fractures, head injury, and so forth). Implement fall prevention strategies (See Appendix E), especially if patient exhibits Parkinson's symptoms (postural instability, rigidity) combined with drug side effects (dizziness, dyskinesias).

• Because of the risk of cardiac arrest and other cardiac involvement, use extreme caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (blood pressure, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L...