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INTRODUCTION

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amantadine (a-man-ta-deen)

Symmetrel

Classification

Therapeutic: antiparkinson agents, antivirals

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Indications
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Symptomatic initial and adjunct treatment of Parkinson's disease. Prophylaxis and treatment of influenza A viral infections.

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Action
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Potentiates the action of dopamine in the CNS. Prevents penetration of influenza A virus into host cell. Therapeutic Effects: Relief of Parkinson's symptoms. Prevention and decreased symptoms of influenza A viral infection.

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Adverse Reactions/Side Effects
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CNS: ataxia, dizziness, insomnia, anxiety, confusion, depression, drowsiness, psychosis, seizures. GI: nausea, vomiting, anorexia, constipation. EENT: blurred vision, dry mouth. Resp: dyspnea. CV: hypotension, CHF, edema. GU: urinary retention. Derm: mottling, livedo reticularis, rashes. Hemat: leukopenia, neutropenia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Be alert for new seizures or increased seizure activity, especially at the onset of drug treatment. Document the number, duration, and severity of seizures, and report these findings to the physician immediately.

  • If treating Parkinson's disease, assess patient's motor function to help document anti-Parkinson effects, especially when starting drug therapy, or during dosing changes or addition of other anti-Parkinson drugs. Motor function should be assessed at different times of the day, such as when drugs are reaching peak therapeutic levels (i.e., 30–60 min after oral dose), as well as when drug effects are minimal (just before the next dose).

  • Assess blood pressure (BP) periodically and compare to normal values (See Appendix F). Report low blood pressure (hypotension), especially if patient experiences dizziness, fatigue, 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 peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles or a sudden increase in body weight due to fluid retention.

  • Monitor signs of leukopenia or neutropenia including fever, sore throat, and signs of infection. Report these signs to the physician.

  • Be alert for anxiety, confusion, depression, psychosis, or other alterations in mental status. Notify physician promptly if these symptoms develop.

  • Be alert for ataxia or dizziness that might affect gait, balance, or other functional activities. Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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Interventions
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  • Because of the risk of CHF and abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

  • For patients with Parkinson's disease:

    • Guard against an increased risk of falls and trauma (hip fractures, head injury, and so forth) due to a combination of Parkinson's symptoms (postural instability, rigidity) and drug side effects (dizziness, ...

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