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INTRODUCTION

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selegiline transdermal (se-lee-ji-leen)

Emsam

Classification

Therapeutic: antidepressants

Pharmacologic: monoamine oxidase type B inhibitors

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Indications
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Major depressive disorder.

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Action
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Following conversion by MAO to its active form, selegiline inactivates MAO by irreversibly binding to it at type B (brain) sites; this results in higher levels of monoamine neurotransmitters in the brain (dopamine, serotonin, norepinephrine). Therapeutic Effects: Decreased symptoms of depression.

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Adverse Reactions/Side Effects
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CNS: insomnia, abnormal thinking, agitation, amnesia, worsening of mania/hypomania. EENT: tinnitus. Resp: ↑ cough. CV: HYPERTENSIVE CRISIS, chest pain, orthostatic hypotension, peripheral edema. GI: diarrhea, altered taste, anorexia, constipation, flatulence, gastroenteritis, vomiting. GU: dysmenorrhea, metrorrhagia, urinary frequency. Derm: application-site reactions, acne, ecchymoses, pruritus, sweating. MS: myalgia, neck pain, pathologic fracture. Neuro: paresthesia.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Measure blood pressure (BP) periodically and compare to normal values (See Appendix F). Immediately report a large, rapid increase in BP (hypertensive crisis). Signs and symptoms of hypertensive crisis include chest pain, tachycardia or bradycardia, severe headache, nausea, vomiting, neck stiffness, sweating, and enlarged pupils. The risk of hypertensive crisis is increased when this drug is taken with other antidepressants, excessive caffeine, other drugs that increase BP, or foods that contain tyramine (e.g., fermented wines, cheeses).

  • Be alert for increased depression, especially in the initial period of drug therapy and in children and teenagers. Notify physician or mental health professional immediately if patient exhibits worsening depression or other changes in mood and behavior.

  • Be alert for agitation, memory problems, abnormal thoughts, or other alterations in mental status. Notify health care professional if these symptoms become problematic.

  • Assess BP when patient assumes a more upright position (lying to standing, sitting to standing, lying to sitting). Document orthostatic hypotension and contact the physician when systolic BP falls >20 mm Hg, or diastolic BP falls >10 mm Hg.

  • Assess peripheral edema using palpation, girth measurements, and volume displacement. Report increased swelling in feet and ankles or other signs of edema caused by fluid retention.

  • Assess any muscle or neck pain, or pain that might indicate fractures. Protect and support any suspected fracture sites, and report the problem to the physician for further evaluation.

  • Assess paresthesias (numbness, tingling), and perform objective tests, including electroneuromyography and sensory testing to document any drug-related neuropathic changes.

  • Monitor transdermal application site for skin reactions (rash, irritation, dermatitis). Report prolonged or excessive application site reactions to the physician.

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Interventions
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  • To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

  • Avoid touching the transdermal application site, and do not apply massage or physical agents (heat, cold, electrotherapeutic modalities) at or near the application site.

  • Help patient explore nonpharmacologic methods to reduce depression, such as exercise, counseling, support groups, and so forth.

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