Glatiramer

INTRODUCTION

Indications

Reduction of frequency of relapses in relapsing-remitting multiple sclerosis (MS).

Action

Appears to modify the immune process thought to be responsible for MS. Therapeutic Effects: Decreased incidence of relapses in relapsing-remitting MS.

Adverse Reactions/Side Effects

CNS: anxiety, weakness, confusion, migraine, vertigo. CV: chest pain, palpitations, edema, syncope, tachycardia, vasodilation. Derm: pruritus, rashes, sweating, erythema. EENT: rhinitis, nystagmus. GI: diarrhea, nausea, anorexia, vomiting. GU: urgency. Local: injection-site reactions. MS: arthralgia, back pain, hypertonia. Neuro: tremor. Resp: dyspnea. Misc: flulike symptoms, lymphadenopathy, fever, immediate postinjection reaction, infection, pain, weight gain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Periodically assess balance, coordination, spasticity, and other aspects of neuromuscular function to help document whether this drug is effective in reducing MS exacerbations.

• Assess heart rate, ECG, and heart sounds, especially during exercise (See Appendices G, H). Report an increased heart rate (tachycardia) or symptoms of other arrhythmias, including palpitations, chest pain, shortness of breath, labored breathing, syncope, and fatigue/weakness.

• Assess peripheral edema using girth measurements, volume displacement, and measurement of pitting edema (See Appendix N). Report increased swelling in feet and ankles due to peripheral vasodilation.

• Report allergy-like responses (wheezing, laryngeal edema, urticaria, other skin reactions) that occur immediately after administration (immediate postinjection reaction).

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

• Assess vertigo or weakness that might affect gait, balance, and other functional activities. 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.

• Be alert for signs of infection and flu-like symptoms, including fever, sore throat, swollen glands, chills, aches, nausea, vomiting, diarrhea, and localized inflammation. Notify physician or nursing staff of these signs.

• Periodically assess body weight and other anthropometric measures (body mass index, body composition). Report a rapid or unexplained weight gain or increased body fat.

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

Interventions

• Design and implement coordination, balance, and other therapeutic exercises to maintain function and complement drug effects in patients with MS.

• Because of the risk of arrhythmias, use 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).

• Do ...