Ropinirole

INTRODUCTION

Indications

Management of signs and symptoms of idiopathic Parkinson's disease. Restless legs syndrome (immediate-release only).

Action

Stimulates dopamine receptors in the brain. Therapeutic Effects: Decreased tremor and rigidity in Parkinson's disease. Decreased leg restlessness.

Adverse Reactions/Side Effects

CNS: SLEEP ATTACKS, dizziness, syncope, confusion, drowsiness, fatigue, hallucinations, headache, ↑ dyskinesia, weakness. EENT: abnormal vision. CV: orthostatic hypotension, peripheral edema. GI: constipation, dry mouth, dyspepsia, nausea, vomiting. Derm: increased sweating.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be aware that ropinirole can cause sudden, unexpected episodes of falling asleep (sleep attacks). Use caution during activities in which patient might fall asleep suddenly.

• Assess gait and motor function to help determine antiparkinson effects, especially when starting drug therapy or during dosing changes or addition of other antiparkinson 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).

• Document increased motor side effects such as involuntary movements (dyskinesias), fluctuations in response (on-off phenomenon, end-of-dose akinesia), or other abnormal movement patterns. Notify physician because increased motor 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 dizziness, drowsiness, and syncope that affects gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

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

• 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.

• If used to treat restless leg syndrome, assess the severity and frequency of restless episodes (i.e., an intense need to get up and move around) and lower extremity symptoms such as crawling, tingling, cramping, aching, burning, creeping, and similar sensations. Document whether drug therapy is effective in reducing these symptoms.

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 ...