Question 5

**Joe has felt very tired at home and at work. One month ago, his physician prescribed modafinil, and his fatigue has gotten better.

5a. What category of drug is modafinil? What conditions is the drug used for?
5b. What are the side effects of modafinil?
5c. How would this drug affect your treatment of Joe?
5d. As a PT, what can you do with respect to helping Joe with his fatigue.**

5a. Modafinil is in a class of medications called wakefulness promoting agents. It is a psychostimulant that also causes increase in attention capacity.Sleepiness or Narcolepsy is what it is commonly used to treat. (Drew)

Modafinil is a schedule IV drug which means that it has a relatively low abuse potential. Other drugs that are in category IV include barbiturates and anti-anxiety medications. (Laura)

5a. Modafinil (Systemic) is in the class of drugs called CNS stimulant. It's commonly used brand name is Provigil. (Amanda)

5b. Some of the most common side effects of modafinil include upper respiratory tract infection, headache, nausea, nervousness, anxiety, and insomnia. The previous listed side effects happen in more than 5% of patients. (Marleigh K.)

5c. As a PT, I would want to have my treatment sessions with Joe while the drug was working to keep him awake. I would want to schedule our sessions during the peak therapeutic time of the drug. (Britt)

5c. I agree with Britt that sessions would want to be scheduled while the drug was working. As a PT, I would also keep my eye out for skin checks during our session because modafinil can cause rashes. (Denise)

5d. As a PT, you could teach Joe energy conservation techniques that allow him to stay within a functional mobility and energy-expenditure range throughout his day without experiencing extreme fatigue. (Mandy) What specifically would you do?

As PTs, we could teach Joe how to organize things in his house so that he is not making a lot of trips up and down the stairs (since he lives in a 2 story). We could also educate Joe on how many times he gets in and out of the bus in a day. (Megan)

5d. In addition to Mandy's suggestions, I would teach Joe how to bundle his ADL's and IDL's to prevent him from further fatigue throughout the day. For example if he was preparing dinner, I would instruct him to get everything out of the cupboards, fridge, pantry etc. first before he began preparing dinner, this would prevent him having to expend extra energy. (Carley)

5d. To add to Carley's post once Joe gets his supplies for dinner he could prepare dinner while sitting in a chair. Other suggestions that I would have for Joe as far as energy conservation goes is that he get a shower chair and if it is at all possible have his laundry on the main floor (if this is not possible he should bring everything to the floor the laundry is on and then stay on that floor until the laundry is done). Bundling his activities and doing them sitting down if at all possible will greatly decrease his energy expenditure. (Kelly)

5d. sitting down whenever possible is a great idea and posture should be another focus for energy conservation. Also, instead of carrying things, he could pull them in something with wheels. This may also allow him to take more things from point A to to point B. (Amber)

5d. Since Modafinil can effect sleep habits, I would remind Joe to be sure he is getting enough sleep at night. Also I would instruct Joe to be sure he is on a healthy balanced diet to help boost his energy. (Jordan)

5d. Also, since I will probably be seeing Joe on a more regular basis I would make sure Joe isn't experiencing any bad side-effects or deviating from the directed use of this drug if he begins to feel well enough that he feels he can stop. Taking modafinil as directed is very important. (Marley)

5d. To go off of Jordan's post - I would document Joe's alertness and ask him his sleeping patterns since he has been on Modafinil. Modafinil has a half-life of 15 hours so it is crucial that Joe knows when it is appropriate to take so it doesn't keep him up when he should be sleeping. (Liz)

5a. Modafinil is commonly used to treat fatigue symptoms in MS patients. (Leslie)


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