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CLINICAL COURSE, TASK C, over the counter supplements that can slow…

- - - - Gold standard for Parkinson's Disease treatment
      - EFFECTIVE in early and late stage of PD (CPG, 2007)
      - Standard and controlled release formulation - efficious as monotherapy in PD (Goetz et al., 2005).
      - Dose of levodopa should be kept minimum necessary to achieve good motor function
      - Older patient preferably prescribe with Levodopa
      - Levodopa cause dykinesias occur frequently especially in young patient
        
        Delay use in young patient
    - - Efficacious as symptomatic monotherapy and adjunct to Levodopa (CPG, 2007)
      - Delay onset of levodopa-induce dyskinesias (Tan & Ondo, 2000)
      - Young people more likely develop motor fluctuations
        
        Young patient preferably prescribed monotherapy with long-acting DOPAMINE AGONIST rather than Levodopa - to reduce dyskinesias
      - Less likely to cause dyskinesias
    - - Efficacious to control symptoms but minimal antiparkinsonian effects
      - Used as initial therapy for PD especially when tremor is predominant (CPG, 2007)
      - Used caution in elderly patient and patient with pre-existing cognitive deficits - because of central and peripheral anticholinergic side effect (blurred vision, confusion, sedation and urinary retention) (CPG, 2007)
      - Used alone or adjunct with Levodopa and other antiparkinson agent - to treat tremors and stiffness in PD patient
      - Young patient able to tolerate anticholinergic side effect
    - - Efficious as symptomatic monotherapy and used in early stage of PD because little antiparkisonism action (CPG, 2007)
      - Do not delay progression but have beneficial effect on motor fluctuations
      - MAO with Levodopa
        
        Prolong action
        
        Attenuates motor fluctuation
        
        Decrease wearing off effect
    - - Effective in PD treatment
      - Used caution in patients with renal impairment, urinary tract infection and dehydration
      - Used as symptomatic monotherapy or adjunct with Levodopa (Snow et al., 2000)
      - Therapy to reduce dyskinesia in PD patient with motor fluctuations
      - Abrupt withdrawal or dose reduction - cause rebound psychosis or neuroleptic malignant syndrome (CPG, 2007)
    - - Reduce daily Levodopa intake if dyskinesia appears or exacerbated
      - Effective and used with Levodopa in patient with motor Fluctuations (CPG, 2007)