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CBL PARKINSON'S DISEASE, Q4) Staging based on Hoehn–Yahr Scale -…

- - - - Blurred vision
      - Itchy eyebrows and scalp
      - Her husband complains that her personality has changed
        
        Shops excessively that strains their budget
- - - - Dose : 0.5mg, 1mg, 2mg
      - Schedule : 0.5mg per day to 1 mg per day(twice daily)
      - Dosage Form : Tablet
      - Duration of therapy : until a satisfactory clinical response is obtained gradually.
      - Adverse effect : Dry mouth, dry eyes, constipation, hypotension, cognitive impairment, urinary retention
  - - - Schedule : 300mg/day (2-3 three times daily)
      - Duration of therapy : until a satisfactory clinical response is obtained gradually.
      - Dose : can be started at a dose of 50 mg daily, increasing every 3-7 days by 50 mg to an initial maintenance dose of 50-100 mg 3x daily.
      - Adverse effect :Nausea, somnolence, dyskinesia, hypotension, hallucinations
      - Dosage Form : Tablet
  - - - Schedule : 2.5-5mg/day (Twice a day, increased at 2-4 week interval)
      - Duration of therapy : until a satisfactory clinical response is obtained gradually.
      - Dose : 2.5mg, 5mg
      - Adverse effect : Nausea, headache, dizziness
      - Dosage Form : Tablet
- - - - Response to therapy(improvement of patient's sign and symptoms due to Parkinson disease)
        
        Monitor adverse effects such as urinary retention,GI depression,decreased sweating and hypotension.
        
        Evaluate patient understanding on drug therapy
        
        Assess for mentioned contraindications and cautions such as glaucoma and myasthenia gravis.
        
        Perform a thorough physical assessment to obtain baseline data,determine drug therapy effectiveness and monitor side effects.
        
        Monitor laboratory test results to determine need for possible dose adjustment.
        
        Monitor risk for impaired thermoregulation related to anticholinergic effects.
    - - immediate- and sustained-release carbidopa/levodopa (Sinemet)
        
        Educate the patient that IR form is best absorbed on an empty stomach but is commonly taken with food to minimize nausea.
        
        Monitor daytime drowsiness (reduce dosage of c/l to address)
        
        Monitor for abnormal involuntary movements (reduce dose of c/l, consider adding on either: dopamine agonist, MAO-I or COMT-I
      - Bromocriptine (Parlodel)
        
        Baseline CXR (pleuropulmonary disease, PPD)
        
        Cardiac symptoms (retroperitoneal fibrosis, cardiac valve dysfunction)
        
        Mental status (consider reducing dose if pt experiences confusion, drowsiness, or hallucinations/delusions)
        
        Nausea (alleviate by titrating down slowly and taking dose with food)
        
        Blood pressure and dizziness upon standing (orthostatic hypotension) (reduce dose it pt is experiencing)
      - Benztropine (Cogentin)
        
        Mental status
        
        Anticholinergic side effects: dry mouth, constipation, urinary retention
      - PERGOLIDE
        
        Assess CV status including ECG before initiation of treatment and periodically thereafter. Perform baseline evaluation of ESR, other inflammatory markers, lung function/chest X-ray, serum creatine, renal function and monitor thereafter. Monitor for signs and symptoms of valvulopathy (e.g. dyspnoea, oedema, CHF, cardiac murmurs), fibrotic disorders (e.g. cough, dyspnoea, oedema, CHF, cardiac rub, uri
        
        nary tract obstruction), development of impulse control disorders.