Parkinson's Disease Information Sheet 1.4
Parkinson's A
a Medication Treatment Options
progressive neurological condition which decarboxylase inhibitor carbidopa. Kinson® is is related to a deficit of dopamine as a the generic form of Sinemet®. Madopar® result of degeneration of dopamine producing neurons. Dopamine is a neurotransmitter which conveys messages between neurons to ensure effective Both of these medications are available in movement and planning of movement. standard and controlled release forms and in varying dosages. Madopar® is available in a
As a consequence, most pharmaceutical dispersible form where rapid action is treatment options focus on restoring the required. Sinemet® may be dispensed in a
liquid form which must be refrigerated and neurotransmitters by several means: prepared freshly every 24 hours. These preparations are less frequently used than the Dopamine replacement therapy standard tablet form. Dopamine agonists replacement therapy are: MAO Type B Inhibition Anticholinergic therapy Nausea and vomiting
Dopamine Replacement Therapy
Postural hypotension (Levodopa)
Increased dreams Replacement of dopamine using levodopa Dyskinesia (involuntary movements) remains the gold standard treatment for Pd providing maximum symptom control, Nausea and vomiting may be experienced
particularly for bradykinesia (slowness of with the introduction of levodopa. On movement), muscle rigidity and to a lesser commencement of therapy it is important to extent tremor. A positive response to take the medication with food however as the levodopa will assist in confirming the body adjusts this side effect may settle. diagnosis of Pd. Constipation may be experienced with the
As it is not possible to directly replace introduction of and any change in medication dopamine pharmaceutically, levodopa (a regime. Extra fluids and a high fibre diet will precursor) is used to cross the blood brain address this problem. barrier where it is converted into dopamine Postural hypotension may present as
neurotransmitter dizziness and unsteadiness on standing and may result in falls. If this is experienced consult your doctor. Levodopa when taken orally is r ap id ly d est r o yed in the peripheral circulation Increased dreams which may be vivid can
resulting in a greatly reduced p r o p o r t io n occur with levodopa. Hallucinations may occur as a result of long
term levodopa therapy. In some cases this lessen the side effects of levodopa the may require medication adjustment. If this is addition of decarboxylase inhibitors is experienced consult your doctor. In some cases July 2007
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Dyskinesia (involuntary movements) may maximised thus, in theory, providing an develop with long term levodopa therapy. extended response to levodopa. This can occur at various times in relation to the drug cycle e.g. peak dose or end of Currently, in Australia, the available dose. Adjustment of medication may be COMT inhibitors are: necessary if the dyskinesia is problematic for PWP. Dyskinesia may be increased by stress. Comtan® (entacapone) designed to be taken with a levodopa preparation. By Dopamine Agonists
itself Comtan® has no action. Medications of the dopamine agonist family mimic dopamine and stimulate the combination therapy of levodopa and dopamine receptors. Dopamine and levodopa are both taken up by the dopamine receptors of which there are several. Historically dopamine agonists The introduction of COMT inhibitors may were used in combination with levodopa exaggerate existing levodopa side effects. however with ongoing development of In addition a harmless side effect is a drugs practice is changing to initiate change in urine colour (bright yellow or a treatment with dopamine agonists. reddish hue). A rare side effect is diarrhoea which may commence several Currently, in Australia, the available months after initiation of therapy. dopamine agonists are: MAO Type B Inhibition
Cabaser® (cabergoline) Permax® (pergolide mesylate) Monoamine oxidase (MAO) is an enzyme Parlodel® (bromocriptine mesylate) dopamine. Type B is found in the brain. Kripton® (bromocriptine mesylate) MAO type B inhibitors are reputed to Apomine® (apomorphine scavenge the free radicals formed by the hydrochloride) (subcutaneous injection oxidative metabolism of dopamine hence or continuous subcutaneous infusion) the unproven theory that they may protect neurons from further damage. Possible side effects of dopamine agonist therapy are similar to those associated Currently, in Australia, the available MAO with levodopa with the additional rare side type B inhibitors used in Pd are: effects of pulmonary or peritoneal fibrosis and cardiac valve changes. Apomine® requires the use of Motilium®
prior to introduction because of nausea Possible side effects include sleep and vomiting. Localised skin reactions at disturbance hence it is important to take the injection sites can occur. this medication early in the day (preferable no later than 12 noon. COMT Inhibition
Drug interactions may occur when PWP Catechol-o-methyl transferase (COMT) is taking selegiline are given Pethidine® and an enzyme which metabolizes both certain types of antidepressants. It is levodopa and dopamine. By inhibiting the essential to check with your doctor before action of COMT availability of levodopa is July 2007
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prescribed selegiline. The previously discussed medications are those which may be prescribed in the Anticholinergic Therapy
management of Pd is complex and ideally Prior to the discovery of levodopa this should be managed by a Consultant group of medications was the first line (Neurologist or Geriatrician). Just as the treatment of Pd. The mode of action of symptoms of Pd vary from person to the anticholinergic therapy is to correct the person so to is the medication regime prescribed to control those symptoms. acetylcholine. They are useful in the treatment of tremor but may also address bradykinesia, rigidity and sialorrhea in the Medication Warning
Pd is complex and often associated with Currently, in Australia, the available other conditions. Many of the medications anticholinergics are: used in the treatment of other conditions have the potential to alter or interfere with Artane® (benzhexol hydrochloride) the brain's dopamine system and maybe Cogentin® (benztropine mesylate) overlooked as having a detrimental effect Akineton® (biperiden hydrochloride) on the symptoms of Pd. Possible side effects (especially in the It is imperative that PWP and health older PWP) include dry mouth, urinary professionals involved in the care of PWP retention, blurred vision and confusion. are aware of drug contraindications. Amantadine
medications which are contraindicated in Amantadine is an anti-viral agent that has anti-Parkinsonian effects. This is Maxolon® Pramin® (metoclopramide)
Symmetrel® (amantadine hydrochloride). Stemetil® (prochlorperazine)
Possible side effects are insomnia, Serenace® Haldol® (haloperidol)
confusion and a mottled rash on the lower limbs. If treatment for nausea is required, Motilium at the minimum effective dose is a safe alternative. (08) 9346 7373
(02) 9767 7881
(03) 9551 1122
(07) 3209 1588

Au st r alian Cap it al Ter r it o r y
(02) 6290 1984
(08) 8357 8909
(08) 9346 7373
(03) 6224 4028
July 2007
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Source: http://ramsgate.org.au/PTAS/pubs/InfoSheet_1.4.pdf


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