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when carbidopa and levodopa are taken in combination, the total daily dose should be at least 70mg. a lower dose may not achieve full inhibition of extracerebral dopa-decarboxylase, with a resultant increase in side effects. therefore, the carbidopa/levodopa 25/250mg should be taken 1 tablet TID instead of BD.

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increased tremor, more rigidity, more slowness of movements with some freezing spell

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Minimise insomnia effect. Insomnia is a side effect of selegiline, thus have to be taken in the day.

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C. Cisapride - promotes gastric emptying and cardiac rate by releasing ACh

A. Selegiline- MAO Type B inhibitor

B. Diphenhydramine- antihistamine and mild anticholinergic effect

D. Pergolide - dopamine receptor agonist

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Common side effects

A. Urinary retention, dry mouth

C. Nausea, abdominal movement

*according to medscape and bnf

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http://www.nice.org.uk/guidance/cg35/evidence/cg35-parkinsons-disease-full-guideline2
page 139-146

-physiotherapy

-occupational therapy

-speech therapy

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freezing spells: sudden episodic inhibition of lower extremities motor function

dyskinetic writhing movement: involuntary jerking movement

total abdominal hysterectomy: removal of uterus and cervix through abdominal incision

HEENT: head, eyes, ear, nose, throat

PERRL: Pupil equal, round, reactive to light

JVD: jagular venous distention

bruits: unusual sound which blood makes when rushes through an obstruction

GU: genital urinary

A&O to T, P, P : alert and oriented to person, place, time

UE: upper extremities

pill-rolling tremor: back and forth rubbing of thumb and fore finger

bradykinesia: decrease of movement

mini MSE: mini mental state examination

A/E: air entry

NAD: nothing abnormal detected

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Physiotherapy

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Physiotherapy

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Question 2

Cl level low (97-110)

HCO3 level high (22-26)

Hct level low (36.1-44.3)

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Physiotherapy

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asdasd

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Iatrogenic

Sustained levodopa treatment causes the fluctuations in response to medication(on/off syndrome). Levodopa results in decreased production of endogenous levodopa which is eventually

counterproductive. In the long term levodopa causes the dyskinesias and hallucinations as experienced by DB

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Wearing off is the term used when the effects of levodopa 'wear off' or diminish before it is time for the next dose. Common symptoms are hypokinesia and tremor.

Methods to overcome:

Changing your dose, dose frequency or timing of medication

Changing your medication to include drug(s) that prevent breakdown of levodopa within your body (these can extend the duration of benefit of levodopa, and may be combined with levodopa in a single tablet or taken separately).

Changing the formulation of your levodopa to provide controlled release

Adding another class of drug, such as a dopamine agonist, to your medication.

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Levodopa is a precursor of dopamine. It crosses the BBB and gets converted to dopamine in the basal ganglia while carbidopa is a dopa-decarboxylase inhibitor. The latter prevents conversion of levodopa to dopamine outside the brain and minimizes the side effects