Problem 9: Managing the progressing PD Flashcards
Explore what motor fluctuations can occur in PD
Motor fluctuations usually happen when levodopa is wearing off, but they can happen at other times too.
This is called ‘end of dose wearing off’ or just ‘wearing off’. Sometimes the effects of wearing off happen
quickly – this is called ‘switching off’ or ‘on/off’
Dyskinesia (involuntary movements like twitches and jerks)
Options may be based around avoiding ‘peaks and troughs’ in doses of levodopa. Strategies include taking
smaller and more frequent doses of levodopa but keeping the overall amount the same.
Discuss how you would approach the subject of medication adherence with Mr Li to ensure he is actually taking his medicines
Keep a diary (to combat motor fluctuations (end of dose wearing off)?
Consider types of open/closed questions
For some people with Parkinson’s, protein (which is found mainly in meat, fish, eggs, cheese, beans and pulses) seems to interfere with how well levodopa is absorbed by the body. Because of this, you may benefit from taking your medication 30 - 60 minutes before you eat a meal.
However, levodopa can sometimes make people feel sick. Eating a low protein snack (such as crackers) when you take your dose may help to reduce this side effect.
Discus the role of MR formulations in PD therapy
Controlled or prolonged release drugs let the levodopa enter your body slowly instead of all at once. They are particularly helpful if they are taken before going to bed to reduce stiffness during the night.
Controlled release can also help to reduce one of the side effects of levodopa - involuntary movements.
Recommend with reason any other options which could be considered for Mr Li
Levodopa: improvement in motor symptoms, improvement in activities of daily living, more motor complications, fewer side effects.
Dopamine agonists: less improvement in motor symptoms and activities of daily living but fewer motor complications. More specified adverse events.
MAO-B (monoamine oxidase B) : less improvement in motor symptoms, less improvement in activities of daily living but fewer motor complications AND fewer adverse events.
6-12 monthly comprehensive review of all aspects of care. Parkinson’s UK, local support groups and PiL for medications.
Liaise with the person’s specialist or Parkinson’s disease nurse if changes to anti-parkinsonian medication are needed:
Only start or alter anti-parkinsonian medication on the advice of a specialist.
Ensure that changes to repeat medications are made accurately and promptly.
Titrate drug treatment between specialist review appointments according to recommendations made by the person’s specialist.
Do not suddenly stop any anti-parkinsonian medication as this can precipitate acute akinesia or neuroleptic malignant syndrome.
How should withdrawal of parkinsons medication be managed?
Antiparkinsonian medicines should not be withdrawn abruptly or allowed to fail suddenly due to poor absorption (for example, gastroenteritis, abdominal surgery) to avoid the potential for acute akinesia or neuroleptic malignant syndrome. [2006]
1.3.3 The practice of withdrawing people from their antiparkinsonian drugs (so called ‘drug holidays’) to reduce motor complications should not be undertaken because of the risk of neuroleptic malignant syndrome.
How can control of motor symptoms be improved?
Dopamine agonists, MAO-B inhibitors, COMT inhibitors, amantadine (no evidence of improvement for amantadine) others all improve motor symptoms. Activities of daily living also improved, more off time reductions (dopamine agonists can increase frequency or risk of hallucinations)
