CASE PRESENTATION ON

PARKINSONISM
PRESENTED BY
152820330
 PATIENT DEMOGRAPHICS
SUBJECTIVE EVIDENCE
• NAME : Mr X
• AGE : 75
• SEX : M
• IP NO : 256344
• DEPT : Neurology
• DOA : 13-01-19
• DOD : 18-01-19
 REASON FOR ADMISSION
• C/O weakness of left side of body
• Numbness positive
• Fever 4 days
• Difficulty in standing and walking
• Loss of balance
• Day time sleepiness

PATIENT MEDICAL HISTORY

•K/C/O Parkinsonism Disease but
medication stops 1 year ago
 OBJECTIVE EVIDENCE
DATE 13 14 15 16 17 18
TEMP (°F) 100 99.6 99 98.8 98.6 98.6
BP (mmHg) 120/80 120/80 110/80 120/80 120/80 120/80
PULSE(bpm) 72 70 79 70 74 72
RR (per min) 20 22 20 20 22 20
BLOOD COUNTS
• Hb :14.6 g/ dl
• TLC:6930 cells/ cumm
• PLATELET:3.20 lakhs cells / cumm
• RBC : 4.72 million cells /cumm
OTHERS
• Patient is having tremors of both the hands
• No neurological deficit.
• Blood sugar
• Renal profile
• Liver profile
• Lipid profile
• Thyroid profile
are all found to be normal
 ASSESSMENT
The subjective evidence shows that patient has a
history of parkinson disease. Difficulty in
standing and walking, Loss of balance, Day
time sleepiness

The objective evidence shows that patient has

tremor of both hands.
From the subjective and objective evidence
patient was diagnosed with parkinsonism .
 DEFINITION
Parkinsonism is a slowly progressive
degenerative neurological disease
characterised by rigidity, tremor, postural
instability and bradykinesia.
 EPIDEMIOLOGY
• It is a second most common type of
neurodegenerative disease affects
approximately 1% individuals over the age of
65.
• Incidence and prevalence increases with age.
 ETIOLOGY
• Genetics
• Oxidative stress
• Fungicide exposure
• Manganese exposure
• Environmental factors
 CLINICAL FEATURES
• Tremor
• Limb rigidity
• Akinesia
• Bradykinesia
• Change in mental status
• Gait and postural difficulty
 DIAGNOSIS
• Clinical finding
• PET
• SPECT
• Transcranial ultrasound
 MANAGEMENT
NON PHARMACOLOGICAL THERAPY
• Surgical therapy
• Grafting and transplantation of human foetal
mesencephalon tissue into the striatum.
 PHARMACOLOGICAL THERAPY
• CENTRAL ANTICHOLINERGICS
• AMANTADINE
• CARBIDOPA/LEVODOPA
• MAO-B INHIBITORS
• COMPT INHIBITORS
• DOPAMINE AGONIST
 PLAN
Sl Brand Name Generic Name Dose 13 14 15 16 17 18
No.
1 T. AMANTREL AMANTADINE 100mg y y y y y Y
1-0-1
2 Inj. PAN PANTOPRAZOLE 40mg iv OD y y

3 T. PRAMIPEX PRAMIPEXOLE 0.5mg y y y y y Y

1-0-1
4 T. PREVA CLOPIDOGREL 75mg OD Y Y Y Y Y Y

5 Inj. RENERVE PLUS MECOBALAMINE 1amp in y y y Y

100 ml NS

6 T.RASALECT RASAGILINE 0.5mg y y y y y y

1-0-0
7 T.SYNDOPA PLUS LEVODOPA+ 25+100mg y y y y y Y
CARBIDOPA 1-1-1
Sl Brand Name Generic Name Dose 13 14 15 16 17 18
No.

8 T.ZOLSOMA ZOLPIDEM 10mg HS Y Y Y Y Y Y

9 T.DOLO PARACETAMOL 650 mg Y Y Y Y

1-1-1

10 T.PAN PANTOPRAZOLE 40mgOD Y Y Y Y

11 T.QUITAN QUETIAPINE 25mg y y y y y

0-0-1
 PROGRESS CHART
• DAY1 : Patient came with case of weakness of
left side of body, Difficulty in standing and
walking, Loss of balance, Day time sleepiness
also Fever for 4 days. Medications are given.
• DAY2 : Patient feels better. Temperature is
slightly decresed.
• DAY3 : Patient is conscious and oriented.
Medications are continued.
• DAY4 : Symptoms are relieved. Inj. RENERVE
PLUS stopped.
• DAY5 : Temperature become normal. So
paracetamol stopped. All other medications
are continued.
• DAY6 : Patient feels better and discharged.
 DISCHARGE MEDICATION
• T.AMANTREL 100mg 1-0-1
• T.PAN 40mg OD⌡
• T.PRAMIPEX 0.5mg 1-0-1
• T.PREVA 75mg OD
• T.QUITAN 25mg 0-0-1
• T.SYNDOPA PLUS 25+100mg 1-0-1
for two weeks
 MONITORING PARAMRTERS
• LEVODOPA+CARBIDOPA
Blood glucose level should be monitored
regularly.
Renal function test should be conducted
• PRAMIPEXOLE
Closely monitored for elevated temperature,
muscular rigidity and altered consciousness.
• QUETIAPINE
Recommend examining lens before therapy begin
and after therapy.
 PHARMACIST NOTE
1. LEVODOPA+PRAMIPEXOL
Pramipexole may potentiate the dopaminergic side
effects of levodopa, resulting in development or
exacerbation of dyskinesia.
MANAGEMENT:
A reduction of Levodopa dosage should be
considered during coadministation with Pramipexole.
2. LEVODOPA+ QUETIAPINE
Agent with central antidopaminergic activity may
antagonize the pharmacological effects of dopamine
agonist
MANAGEMENT:
Concomitant use of dopamine agonist with
antidopaminergic agents should generally be
avoided.
3. RASAGILINE+LEVODOPA
MECHANISM:
Pharmacodynamic synergism. Potential for
dangerous interaction.
MANAGEMENT:
Use with caution and monitor closely. Risk of acute
hypertensive episodes
 PATIENT COUNSELLING
DISEASE RELATED COUNSELLING
• Physiotherapy helps the patient to deal with
anxiety
• Speech therapy for speech problem
• Eating fruits and vegetables can keep the
patient energised and hydrated.
• Drinking the right amount of water in
proportion to how much Na you are loosing.
 DRUG RELATED COUNSELLING
• T.SYNDOPA PLUS
Carbidopa/ levodopa is best absorbed in an empty
stomach but it commonly taken with food to minimize
nausea
Swallow it as a whole, do not chew, crush or break.
• PRAMIPEXOLE
Instruct the patient not to rise rapidly after sitting or
lying down because of risk of orthostatic hypertension.
Tell the patient not to stop drug abruptly.
• AMANTADINE
Warn the patient that drug may impair mental
alertness.
Take with meal to avoid nausea.
THANK YOU