PARKINSON’S DISEASE

A DEGENERATIVE DISORDER OF THE CENTRAL NERVOUS SYSTEM

ASUNCION | BALISI | CAUAN | TAN

PARKINSON’S DISEASE

 Parkinson disease is a slowly progressive

degenerative neurologic disease
characterized by tremor, rigidity, bradykinesia
(sluggish neuromuscular responsiveness), and
postural instability.

Comprehensive Pharmacy Review for NAPLEX 8th Edition

PARKINSON’S DISEASE
 Ithas a prevalence of 1 to 2 per 1000 of
the general population and 2 per 100
among people >65 years
ANATOMY, PHYSIOLOGY, AND
PATHOPHYSIOLOGY
ANATOMY AND PHYSIOLOGY
PATHOPHYSIOLOGY
PATHOPHYSIOLOGY
CLASSIFICATION:
 Naturally occurring parkinsonism
 Uncertain origin and occurs with
increasing frequency during aging from the
fifth or sixth decade of life onward
 Drug-induced parkinsonism
 From a known cause
EPIDEMIOLOGY
 Parkinson’s disease is the second most common age-
related neurodegenerative disorder after Alzheimer’s
disease.
 An estimated 7 to 10 million people worldwide have
Parkinson’s disease.
 The prevalence of the disease ranges from 41 people
per 100,000 in the fourth decade of life to more than
1,900 people per 100,000 among those who are 80
and older.
Parkinson’s News Today
EPIDEMIOLOGY
 An estimated 4 percent of people with
PD are diagnosed before age 50
 Men are 1.5 times more likely to have PD
than women

Parkinson’s News Today

EPIDEMIOLOGY
 Inthe Philippines, there are about
120,000 PD cases. These are only the
diagnosed patients and there are a lot
more that are undiagnosed.

Rappler.com
RISK FACTORS
 Age – occurs between age 50 and 65 years old
 Exposure to chemicals i.e. pesticides
 Head trauma
 Gender – more common in men than women
 Ethnicity – more common in whites than in blacks or
Asians
 Family history and genetics
CLINICAL MANIFESTATION
MOTOR AND RELATED SYMPTOMS
 Tremor
 Limb rigidity
 Akinesia/Bradykinesia
 Gait/postural difficulties
 Vocal symptoms
CLINICAL MANIFESTATION
NON-MOTOR SYMPTOMS
 Disturbances in the sense
of smell
 Sleep problems
 Depression and anxiety
 Fatigue
 Mental processes
 Weight loss
 Lightheadedness
 Urinary issues
 Sexual concerns
 Sweating
 Melanoma
TREATMENT AND MANAGEMENT
PHARMACOLOGIC
NON-PHARMACOLOGIC
 Exercise
 Nutrition
CASE PROPER
Demographics

Name: AJ
Gender: Female
Age: 43
Race: White
Status: Married
Chief Complaint
• I went to a blood pressure
screening at the health center a
couple of weeks ago and the
nurse said my blood pressure is
still high
History of Present Illness
• The patient went to internal medicine clinic for
evaluation and follow up of her medical problems. She
attended a blood pressure screening three weeks ago,
and her blood pressure at that time was 162/97 with a
pulse of 74. She reports that her previous physician
diagnosed her with high blood pressure several years
ago, but she did not return for follow up. At that time,
she was instructed to exercise regularly and improve her
eating habits, which she has tried to do. Since she had to
stop running due to knee pain, she has recently started
low impact aerobics twice weekly to try to lose weight.
 Other Patient Information
Family Medical History Past Medical History Social History

Father Died of heart disease Seasonal Allergic Rhinitis

Married for 19 years; 2 sons
at age 73, first MI was
at age 41 Hypertension
Quit smoking 15 years ago
Mother Mother died at age 69
and had HTN Surgery on left knee (10 years ago) Occasionally drinks alcohol (1-2
Brother Age 48 has HTN and drinks per week)
high cholesterol Caesarean section (4 years ago)
She has been trying to “eat healthy”
Younger Age 35 has no known
Sister medical problems Allergy

Penicillin

Instant noodles
 Review of Systems

Well
Monotone
No postural developed, speech with low
instabilty well nourished volume; masked
male in no facies
apparent
distress

Mild Rest Slow, shuffling Educed arm

tremor gait swing
Laboratory Results
Vital Signs

Vital Signs Reading Interpretation

164/108mmHg (LA, Seated)
Blood Pressure 159/102mmHg (RA, Seated)

Heart Rate 60-100 bpm 66 bpm Normal

Respiratory Rate 12-18cpm 16 Normal
Temperature 36.5-37.5°C 37.1°C Normal
Laboratory Results
Lipid Panel

Hematology Reading Interpretation

TC <200 mg/dL 198 mg/dL Normal

HDL ≥46 mg/dL 39 mg/dL Below Normal

LDL ≤130 mg/dL 134 mg/dL Above Normal

TG ≤150 mg/dL 122 mg/dL Normal

Laboratory Results
Hepatic Tests
Liver Function Tests Reading Interpretation
Elevated maybe
due to acute
AST 10-30 U/L 35
congestion caused
by HF
ALT 6-40 U/L 28 Normal
T Bilirubin 0.2-1.2 mg/dL 0.3 Normal

T Protein 6.2-8.3 g/dL 6.7g/dL Normal

Laboratory Results
Blood Chemistry
Blood Chemistry Reading Interpretation
Sodium 135-155 mEq/L 142 Normal
Potassium 3.6-5.5 mEqL 4.4 Normal
Chloride 98-106 mEq/L 101 Normal
Calcium 8.6-10.2 mg/dL 9.7 Normal
Magnesium 1.6-2.6 mg/dL 2.3 Normal
BUN 8-25 mg/dL (Male) 16 Normal
SCr 0.6-1.2 mg/dL (Male) 0.9 Normal
CO2 23-29 mEq/L 27 Normal
Glucose 70-100 mg/dL 92 Normal
 Present Working Impression

PD (Symptoms
HTN(Uncontrolled, . relief doesn’t .
regimen) seem to last until
the next dose)

.
Medications and Indications

Fluticasone nasal spray, For treatment of Seasonal Allergic

1 spray in each Rhinitis

Ibuprofen 200 mg 2-3 For treatment of Knee pain

tablets PO

Pseudoephedrine 30 mg
1-2 tablets PO TID For treatment of PD motor symptoms
Drug Therapy Problem 1
Unnecessary drug therapy
Allopurinol is indicated for
gout. No valid medication
indication for the drug at this
time
Intervention
• We would like to suggest to
discontinue Allopurinol 300
mg tab PO OD for the
treatment of gout which has
no valid indication at this time.
Drug Therapy Problem 1

Adverse Drug Reaction between Multivitamins and Vitamin B

complex to Carbidopa/Levodopa

Vitamin pyrodoxine (B6) Intervention

increases the peripheral We respectfully suggest to
breakdown of levodopa and discontinue Vitamin B complex 2
tabs PO BID and Multivitamins 1
diminishes its effectiveness. In
tablet PO QD.
addition, iron reduces serum
concentration of Levodopa as
per Lexicomp.
Drug Therapy Problem 1

Adverse Drug Reaction, Amantadine causes undesirable

reaction

Amantadine causes edema Intervention

and livedo reticularis and We respectfully suggest to discontinue
Vitamin B complex 2 tabs PO BID and
tolerance occur for long term Multivitamins 1 tablet PO QD.
use as per CPR 8th Ed.
 Pharmacist Care Plan
Health
Pharmacothera Recommendations / Monitoring Desired
Care Frequency
peutic Goal Interventions Parameters Endpoint
Need
Objective Therapeutic (-) signs of
To provide We respectfully suggest to shiftSigns of Parkinsons parkinsons Daily
symptomatic relief from Carbidopa/levodopa Disease disease
of P.D symptoms 25/100mg tab PO TID to
such as Tremor, carbidopa/levodopa/entacapo Subjective Therapeutic (-) Drowsiness
Masked facies, ne 12.5mg/50mg/200mg tab PO Drowsiness, Dizziness (-) Dizziness Daily
Seasonal allergic rhinitis

rigidity and TID.

bradykinesia. Subjective Toxic: No occurrence of Daily
Management of

We respectfully recommend to Orthostatic hypotension S.E

inform patient to swallow tablet
whole; do not crush, break or
chew. Only 1 tablet should be
administered at each dosing
interval as per Lexicomp.
Health
Pharmacothera Recommendations / Desired Frequen
Care Monitoring Parameters
peutic Goal Interventions Endpoint cy
Need
Objective Therapeutic (-) signs of
Manag To provide We respectfully Signs of Parkinsons parkinsons Daily
ement symptomatic recommend compliance Disease disease
of P.D relief of P.D with Rasagiline 1mg
symptoms such tablet PO QD for the Subjective Therapeutic (-) Drowsiness
as Tremor, management of symptoms Drowsiness, Dizziness (-) Dizziness Daily
Masked facies, of parkinson’s disease
rigidity and Subjective Toxic: No occurrence Daily
bradykinesia. Orthostatic hypotension of S.E
Health
Pharmacothera Recommendations / Desired Frequen
Care Monitoring Parameters
peutic Goal Interventions Endpoint cy
Need

Objective Therapeutic
Manag To manage high We respectfully suggest BP <130/80 mmHg
ement blood pressure patient to comply to HR 60-100BPM Daily
of HTN and prevent Atenolol 50 mg tab PO BUN 8-25 mg/dL
further QD, Hydrochlorothiazide
complications 25 mg tab PO QD for the Subjective Therapeutic
managament of high blood Tachycardia (-) Tachycardia Daily
pressure
Subjective Toxic:
Watch out for SE of : No occurrence Daily
Atenolol: Hypotension of S.E.
Hydrochlorothiazide:
Hypotension
Health
Pharmacothera Recommendations / Desired Frequen
Care Monitoring Parameters
peutic Goal Interventions Endpoint cy
Need

Objective Therapeutic
Unnec To remove We respectfully suggest to Serum Uric acid 3.4 – 7 mg/dL Every 2-5
essary unnecessary discontinue Allopurinol weeks
Drug drug 300mg tab PO OD Subjective Therapeutic
therap Gouty attacks (-) Gouty attacks
y Rationale:
Allopurinol is indicated for Subjective Toxic: Daily
gout. No valid medication Watch out for SE of : No occurrence
indication for the drug at Skin Rash of S.E.
this time Gout Daily
Health
Pharmacothera Recommendations / Desired Frequen
Care Monitoring Parameters
peutic Goal Interventions Endpoint cy
Need

Objective Therapeutic
Advers To manage We respectfully suggest to N/A N/A
e Drug interaction discontinue Vitamin B
Reacti between complex 2 tabs PO BID Subjective Therapeutic
on levodopa and and Multivitamins 1 Stomach upset (-) Stomach Daily
Iron, Vitamin B6 tablet PO QD upset
in Multivitamins Subjective Toxic:
and Vitamin Rationale: Watch out for SE of : Daily
Complex Vitamin pyrodoxine (B6) Skin hypersensitivity No occurrence
increases the peripheral of S.E.
breakdown of levodopa
and diminishes its
effectiveness as per
Lippincott 7th Edition. In
addition iron reduces
serum concentration of
Levodopa as per
Lexicomp.
Health
Pharmacothera Recommendations / Desired Frequen
Care Monitoring Parameters
peutic Goal Interventions Endpoint cy
Need

Objective Therapeutic (-) Signs of

Advers To manage We respectfully suggest to Signs of Parkinsons Parkinsons Daily
e Drug adverse drug discontinue Amantadine Disease Disease
Reacti reaction of 100 mg tab PO TID for the
on amantadine managemnt of symptoms Subjective Therapeutic (-) Nausea and Daily
such as of parkinon’s disease Nausea and Vomiting Vomiting
pheripheral
edema and Rationale: Subjective Toxic: No Occurrence Daily
livedo Amantadine causes Watch out for SE of : of S.E.
reticularis. edema and livedo Orthostatic hypotension
reticularis and tolerance Livedo reticularis
occur for long term use as
per CPR 8th Ed.
Lifestyle Modifications
 Maintain adequate intake of dietary potassium
(approximately 90mmol/day)
 Maintain adequate intake of dietary calcium and
magnesium for general health
 Reduce intake of dietary saturated fat and
cholesterol for overall cardiovascular health
 Engage in aerobic exercise at least 30 minutes daily for
most days (range of approximate SBP reduction, 4-9 mm
Hg)
-THE END-