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Muhammad Aftkhar
Parkinsonism- Pharmaceutical Treatment Plan.docx
Summary
1140 Words
1 Running Header: PARKINSON'S DISEASE
2 PARKINSON'S DISEASE
Parkinson’s disease
Parkinson's disease is a neuro de-generative disease that occurs and depletes the neurons
present in substansia nigra. These neurons are involved in the transmission of nerve impulses
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PARKINSON'S DISEASE
MUHAMMAD AFTKHAR
NUR 635 (GCU)
Mar 4th, 2020
from corpus collosum to the susbtansia nigra part of the mid brain. These are the character
playing neurons in managing voluntary motor movements in the body. It mostly occurs in elderly
patients describe by involuntary movements and multi-dimensional brain functioning. The part
of this disease may occur due to the effective and excessive use of medications indulging in bi
polar or Alzheimer's disease (Davie, 2008). The decline of dopamine in par compacta
deteriorates the normal functioning of the brain in controlling motor activities.
Prescription medication
The prescribed medications used for Parkinson’s disease includes the use of Levodopa
directly with replenishes the pool for dopamine neurotransmitter. This drug can’t be given in a
single dose rather without carbidopa (LODOSYN) the levodopa will break down into dopamine
and then to epinephrine in the body’s periphery. This will create severe symptomatic side effects
like an increase in heart rate and sympathetic system dominancy. Dopa-decarboxylase enzyme
breaks down the levodopa in the periphery so along with levodopa carbidopa is given. This
inhibits the dopa-decarboxylase enzyme and allows levodopa to travel into the blood brain
barrier easily.
For the calculations of drug regimen there must be precautionary measures for kidney
and liver sensitive enzyme dependent patients. LFT and RFT’s for sensitive patients are done to
ensure the correct for dose adjustments not lying in range affecting kidneys and liver function.
Below are some of the medications for Parkinson’s disease.
3 PARKINSON'S DISEASE
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a. Agonist of dopamine: - Use of ergot containing drugs like bromocriptine, ropinirole
(Requip) and pramipexole (Mirapex). Requip works by increasing dopamine levels in the
brain. They are used for the patch medication there are some drugs given in patch
because elder patients sometimes can’t swallow capsules or tablets may be due to fear so
Neupro is given as a patch that contains rotigotine in it as active ingredient. Yet another
way to administer medication through injectable which involves Apokyn has
apomorphine as an active participate of treatment (Xu et.al, 2019).
b. MOA inhibitors: - These are the enzymes that break down the dopamine in the
periphery of neuron in synaptic cleft. For observing the action they are blocked by these
MOA inhibitors (mono amine oxidase inhibitors) including Zelapar, Eldepryl residing
selegiline in it.
c. COMT inhibitors: - These are the reuptake channels and enzymatic control of dopamine
from the synaptic cleft. If they are blocked then there will no uptake of dopamine in the
neuron and there will be much more dopamine to perform its function and meet the other
synaptic surface of a leading neuron. Comtan containing entacapone is used to replenish
dopamine concentration in synaptic cleft and Tasmar as Tolcapone.
d. Anti-cholinergic: - The use of these mnedications is to control the frequency of tremors
and muscles movement which results in the deprivation of energy and loss of nutrients
from cells resulting in weakening of muscle. Cogentin containing benztropine is the
4 PARKINSON'S DISEASE
5 PARKINSON'S DISEASE
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assist, assistance (help): assistance help
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chiefly used drug in regimens prescribed by doctors ( Richardson et.al, 2018) .
e. Non- prescribed drug treatment: - Many ways are there for those patients who wanted
to mend their way in treating of Parkinson disease. Most effective practices are exercise,
proper muscle movements and massage therapy, speech and locomotors junction therapy.
Some of the occupational therapy sessions with therapist recommendations are beneficial
for Parkinsonism. Use of motivated speeches and psychological sessions will bring
patients from holding the strong grip over their disease and will think less about it.
Singing could also do a great job in managing the Parkinson disease symptoms. It will
help the patient to improve on his or her voice which will result to improved social
interactions. Aqua therapy can also help the patient in terms of removing the worry or
fear of falling as he or she will be swimming and moving in water freely. Acupuncture
will reduce the pain and muscle stiffness in the patient’s body ( Giugni & Okun, 2014).
Adverse effects and drug –drug interaction
Most probably the use of drugs for one ailment may cause damage to other parts of the
body if it left unaware or unattended. Especially in the case of depression therapy and
medication, some of the drugs are related to the origin of Parkinson disease. Alzheimer's is a
psychotic disorder that may lead to Parkinsonism symptoms during its treatment. Dementia and
sleeplessness are the most effective adverse effects of drugs used in Parkinson's disease.
Hallucinations and delusions are also common as these drugs are used as adjunct therapy for
depression ( Katzenschlager et.al, 2018) .
Warfarin has a severe drug-drug interaction with ropinirole and this causes an
anticoagulant effect in the blood which forms less solubility of drug and interaction mode of the
drug in serum plasma is decreased. Medications use for liver functioning and kidney assistance
like thiazide diuretics and loop diuretic used in hypertensive patients will get affected by
ropinirole. Gastric drugs for ulcerations and bleeding in the small intestine may be enhanced by
the use of levodopa. It will bind to complexes formed by aluminum hydroxide in gastric track
thus inhibits the efficacy of the drug and formulate ulceration.
Pediatrics and geriatrics
Use of a controlled amount of drug regimens in the clinical setup there must be an
important note for breast feeding mothers to restrict the required dose for Parkinson's disease.
Related to pediatrics calculated initiated amount of dosage regimen is selected. As ropinirole has
severe dementia effect in children. In children, sudden mood swings and motor impartment
6 PARKINSON'S DISEASE
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during exercise and running is seen. But improved therapy sessions have presented the group of
medications in one role (Katzenschlager et.al, 2018). Rather put elder patients in that category
that deals with the slow and shaking movement of facial muscles and hands, pill rolling
movement and improved muscle rigidity is seen. Geriatrics has an affective therapeutic goal in
improving dopamine level in the body.
References
Davie, C. A. (2008). A review of Parkinson's disease. British medical bulletin, 86(1), 109-127.
Retrieved from:
https://www.researchgate.net/profile/Charles_Davie/publication/5454757_A_review_of_Parkins
on's_disease/links/5866522a08ae8fce490ee2e6/A-review-of-Parkinsons-disease.pdf
Katzenschlager, R., Poewe, W., Rascol, O., Trenkwalder, C., Deuschl, G., Chaudhuri, K. R., ...
& Staines, H. (2018). Apomorphine subcutaneous infusion in patients with Parkinson's disease
with persistent motor fluctuations (TOLEDO): a multicentre, double-blind, randomised, placebo-
controlled trial. The Lancet Neurology, 17(9), 749-759. Retrieved from
https://www.sciencedirect.com/science/article/abs/pii/S1474442218302394
Richardson, K., Fox, C., Maidment, I., Steel, N., Loke, Y. K., Arthur, A., ... & Campbell, N. L.
(2018). Anticholinergic drugs and risk of dementia: case-control study. bmj, 361, k1315.
Xu, W., Reith, M. E., Liu-Chen, L. Y., & Kortagere, S. (2019). Biased signaling agonist of
dopamine D3 receptor induces receptor internalization independent of β-arrestin recruitment.
Pharmacological research, 143, 48-57. Retrieved from
https://www.sciencedirect.com/science/article/abs/pii/S1043661818321078
Giugni, J. C., & Okun, M. S. (2014). Treatment of advanced Parkinson’s disease. Current
opinion in neurology, 27(4), 450. Retrieved from:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4140171/
