The document presents a case study of a 77-year-old male patient diagnosed with Parkinson's disease based on symptoms of slow movements, resting tremors, postural instability, and mask-like face. Laboratory tests and investigations revealed abnormalities. The patient was diagnosed with Parkinson's disease and mood disturbance. He was prescribed various medications including Syndopa Plus, Rosalect, and Loraazep and counseled on lifestyle modifications and managing his condition and medications.

1. Presented by
KANMANI S
Vth pharm D
Department of pharmacy practice
C L Baid metha college of pharmacy
CASE PRESENTATION ON
PARKINSONISM

2. PATIENT DEMOGRAPHIC DETAILS
 Name : X
 Sex : Male
 AGE : 77 years
 IP NO : 1710
 WARD : 7B GW

3. SUBJECTIVE EVIDENCE
 COMPLAINTS OF THE PATIENT
 Cough with expectoration x 4 days
 Slowness in movements x 2 months
 Constipation
 Sleep disturbance present
 PAST MEDICAL HISTORY
 Systemic hypertension for past 6 yrs and on Rx
 PAST MEDICATION HISTORY
 T. telma 40mg 1-0-0

4. OBJECTIVE EVIDENCE
 Conscious, oriented, afebrile, mask like faces
 Abdomen : Soft
 General : Abnormal gait,resting tremors,postural
instability.

5. LAB INVESTIGATIONS
GENERAL
PARAMETERS OBSERVED
VALUE
NORMAL VALUE
Blood pressure 100/60mmHg 120/80mmHg
Pulse rate 82/min 60-100 /min
Respiratory rate 20/min 12-16 /min
Temperature 98.1*F 98.2*F

6. CLINICAL HEMATOLOGY
PARAMETERS OBSERVED VALUE NORMAL VALUE
HEMOGLOBIN 13.0g/dl 14-18g/dl
TOTAL COUNT 6.1x10*3/mm3 3.2-9.8x10*3/mm3
LYMPHOCYTES 15% 25-33%
SEGMENTED
NEUTROPHILS
78% 40-80%
ESR 15mm in Ist hr 0-20mm in Ist hr
RBC 4.62×10*6/mm3 4.3-5-9×10*6/mm3
PCV 38.0% 39-49%
MCV 82.3% 76-100µm3
MCHC 34.2g/dl 33-37g/dl

7. ELECTROLYTES & RENAL FUNCTION TEST
PARAMETERS OBSERVED VALUE NORMAL VALUE
SODIUM 126 135-147 mEq/L
POTASSIUM 4.40 3.5-5 mEq/L
SERUM
CREATININE
0.8 0.6-1.2 mg/dl
BLOOD UREA
NITROGEN
10 8-18 mg/dl

8. PARKINSONS DISEASE

9.  Slowness in movements positive
 Unsteady gait
 Resting tremors present
 Mask like face
 postural instability present

10. FINAL DIAGNOSIS
 From the subjective and objective evidence the
patient is found to have PARKINSONS DISEASE
WITH MOOD DISTURBANCE

11. PLAN
S
NO
BRAND NAME GENERIC
NAME
DOSE FREQU
ENCY
DAY
1
DAY
2
DAY3
1 T.SYNDOPA CR CARBIDOPA +
LEVODOPA
125MG 1-1-1
_ _
2 T.ROSALECT RASAGILINE 0.5MG 1-0-0
3 T.ZOLFRESH MELATONIN 5MG 0-0-1
4 T.DEPLATT CLOPIDOGREL 75MG 0-1-0
5 T.TELEACT TELMISARTAN 40MG 1-0-0
6 SYP
BROZEDEX
TERBUTALINE 1TSP 1-1-1
7 INJ.MAGNOVA CEFEPIME +
TAZOBACTUM
1.125G 1-0-1

12. S NO BRAND NAME GENERIC NAME DOSE FREQUE
NCY
DAY
1
DAY
2
DA
Y3
7 T.VIZYLAC LACTIC ACID 1 TAB 1-0-0 _
8 T.FOLVITE FOLIC ACID 5MG 1-0-1 _
9 ZYRTEC GEL CETRIZINE - SOS
(L/A)
_
10 T.ARIP ARIPIPRAZOLE 5MG ½ -0-0 _
11 T.LONAZEP CLONAZEPAM 5MG 0-0-1 _
12 SYP
BENADRYL
DIPHENHYDRAM
INE
2Tbsp 1-0-1 _
13 T.SYNDOPA
PLUS
CARBIDOPA +
LEVODOPA
125MG 1 ½ -1 ½
- 1 ½
_

13. DRUG INTERACTIONS
 SERIOUS
ARIPRIPRAZOLE+LEVODOPA
Aripiprazole decreases the effect of
levodopa by pharmacodynamic antagonism.
 SIGNIFICANT
RASAGILINE +LEVODOPA
synergism – risk of acute hypertensive
episodes.

14. INTERVENTION
 ARIPIPRAZOLE an atypical antipyschotic given
to treat mood disturbance can cause life
threatening interaction with LEVODOPA by
antagonistic effect
Suggestion _ most antipsychotics causes the
same major interaction. Therefore co
administration is mostly avoided until benefits
overweighs risk

15. DRUGS ON DISCHARGE
S.NO BRAND NAME DOSE ROA FREQ DURATION
1 T. SYNDOPA
PLUS
125 MG ORAL 1 ½ -1 ½ -1
½
2 WEEKS
2 T. ROSALECT 0.5 MG ORAL I-O-O 2 WEEKS
3 T. LORAZEP 0.5 MG ORAL 0-0-1 2 WEEKS
4 T. CEFPODEM
XP
325 MG ORAL 1-0-1 5 DAYS
5 SYP. BENADRYL 2 TSP ORAL 0-0-1 1 WEEK
6 T.FOLVITE 5 MG ORAL 1-0-1 2 WEEKS
7 T. TELEACT 40MG ORAL 1-0-1 2 WEEKS

16. PATIENT COUNSELLING
 REGARDING DISEASE:
 The presence of tremor at rest, rigidity, slowing of movements
and postural instability are considered the hallmark motor
features of Parkinsonism.
 REGARDING DRUGS:
 Dopa agonists are given to reduce Parkinsonism incidence.
Should follow the drug therapy strictly in the right dose, right
frequency and for the right duration as per the physician’s
instruction.
 Do not skip any medication or duplicate it.
 Be cautious about any side effects occurring due to the
medication and if happens so consult your physician immediately.
 patients taking antiparkinsonian drugs has depletion in sodium
levels,hence it should me balanced with diet

17.  LIFE STYLE MODIFICATIONS:
 Avoid coffee as it may increase the severity of
parkinsonism.
 Do regular physiotherapy to avoid stiffness and
immobility.
 Do speech therapy and audio therapy.
 Include fibrous food like wheat bran, oats, fruit juices
and leafy vegetables to avoid constipation.