Case study on Parkinsons disease

1. CLERKSHIPASSESSMENT -II
DEPARTMENT : NEUROLOGY

2.  DEMOGRAPHIC DETAILS :
 NAME : XYZ AGE : 70 DATE :12/06/17
 SEX : M DEPT : NEUROLOGY
 CHIEF COMPLAINTS :
 Patient came to OP clinic of neurology with
 c/o Tingling over Lt lower limbs ,decreased appetite
 involuntary movemnts of upper limbs ,altered behaviour
 lips twitching, visual hallucinations ,insomnia,rt shoulder pain ; since 3days
 PAST MEDICAL HISTORY : since 2 years
 k/c/o lacunar stroke (on ECOSPIRIN AV 150/20)
 HTN ( on TELMISARTAN 20mg)
 Parkinsons disease (on TRIHEXPHENIDYL 2mg, -BD
 snyndopa plus - QID)
 *not on Rx since 1 week

3.  GENERAL EXMANINATION :
 o/e pt c/c
 temp : afebrile
 SYSTEMIC EXAMINATION :
 BP : 110/80 mmhg PR : 75 /min
 RESP : BAE+ CVS : S1+S2+
 DIAGNOSIS : PARKINSON'S DISEASE

4.  TREATMENT
 Tab.TRIHEXPHENIDYL 2mg OD PO anticholinergic
 Tab.SYNDOPA PLUS 100/25mg BD PO dopamine precrsr
 Tab.RASAGILINE 0.5mg OD PO MAO I
 Tab.ECOSPIRIN AV 150/20 OD PO antiplatelet
 Tab.RABEPRAZOLE 20mg OD PO PPI
 Tab.METAXALONE+ 400/50 OD(SOS) PO analgesic
 DICLOFENAC
 Tab.QUETIAPINE SR 50mg OD PO antipsychotic
 SYP.PRACTIN 2TSP BD PO apetite enhnser

5.  ON 20/06/17
 pt c/c
 no fresh complaints
 BP: 130/80 mmhg PR : 80/min
 RESP : BAE+ CVS : S1+S2+
 ADVICE : STOP Tab.TRIHEXYPHENIDYL,
Tab.METAXALONE+DICLO
 CONTINUE SAME TREATMENT

6.  PARKINSON'S DISEASE :
 Its a progressive neurodegenerative disorder mostly affecting older people
 Most cases are Idiopathic ,some are arteriosclerotic
 Degeneration of neurons in substansia nigra pars compacta and nigrostriatal
tract leads to deficiency of Dopamine in striatum which controls muscle tone
and coordianates movements
 Inbalance between Dopamine and Acetylcholine in striatum occurs giving rise
to motor defects
 Causes : Age,idiopathic
 environmental factors
 free radicals
 genetic (mutation in alpha synuclein)
 Clinical manifestations : Bradykinesia,resting tremors
 rigidity, postural instability,
 hypophonic,micrographia

7.  GOALS OF THERAPY :
• To control the parkinsons manisfestations
• To avoid disease progressing to psychosis
• Treat the other presentng symptoms

8. STANDARD TREATMENT :
 Consider MAO-B inhibitors in newly diagnosed patients
 If needed any additional symptomatic treatment
• for tremor dominent add : anticholinergic/amantadine(age<65yrs)
amantadine (age >65yrs)
• for bradykinesia /rigidity add: Dopamine agonist/carbidopa+levadopa
 patients who are older ,cognitively impaired : prefer L-Dopa
 surgical treatment (if more symptomatic treatment is needed/ in uncontrolled
parkinsons disease )
 (Deep brain stimulation )

9.  Drug interaction :
 Atorvastatin and Levodopa(acting additively) leads to peripheral neuropathy
( more prone are those with DM and age over 60)
 PHARMACIST INTERVENTION
 Neuropathy (tingling over LT LL) is reported. But no measures were taken to
treat it.
 As the patient age is 70 it is not advisable to treat him with anti cholinergic
agent.Because he may not tolerate anticholinergic side effects( mostly
dementia)

10.  NON PHARMACOLOGICAL :
 Exercise and physical therapy
 speech therapy
 occupational therapy

11.  PATIENT COUNSELLING :
 Patients with Parkinson disease must have regular follow-up care to ensure
adequate treatment of motor and behavioral abnormalities,atleast every 3-6
months, and to periodically adjust medication dosages as necessary.
 Immediately report to physician if u find any adverse events on treatment
 Take levadopa before food.And diet should be with low protien.
 Take fibre rich food,to avoid constipation
 Dont take thyramine rich food (cheese,smoked meat) with rasagiline.This may
lead to increased blood pressure
 Don’t drink alcohol while on metaxalone.Becuase it increases nervous
system side effects of metaxalone drowsiness

12. PRESENTED BY
K.ARUN
PHARM.D V YEAR
13371D1009
VAAGDEVI INSTITUTE OF PHARMACEUTICAL SCIENCES