Monday, February 16, 2015

Study group discussion: Management of Parkinson's disease

50 year old male, has no expressions, walks to your office, slowly. He complains of tremor while watching television. He says he can do tasks without the trembling his hands. His fingers keep moving as if he is rolling a pill as he is talking to you. Which drug will you prescribe to relieve his tremor?

It is Parkinson's disease. Anticholinergics will be prescribed.

Why not L-dopa? With carbidopa?

We prefer anti cholinergics for the tremors since patients respond better. Levodopa & carbidopa are not given to treat the tremor per se. Dopamine agonists are only prescribed in 3rd and 4th stages.

You prescribe benztropine to our previous patient and he develops dry mouth, constipation. He requests another medication. What do you do next? (You're trying to treat tremor, nothing else.)

Amantadine.

You prescribe Amantidine in old patients with tremors who develop or have a possibility of anti cholinergic side effects (Example, BPH). If the tremor and rigidity is very severe, deep brain simulation may help the patient.

Why not move over to dopamine agonists?
Patient has mild disease and he can take care of himself (No orthostatic hypotension, no severe impairment) So you don't wanna give him dopamine agonists yet!

What is the name of the tremor described?

Resting tremor aka pill rolling tremor!

What are the types of rigidity seen in Parkinson's?

Lead pipe rigidity
Cog wheel rigidity

The name of attitude of the trunk assumed?
The person bends down.. As if his centre of gravity has been shifted. The stance is Simian attitude.

What is festinant gait?

Festinant gait is the baby steps, hands by the side and stooped posture. The patient chases his centre of gravity while walking.

2 comments:

  1. Can you please tell what drug should be given in a psychiatric female on antidepressants to suppress lactation???
    Bromocriptine and cabergoline interact with antidepressants right...so what drugs are safe in this female??
    Please reply..thank you :)

    ReplyDelete
    Replies
    1. You reduce dose or change the medication.

      Delete

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