Question

Mr. Carl, age 62 years old, has been diagnosed with Parkinson's disease (PD). He lives in downtown Toronto with his wife of 25 years. His initial symptoms were depression, monotonous, indistinct speech, stooped posture, loss of energy, and hand tremors. His While discussing his medication histor 300mg/ day PO (levodopa-carbidopa combination). multivitamin that contains vitamin B rory with him, you find out that he takes a B-complex take some of her phenothiazine (an antipsychotic) since she this wife it mandra "lift him out of his depressed mood." A year has passed, and his symptoms have worsened when you see Mr. Carl again. He feels muscle rigidity, fixed facial expressions, slowed movement, arm numbness, and cognitive difficulty. His physician has changed his Sinemet ∘ to Stalevo ∘100 (levodopa-carbidopaagonist, and an antidion); he has also added pramipexole (Mirapex ER), a dopamine

Pharmacology Questions
1. What are some non-pharmacological and diet changes that Mr. Carl needs to consider altering due to his diagnosis of Parkinson's disease?
2. Mr. Carl has some difficulty in understanding how levodopa works. Provide a written dialogue of what you would say to Mr. Carl regarding the mechanism of action, why is carbidopa added to the combination, some of the adverse effects, and how can they be managed?
3. Mr. Carl asks if he can continue taking his multivitamin while taking Sinemet. ∘. What can you tell him about taking the multivitamin while taking levodopa medication?
4. Explain why Mr. Carl's physician has switched him from Sinemet " to Stalevo 100 at his follow-up appointment.
5. Mr. Carl has been instructed to stop taking his wife's antipsychotic. He is not happy with this decision, nor is his wife. Mr. Carl's wife states, "....he is happier now...how dare you tell him to stop taking the medication!" What is your initial nursing response to Mr. Carl's wife? Following your initial reaction, how do you explain to Carl's why taking his wife's medication is not a good idea

Answer 1

Mr. Carl should consider exercise, therapy, and diet changes. Levodopa converts into dopamine in the brain to alleviate Parkinson's symptoms, and carbidopa helps deliver more levodopa to the brain, reducing side effects. Stalevo includes another drug for longer relief, and antipsychotics should be avoided as they can worsen Parkinson's symptoms.

Step-by-step explanation:

Non-pharmacological and diet changes for Mr. Carl include regular exercise to improve flexibility and strength, physical and occupational therapy, and a balanced diet possibly including antioxidants, omega-3 fatty acids, and a controlled protein intake to not interfere with levodopa absorption.

Explaining Levodopa and Carbidopa: Levodopa works by converting into dopamine in the brain, helping to alleviate symptoms of Parkinson's. Carbidopa is combined with levodopa to prevent early conversion of levodopa to dopamine outside the brain, reducing side effects and increasing the amount that reaches the brain. Adverse effects like nausea can be managed with dosage adjustments and taking the medication with food.

Mr. Carl can generally continue taking his multivitamin but should avoid taking it at the same time as his levodopa medication due to potential interactions, particularly with vitamin B6, which can increase the peripheral metabolism of levodopa, reducing its efficacy.

Switch to Stalevo: Mr. Carl's physician switched him to Stalevo, which includes entacapone with levodopa and carbidopa, to improve the duration of symptom relief. This change may be due to decreasing response to Sinemet alone.

Concerns with Antipsychotic Medication: Taking his wife's antipsychotic should be discontinued because it can worsen Parkinson's symptoms and cause other serious side effects. It's not intended for his condition and the management of his mood should be medically supervised.