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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Recognize motor and nonmotor symptoms of Parkinson disease (PD).

  • Develop an optimal pharmacotherapeutic plan for a patient with PD as he or she progresses through different stages of the disease.

  • Recommend alterations in therapy for a patient experiencing adverse drug effects, drug–drug interactions, and drug–food interactions.

  • Educate patients with PD about the disease, its drug therapy, and nonpharmacologic treatments.

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PATIENT PRESENTATION

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Chief Complaint

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“My work performance has declined because my tremor makes it difficult to type on the computer, and I am slower with most tasks.”

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HPI

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Lisa Farmer is a 53-year-old, right-handed woman who presents to the neurology clinic because of a mild tremor in her right hand that has worsened over the past 6 months. It takes her longer to do things because it takes a little more effort to get movement started, and her muscles feel a little stiff. She also admits to waking up several times during the night. The stiffness, slowness, tremor, and sleep problems have affected her job performance as a graphic designer, resulting in her contemplating early retirement. She also complains of constipation, loss of sense of smell for about 2 years, decreased libido for 6–8 months, night sweats that cause nighttime awakenings, and very irregular menstrual periods for the past year.

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PMH

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  • HTN × 1 year

  • Broken left wrist after fall 2 years ago

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FH

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Mother died at age 89 of complications associated with a hip fracture, osteoporosis, and Alzheimer disease (clinical diagnosis without postmortem confirmation); father died from an ischemic stroke; two daughters are in good health

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SH

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(–) Alcohol, (–) tobacco, married for 23 years

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ROS

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No complaints other than those noted in the HPI. She denies any other symptoms of autonomic dysfunction such as problems with swallowing, urination, drooling, or dizziness. She also denies any psychological problems such as depression, panic attacks, vivid dreams, acting out dreams, hallucinations, or paranoia.

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Meds

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  • Verapamil SR 180 mg PO every morning for 1 year

  • Calcium carbonate 600 mg PO every morning and night

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All

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None

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Physical Examination

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Gen
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The patient is a Caucasian woman who appears to be her stated age but with minimal hypomimia

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VS
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BP 118/74 mm Hg sitting, 116/70 mm Hg standing, P 70 bpm, RR 13; T 36.8°C; Wt 53 kg, Ht 5′2″

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Skin
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Small amount of dry yellow scales in her eyebrows

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HEENT
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