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Patient Care Process for the Management of Parkinson Disease

Collect
Patient characteristics (e.g., age, race, sex, hand dominance)
Patient history (past medical, family, social—dietary habits, alcohol and tobacco use)
Motor and nonmotor symptoms (see Table 59-1 and 59-2)
Current medications, prior medication use for Parkinson disease and response to prior medications for Parkinson disease (e.g., effectiveness, side effects), prior use of dopamine receptor blockers
Objective data
Assess
Past and current use of medications associated with drug-induced parkinsonism (e.g., antipsychotics, metoclopramide, tetrabenazine)
Difficulties with performing activities of daily living
Gait difficulties and fall risk
Motor or nonmotor symptoms that are most troublesome for the patient
Appropriateness, effectiveness, and side effects of current medications for the motor and nonmotor symptoms of Parkinson disease
Presence of motor complications (e.g., motor fluctuations, dyskinesias, freezing)
Plan*
Tailored lifestyle modifications (e.g., exercise)
Drug therapy regimen including specific medications for Parkinson disease, dose, route, frequency, and duration; specify the continuation and discontinuation of existing therapies (see Table 59-3)
Monitoring parameters including efficacy (e.g., symptom improvement, safety (medication-specific adverse effects; see Table 59-4), and timeframe
Patient education (e.g., purpose of treatment, lifestyle modification, drug therapy, side effects)
Self-monitoring of symptoms—where and how to record results
Referrals to other providers when appropriate (e.g., physician, physical therapy, speech therapy)
Implement*
Follow-up: Monitor and Evaluate
Determine symptom relief goal attainment
Presence of adverse effects
Occurrence of motor complications, falls, and development/progression of non-motor symptoms
Patient adherence to treatment plan using multiple sources of information
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CHAPTER SUMMARY FROM THE PHARMACOTHERAPY HANDBOOK
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For the chapter in the Wells Handbook, please go to Chapter 56. Parkinson Disease.
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Content Update
July 24, 2017
Safinamide (Xadago) for Parkinson Disease "Off" Episodes: Safinamide is a selective, reversible monoamine oxidase type B (MAO-B) inhibitor approved as adjunctive treatment with levodopa/carbidopa (with or without other agents) in patients with Parkinson disease experiencing "off" episodes. Other MAO-B inhibitors (rasagiline, selegiline), COMT inhibitors (entacapone), and amantadine are other options for patients experiencing "off" episodes after optimizing dopaminergic therapy. In clinical trials, safinamide modestly increased the mean daily "on" time without troublesome dyskinesia; it may also improve motor function, clinical status, and health-related quality of life. The initial dose is 50 mg orally once daily, increased to 100 mg once daily after 2 weeks. The most common adverse events are dyskinesia, nausea, insomnia, falls, hypertension, hallucinations, impulse control disorder, and serotonin syndrome. Safinamide has numerous potential drug interactions due to risk of serotonin syndrome. High cost could limit its use clinically.
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KEY CONCEPTS
Awareness ...