RT Book, Section A1 Koch, Jessa M. A1 Dashtipour, Khashayar A1 Chen, Jack J. A2 DiPiro, Joseph T. A2 Yee, Gary C. A2 Michael Posey, L. A2 Haines, Stuart T. A2 Nolin, Thomas D. A2 Ellingrod, Vicki L. SR Print(0) ID 1191800175 T1 Parkinson Disease T2 DiPiro: Pharmacotherapy A Pathophysiologic Approach, 12e YR 2021 FD 2021 PB McGraw Hill PP New York, NY SN 9781260116564 LK accesspharmacy.mhmedical.com/content.aspx?aid=1191800175 RD 2022/07/07 AB KEY CONCEPTS To optimize long-term therapeutic outcomes, minimize adverse effects, and improve quality of life for individuals with idiopathic Parkinson disease (PD), clinicians need to (1) continually access motor and nonmotor symptoms, (2) thoughtfully consider initial and adjunctive therapies, and (3) continually adjust medication dosages throughout the course of this illness. In general, treatment should be initiated when the disease begins to interfere with activities of daily living, employment, or quality of life. Surgery is an option for patients who require additional symptomatic relief or control of motor complications. Anticholinergic medication can be useful for mild symptoms of PD but, due to adverse medication effects, it should be used with caution in older patients and those with pre-existing cognitive difficulties. Monotherapy with amantadine or the irreversible monoamine oxidase type B (MAO-B) inhibitors provide symptomatic benefit, but less than that of dopamine agonists or carbidopa/levodopa (L-dopa). Carbidopa/L-dopa is the most effective medication for symptomatic treatment. Most patients treated with carbidopa/L-dopa will develop motor complications (eg, fluctuations and dyskinesias). MAO-B inhibitors (irreversible and reversible), catechol-O-methyltransferase (COMT) inhibitors, and adenosine A2 receptor antagonists are useful add-on therapies to attenuate motor fluctuations in patients treated with carbidopa/L-dopa. Amantadine is a useful add-on agent to attenuate dyskinesias. Dopamine agonists are effective and, compared to L-dopa, associated with less risk of developing motor complications. They do however carry a greater risk for psychiatric symptoms, such as hallucinations and impulse control disorders.