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.