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Flashcards in Parkinson's Disease Deck (18)
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1

What is an example of a clear explanation of indication/benefit for pramipexole?

This medicine helps to control the symptoms of Parkinson’s Disease, but it does not cure it. It belongs to a group of medicines which have similar effects to dopamine in the brain. It should help to reduce your symptoms (muscle rigidity, gait, etc.). It will only work if you take it every day. Try not to miss any doses or stop it suddenly as this can make your symptoms get very bad quite quickly.

2

What is an example of clear directions for a patient starting on pramipexole?

Your doctor has given you two different strengths of the same drug. You will start with the lower strength (375 µg), one tablet once daily, for one week only. Then you take two tablets once daily for the next week. Then you move up to the higher strength (1.5 mg). You will take one of these once daily until you see your doctor again. You start with a low dose and build up to minimise side effects. You should always swallow your tablets whole because they have a special coating which controls their breakdown in the body. Take them with food as they can cause stomach upset and nausea. Try to take each dose at roughly the same time each day, to get more consistent effects.

3

What are 6 major counselling points regarding side effects and precautions of pramipexole?

1. This medicine can cause some side effects, particularly at first. Some people get nausea, but this usually passes with time, and taking with food can help. If it does not get better, or is not relieved with food, let your doctor know.
2. You can feel dizzy or lightheaded, especially at first. Make sure you stand up slowly.
3. It can also make you feel drowsy. Do not rush to drive or do things where you need to be alert, give it some time to see how it affects you first.
4. Ask if the patient drinks alcohol as this can make this drowsiness worse.
5. Some people may have visual disturbances or see things that are not there. Tell your doctor straight away if this happens.
6. It can make you more impulsive – so you might start eating, hoarding, shopping, and gambling more than normal. You should let your family/friends know to keep an eye out for this.

4

What are 2 examples of monitoring/tests that should be done for pramipexole?

1. Self-monitoring of symptoms
2. Maintain regular appointments

5

What should you always do if a patient asks about whether a drug contains lactose, gluten, etc?

Check the CMI and show them while you check.

6

What is an example of a clear explanation of indication/benefit for levodopa-carbidopa 100/25 tablets?

Like pramipexole, this medicine helps to control the symptoms of Parkinson’s Disease, but works in a different way. It will only work if you take it regularly every day. Try not to miss any doses or stop the medicine suddenly as it can make your symptoms worsen quickly.

7

What is an example of clear directions for levodopa-carbidopa 100/25 tablets?

Start this medicine by taking half a tablet three times a day for the first week. Take your doses with food at 8:00am, 1:00pm and 6:00pm consistently to get the best effect. Taking them with food can reduce nausea or stomach upset (which may occur).

8

What are 5 major counselling points regarding side effects and precautions for levodopa-carbidopa 100/25 tablets?

1. This medicine can cause some side effects, particularly at first. Some people get nausea at first, but this usually goes away. Taking with food can help. If it does not get better, and is not relieved with food, let your doctor know.
2. They may make you feel dizzy or lightheaded, especially at first, so get up slowly from sitting or lying positions (orthostatic hypotension)
3. It can also make you feel drowsy. Do not rush to drive or do things where you need to be alert, give it some time to see how it affects you first.
4. Ask if the patient drinks alcohol as this can make this drowsiness worse.
5. Tell your doctor about any other unusual adverse effects that you experience

9

What is an example of monitoring/tests that should be done for levodopa-carbidopa 100/25 tablets?

Ensure the patient goes back to their general practitioner for a follow up appointment in a week’s time

10

If a patient has recently started on levodopa-carbidopa 100/25 tablets, after experiencing nausea with pramipexole, how should you respond if they are concerned about getting nausea again?

This medicine can also cause nausea when you first start. Taking it with food usually helps. If it doesn’t, and it is an issue, see your GP.

11

What is an example of a clear explanation of indication/benefit for levodopa/benserazide 100/25mg (Madopar Rapid®)?

Just like levodopa/carbidopa, this medicine helps control symptoms of Parkinson’s, but does not cure it. It comes as dispersible tablets which work very quickly. If you take them when you wake up it will help to get you moving in the morning.

12

What is an example of clear directions for levodopa/benserazide 100/25mg (Madopar Rapid®)?

Dissolve ONE tablet in at least 25-50mL of water (~1/4 glass) when you wake up in the morning and drink the whole glass within 30 minutes. It will take a few minutes to dissolve and form a milky-looking liquid. You should stir it immediately before drinking. Taking it with food will reduce any stomach upset or nausea that may occur

13

What are 6 major counselling points regarding side effects and precautions of entacapone?

1. This medicine can cause some side effects, particularly when at first. Some people get nausea at first, but this usually goes away. Taking with food can help. If it does not get better, and is not relieved with food, let your doctor know.
2. They may make you feel dizzy or lightheaded, especially at first, so get up slowly from sitting or lying positions (orthostatic hypotension)
3. It can also make you feel drowsy. Do not rush to drive or do things where you need to be alert, give it some time to see how it affects you first.
4. Ask if the patient drinks alcohol as this can make this drowsiness worse.
5. Tell your doctor about any other unusual adverse effects that you experience

14

Describe the evidence for the effectiveness of Ginkgo Biloba in Parkinson’s Disease

It is lacking.

15

What should you always recommend when a patient (who has started a new prescription medication) mentions that they have heard a complementary/alternative medicine is effective for their condition?

Recommend that they stabilise on her new medication before considering new approaches, and that they don’t buy/take any other supplements without discussing them with their doctor

16

What is an example of a clear explanation of indication/benefit for entacapone?

Like your other medicines – this also helps to control the symptoms of Parkinson’s Disease, but does not cure it. The symptoms are caused by a low level of dopamine in the brain. Entacapone makes levodopa (check what name the patient knows the medicine by) work better. It increases the amount of levodopa (use the name the patient knows the medicine by – write it down on medicine list – or if patient has a medicine list point to it when you are saying the name so the patient hears and see the name – easier to recall) available to the brain to make it work better for longer.

17

What is an example of clear directions for entacapone tablets?

Take ONE tablet four times a day, with or without food (if they experience nausea, take with food). Try to take each dose at roughly the same time each day, to get a consistent effect. Do NOT stop treatment suddenly (risk of withdrawal syndrome symptoms).

18

What are 2 major counselling points regarding side effects and precautions associated with entacapone?

1. Because this medicine enhances the effects of levodopa it can increase side effects such as dizziness (stand up slowly) and drowsiness (if affected, do not drive or operate machinery).
2. The patient should also be aware that their urine may go reddish-brown while taking this medication (but this is harmless).