1.
Parkinsonism
By
Asiya Naaz
Pharm.D

2.
https://youtu.be/NAfQoviLFR8

3.
Clinical Presentation of Parkinsonism Disease

4.
DESIRED OUTCOME
• The goals of treatment are to
minimize symptoms, disability,
and side effects while
maintaining quality of life.
• Education of patients and care
givers is critical, and exercise
and proper nutrition are
essential.
TREATMENT
PHARMACOLOGIC THERAPY
• Monotherapy usually begins with a monoamine oxidase-B
(MAO-B) inhibitor, or if the patient is physiologically young, a
dopamine agonist.
• When additional relief is needed, the addition of levodopa
(L-dopa) should be considered. With the development of
motor fluctuations, addition of a catechol-O-methyltransferase
(COMT) inhibitor should be considered to extend L-dopa
duration of activity.
• For management of L-dopa–induced dyskinesias, the
addition of amantadine should be considered.

5.
General approach to the management of early to advanced Parkinson’s disease.

6.
Drugs Used in
Parkinson’s Disease

7.
Common Motor Complications and Possible Treatments

8.
Stepwise Approach to Management of Drug-Induced Hallucinosis and Psychosis in Parkinson’s Disease
1. General measures such as evaluating for electrolyte disturbance (especially hypercalcemia or hyponatremia),
hypoxemia, or infection (especially encephalitis, sepsis, or urinary tract infection).
2. Simplify the antiparkinsonian regimen as much as possible by discontinuing or reducing the dosage of
medications with the highest risk-to-benefit ratio first.
(If dosage reduction or medication discontinuation is either infeasible or undesirable, go to step 3).
a. Discontinue anticholinergics, including other nonparkinsonian medications with anticholinergic activity such as
antihistamines or tricyclic antidepressants.
b. Taper and discontinue amantadine.
c. Discontinue monoamine oxidase-B inhibitor.
d. Taper and discontinue dopamine agonist.
e. Consider reduction of L-dopa (especially at the end of day) and discontinuation of catechol-O-methyltransferase
inhibitors.
3. Consider atypical antipsychotic medication if disruptive hallucinosis or psychosis persists.
a. Quetiapine 12.5–25 mg at bedtime; gradually increase by 25 mg each week if necessary, until hallucinosis or
psychosis improves or
b. Clozapine 12.5–50 mg at bedtime; gradually increase by 25 mg each week if necessary until hallucinosis or
psychosis improves (requires frequent monitoring for leukopenia).

9.
EVALUATION OF THERAPEUTIC OUTCOMES
• Patients and caregivers should be educated so that they can
participate in treatment by recording medication administration times
and duration of “on” and “off ” periods.
• Symptoms, side effects, and activities of daily living must be
scrupulously monitored and therapy individualized.
• Concomitant medications which may worsen motor symptoms,
memory, falls, or behavioral symptoms should be discontinued if
possible.