CASE PRESENTATION ON PARKINSON’S DISEASE

SENTHIL RAJ V

CASE PRESENTATION ON PARKINSON’S DISEASE Name : xxx

Age/Sex: 81/Male

DOA: 12/10/2014

DOD: 13/10/2014

ADMISSION COMPLAINTS: Fever * 4 days.

Cough with expectorations * 4 days

Breathelessness * 4 days

HISTORY OF PRESENT ILLNESS 80 year old male a K/C/O PTB, Parkinson’s disease & old

CVA came to the ER with C/O of Cough with Expectorations * 4 days, minimal expectorations, White colour Sputum.

No Blood in sputum. No Foul Smelling. H/O Breathelessness * 4 days, Worsening of

breathelessness since 2 days, associated with Wheeze. H/O Fever present. No H/O Bleeding manifestations. No H/O Burning Micturation. No H/O Chest Pain. No H/O Loose Stools.

PAST MEDICAL HISTORY: Old CVA 6 years back.

Parkinson’s disease *1 year.

Old PTB 10 years back completed full course of treatment.

N/K/C/O HTN/BA/DM.

Disease Condition was Mentioned, No records were available.

GENERAL EXAMINATION: SOCIAL HISTORY:

NIL PAST MEDICATION HISTORY:

No Records Were Available. FAMILY HISTORY:

NIL P+, NO ICCLE TEMP: 99 F PULSE: 100/MIN RR: 20/MIN BP: 120/80 mm/Hg

SYSTEM EXAMINATION: CVS:

S1 S2. No murmurs CNS:

Patient is having Tremors of both the hands. Moving all Four Limbs. No Neurological Deficits.

RS: Bilateral Air entry. Bilateral Wheeze present. Right mammary crepitations present. Inframammary crepitations present. Infrascapular crepitations present.

GU/GI: P/A – Soft, BS +, No Organomegaly.

OTHER INVESTIGATIONS: Normal Chamber Dimensions Sclerosed Cardiac Valves Trivial Mitral Regurgitation Trivial TR with Normal PA pressure No Regional wall Motion Abnormality N/LV Systolic Function with Grade I Diastolic Dysfunction

Urobilinogen – 0.2 mg/dl(0.2-1.0) HRCT Throax done & reported as

BRONCHIECTASIS & RIGHT ASPIRATION PNEUMONIA

LABORATORY DATAPARAMETERS LAB FINDINGS NORMAL VALUES

HB(g/dl) 13.3 (13-17)

PCV(%) 39.5 (40-50)

TC(cumm) 24600 (4000-11000)

DC - P(%) L(%) E(%) M(%) B(%)

90.66.602.80

(45-70)(25-40)(1-6)(2-10)<1

MCV (fl) 87.3 (83-101)

MCH(pg) 29.3 (27-33)

MCHC 33.6 (31.5-34.5)

PLT(lakhs/cumm) 2.47 (1.5-4)

ESR(mm/hr) 20 (4-30)

RBC(mill/cc) 4.52 (4.5-5.5)

Blood sugar Renal Profile Liver Profile Lipid Profile Thyroid profile

are all found to be Normal.

FINAL DIAGNOSIS LRTI OLD CVA OLD CT PARKINSONS DISEASE

DRUG CHART DRUGS GENERIC

NAME DOSE ROUTE FREQUENC

Y

INJ. CEFTRIAXONE

CEFTRIAXONE 2g IV 1-0-0

INJ PAN PANTOPRAZOLE

40mg IV 1-0-0

NEB IPRAVENT IPRATROPIUM BROMIDE

2CC NASAL Q 6 H

NEB BUDECORT

BUDESONIDE 2CC NASAL Q 8 H

T AZIWOK AZITHROMYCIN

500mg P/O 1-0-0

T SYNDOPA PLUS

CARBIDOPA + LEVODOPA

25+100mg

P/O 1-1-1

T RASALECT RASAGILINE 0.5mg P/O 1-0-0

T DOLO PARACETAMOL

650mg P/O 1-1-1

PHARMACIST INTERVENTION

GUIDELINES: For LRTI(Acquired Pneumonia) –

AMERICAN SOCIETY OF THORACIC SOCIETY(Guidelines on the Management of Community Acquired Pneumonia)

Drug of Choice : Primary- Azithromycin Secondary - Ceftriaxone

For LRTI(Bronchiectacsis) – GLOBAL INITIATIVE FOR COPD(Global Strategy For The Diagnosis, Management, & Prevention of COPD 2014)

Drug of Choice : Ipratropium Bromide + Budesonide

For Parkinsons disease – Parkinsons Disease Society (The Professionals Guide to Parkinsons Disease)

Drug of Choice : T SYNDOPA PLUS ( CARBIDOPA 25mg+ LEVODOPA 100mg ) & Rasagiline

For Fever - Paracetamol

DRUG DISCUSSION: Ceftriaxone

MOA: Interferes with the synthesis of bacterial cell wall.Adverse Effects: Hypoprothrombinaemia, bleeding & Haemolysis.

PantoprazoleMOA: Proton Pump InhibitorAdverse Effects: Nausea, Headache, Loose stools, Abdominal Pain

Ipratropium BromideMOA: Bronchodilators ( Anticholinergics )Adverse Effects: Dryness of Mouth

BudesonideMOA: Inhalational CorticosteriodAdverse Effects: Oral Candidiasis, Hoarse voice, Skin bruising

AzithromycinMOA: Inhibition of Bacterial Protein synthesis by combining with 5os Bacterial ribosome and interferes with translocation.Adverse Effects: Mild gastric upset, Abdominal Pain, Headache and dizziness.

RasagilineMOA: MAO – B inhibitor (Increases the amount of dopamine)Adverse Effects: Dry mouth, Constipation and Headache

Levodopa + CarbidopaMOA: Dopamine Precursor + Peripheral Decarboxylase InhibitorAdverse Effects: Dyskinesia ( Uncontrolled or Excessive Movements)

DRUG INTERACTIONS rasagiline + levodopa

rasagiline, levodopa. Mechanism: pharmacodynamic synergism. Potential for dangerous interaction. Use with caution and monitor closely. Risk of acute hypertensive episode.

PATIENT COUNSELLING: You may walk more slowly than before, but a

daily walk is good exercise and may help to loose up stiff muscles.

If feeling any mental illness, sickness, vertigo and dizziness, should report to the physician.

Make sure exactly when to take your medicine.

Any compliance with the drug should be reported to the physician.

Use of mouth wash can keep away from aspirating infections.

Breathing exercises should be taught.

REFERENCE: AMERICAN SOCIETY OF THORACIC

SOCIETY(Guidelines on the Management of Community Acquired Pneumonia)

GLOBAL INITIATIVE FOR COPD(Global Strategy For The Diagnosis, Management, & Prevention of COPD 2014)

Parkinsons Disease Society (The Professionals Guide to Parkinsons Disease)

Drug Interactions Checker ( Medscape ) Patient.co.uk

THANK YOU