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