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Clinical Pearls

Medication Considerations with Parkinson’s Disease: Case Study

by Tamatha (Tammy) Arms

A 72-year-old male patient living in an assisted living facility is diagnosed with Parkinson’s Disease.

He is independent with feeding himself after a meal set up and needs assistance with bathing and dressing at his baseline status. He is able to stand and pivot from bed to wheelchair and mobilizes throughout the facility independently in wheelchair.

An on-call provider, who was not familiar with this patient, was called over a holiday weekend and notified that staff were unable to bathe patient due to “agitated behaviors.”

Haldol® 0.5 mg 1-tab PO daily PRN for agitated behaviors was ordered. Haldol 0.5 mg PO was given by the medical techs daily for a week.

Patient developed psychomotor retardation, was unable to feed himself, and was unable to self-propel the wheelchair with overall worsening symptoms of Parkinson’s Disease. A family member called the provider’s office with concerns. An adult/geriatric and family psychiatric mental health nurse practitioner visited the patient. After an assessment and medication review, new orders were placed.

Haldol was discontinued due to the dopamine-blocking properties of conventional antipsychotics. This medication blocks D2 in the nigrostriatal pathway (Stahl, 2016). Therefore, it is useful in treating tics associated with Tourette’s syndrome but will worsen physical signs and symptoms of Parkinson’s Disease.

If this patient truly needs an antipsychotic medication, Seroquel® 25 mg is the medication of choice. Seroquel blocks 2A receptors which causes enhanced dopamine release in certain areas of the brain, reducing motor side effects (Stahl, 2016). Seroquel is an atypical antipsychotic and will treat psychosis which may be displayed as “agitated behaviors,” while not causing the side effects conventional antipsychotics will for a person with Parkinson’s Disease.

Tamatha (Tammy) Arms, DNP, PMHNP-BC, NP-C
armst@uncw.edu

Reference
Stahl, S. (2016). Essential psychopharmacology prescriber’s guide (5th ed.). San Diego, CA: Cambridge University Press

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