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Old 09-11-2011
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Default Treatment of Parkinsonism Q

65 years old man, presented to family doctor, complaining from abnormal hands movement, and abnormality of the gait, after history and examination the diagnosis of parkinsonism was made, the patient is living alone & he is taking care of him self normally. What is the best initial therapy?
  • Benztropine.
  • Amantadine.
  • Levodopa alone.
  • Bromocriptine
  • Selegiline
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Old 09-11-2011
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Selegiline
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Knowing is not enough; we must apply.
Willing is not enough; we must do.
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Old 09-11-2011
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Quote:
Originally Posted by ag2011n View Post
65 years old man, presented to family doctor, complaining from abnormal hands movement, and abnormality of the gait, after history and examination the diagnosis of parkinsonism was made, the patient is living alone & he is taking care of him self normally. What is the best initial therapy?
  • Benztropine.
  • Amantadine.
  • Levodopa alone.
  • Bromocriptine
  • Selegiline
y cant they give levodopa n carbidopa combination as an option.....uggggh...which is the best drug..!! so what is the answer??
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Old 09-11-2011
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The correct answer is (2 ), Amantadine.
Treatment of Parkinsonism:
< 60 with mild functional impairment, give Benztropine. If > 60 give Amantadine (increases Dopamine release, little effect on Ach)
Sever disease: Levodopa combined with carbidopa: good therapy but on & off effect, ie not smooth level of the drug in the system. If still no good effect, you can add: 1. COMT inhibitors: Tolcapone & entacapone (blocks the degradation of dopamine), so canít be used alone. 2. Selegiline decreases the degradation of dopamine, it is adjuvant drug that can be used at any time.
Ropinirole & Pramipexole are direct stimulator dopamine receptors (less adverse effects, less on & off phenomenon, but less potent).
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