>Would someone tell the rest of us how to get the two documents Joy wrote of?
> Wish her and hers the best.  Only a CG would pick up a PD article in a
>waiting room and share with her husband while his eyes are flying
>around-ha-way to go Joy! IYQ;Mary CG for MEl 75/11

Dear Mary,

I was recently hospitalized for a minor operation and found the information
on from a brochure produced by the Western Australian Parkinson's
Association entitled "DRUGS TO BE GIVEN WITH CAUTION TO PEOPLE WITH
PARKINSON'S DISEASE" very helpful.  I gave a photocopy of this brochure to
the nursing staff as well as anaesthetist to put in my file.  Also, I
brought in my medication in their original bottles and gave them to the
nurses to administer.  This worked out much better than a time when I had
another operation and experienced lots of hassles in getting my medications.

I scanned the brochure as well as an article I included a couple of years
ago in the Victorian Parkinson's
Newsletter.  The article is entitled 'HOSPITALIZATION OF A PARKINSON
PATIENT' by Joseph H. Friedman, M.D. Director of Brown University
Parkinson's Disease and Movement Disorders Unit and have included the
material below. In scanning the brochure and article, I had to do several
corrections, and I hope I got most of them.

Incidently, the Western Australia Parkinson's Association has a home page of
the net:
        http://www.quartec.com.au/parkinsons/    and I am working on a home
page for our Victorian Parkinson's Association.  Creating home pages for
support groups can do much to raising the profile for Parkinson's Disease.

Celia Jones
***********
DRUGS TO BE GIVEN WITH CAUTION TO
PEOPLE WITH PARKINSON'S
DISEASE

Parkinson's disease is a neurological disorder which is characterised by
tremor, stiffness and slowness of movement.  The symptoms of this disorder
are due to a deficiency in the brain of a chemical substance called
dopamine.  Many drugs used for the treatment of other medical conditions
have the potential to alter or interfere with the brain's dopamine system
and are sometimes overlooked as having a detrimental effect on Parkinson's
disease.  The need to effectively treat other medical conditions and the
possibility of causing or worsening existing Parkinson's disease has to be
considered.

Potentially fatal interactions can occur when some drugs are combined with
medications to treat Parkinson's disease.  These drugs or drug combinations
must not be given to people with Parkinson's disease (see A below).

Some drugs such as anti-emetics and powerful tranquillisers can induce a
form of Parkinsonism which may take weeks or months to appear.  If given to
people who already have Parkinson's disease their symptoms may worsen.
Several months may elapse after the offending medication is stopped before
the symptoms decrease or disappear.

When commencing cardiovascular drugs-(for example drugs to treat high blood
pressure or angina) a check of tying and standing blood pressure is
extremely important.  The addition of these drugs to anti-Parkinson's
medication may cause extremely low blood pressure.

If you are contemplating surgery you should:
- Talk to your doctor and anaesthetist before surgery and give him/her a copy
of this list;
- If admitted to hospital, give staff a copy of this list;
-Make sure your neurologist has a copy of this drug list and is aware of
your reason for surgery.
Note    It is particularly important that the potentially fatal interaction
between Selegiline [DEPRENYL/ELDEPRYL] and Pethidine is noted.

For all of the above reasons you should always tell your doctor and pharmacist
about all the medications you are taking, particularly if you have been
started on a new medication.

This list of medications has been produced for you to have available in
emergency situations and as a reminder for your doctor and pharmacist.
Please discuss any concerns and questions which you may have with them.


Note:   Brand names are listed in capitals

A.      The following drug combinations
are contraindicated

(1)     Antidepressants (to treat depression)
(1A) monoamine oxidase inhibitors - not to be used in combination with
levodopa containing drugs (e.g. SINEMET, MADOPAR, KINSON, SINACARB) or with
Selegiline [DEPRENYL/ELDEPRYL].

Type A (non-selective)
        Phenelzine      NARDIL
        Tranylcypromine PARNATE (in PARSTELIN)

        Type A (selective)
        Moclobemide*    AURORIX*

*Combination with levodopa (SINEMET, MADOPAR, SINACARB, KINSON)
may require a reduction in dose of levodopa.  Your doctor will advise.

(1B) selective serotonin re-uptake inhibitors (SSRI's) - not to be used in
combination with Selegiline [DEPRENYL/ELDEPRYL].
Fluoxetine      LOVAN, PROZAC, ZACTIN
Paroxetine      AROPAX
Sertraline      ZOLOFT

(1C) serotonin-noradrenaline re-uptake inhibitors (SNRI's) - not to be used
with Selegiline [DEPRENYL/ELDEPRYL].
Venlafaxine            EFEXOR

(2)     Analgesics (for pain) - not to be used in conjunction with Selegiline
[DEPRENYL/ELDEPRYL].

Pethidine [Meperidine(USA)1 [DEMEROL(USA)1

B.      The following drugs have the potential to worsen
Parkinson's Disease symptoms
(Your doctor may decide their use is justified)

(1)     Anti-emetics (to treat nausea and vomiting)

Metoclopramide                MAXOLON, PRAMIN
Prochlorperazine              STEMETIL


Note:   Brand names are listed in capitals

(2)     Antipsychotics (also known as major tranquillisers)

Chlorpromazine  LARGACTIL
Flupenthixol    FLUANXOL
Fluphenazine    ANATENSOL, MODECATE
Haloperidol     HALDOL, SERENACE
Methdilazine    DILOSYN
Pericyazine     NEULACTIL
Perphenazine    TRILAFON, (in MUTABON D)
Pimozide        ORAP
Promethazine    AVOMINE, PHENERGAN (also in some cough/cold preparations)
Risperidone     RISPERDAL
Thiothixine     NAVANE
Thioridazine    ALDAZINE, MELLER1L
Trifluoperazine STELAZINE, (in PARSTELIN)
Trimeprazine    VALLERGAN

(3)     Cardiovascular (blood pressure and heart drugs)

Amlodipine      NORVASC
Diltiazem       CARDCAL, CORAS, DILTIAZEM
Felodipine      ACON, PLENDIL
Methyldopa      ALDOMET, ALDOPREN, HYDOPA, NUDOPA
Nifedipine      ADALAT, NIFECARD, NYEFAX
Verapamil       ANPEC, CORDILOX, ISOPTIN,VERACAPS

(4)     Anti-anxiety

Buspirone             BUSPAR

(5)     Others (less common)

        Captopril       ACENORM, CAPOTEN
        Lithium LITFUCARB
        Phenytoin       DILANNN
        Tetrabenazine   NITOMAN

Note The intake of caffeine (tea/coffee) should be limited whilst taking
Amantadine/SYMMETREL.



Note    Many older drugs which have been removed from the Australian market may
still be available in some overseas countries; ensure you have adequate
supplies of all medications when travelling.

This list is not exhaustive but contains many drugs known to cause problems
or which can be anticipated to cause problems in some people with
Parkinson's Disease.


*********

The following article might be of interest to some of you facing
hospitalization. 1 wish I had read it when 1 had my gailbladder operation as
the hospital staff was quite disconcerted about my PD medications, and 1
even got a visit from the head of Pharmacology at the hospital.  There was
so much confusion over who should administer which medication that 1 just
gave up trying to maintain my normal medication routine in the end.



HOSPITALIZATION OF
A PARKINSON PATIENT

Joseph H. Friedman, M.D. Director
Brown University Parkinson's Disease
and Movement Disorders Unit

Director, APDA Information and Referral Center
Providence, Rhode Island

Hospitalization is an occasional necessity for patients with Parkinson's
disease (PD).  Rarely, however, is PD itself the cause.  Other conditions
may develop, such as a hip fracture or pneumonia, the most common
complications of PD, as well as all the other medical problems that afflict
PD patients in equal proportion to the general population.

The problems that PD patients run into are so similar, regardless of the
hospital or the medical condition, that it is important for the patient and
the caregiver to be aware in advance of what is likely to happen and to make
proper provisions ahead of time.

First, it is unlikely that PD medications will be given as prescribed by the
physician who originally ordered them, unless the nursing staff and
attending physician (if he or she is not a neurologist) are explicitly given
schedules in advance.  If a person takes Sinimet (carbidopa / levodopa)
three times a day before meals, the hospital staff frequently transcribe
this order into "TID" (an abbreviation for the Latin translation of three
times daily), which could result in a 8 AM - 4 PM - Midnight schedule.  A
home schedule of 7 AM -
11 AM - 3 PM 7 PM may be translated into a "QID" (four times daily) or "Q6h"
(every six hours) schedule of 7 AM - 1 PM - 7 PM - 1 AM.  When the daily
schedule gets more complex, with bromocriptine at mealtimes, a whole and
half tablet of Sinemet scheduled at different times, or when patients take
Sinemet on an "as needed" or "demand" schedule, (PRN is the hospital term),
all hell breaks loose.  Most physicians and nurses are used to dealing with
antihypertensives, diuretics,antibiotics and other drugs where a firm
schedule either doesn't matter, or where the aim is to provide a fairly
continuous drug level over a 24 hour period.  It is not usual hospital
policy to allow the patients to take medications when they deem necessary.
This requires a physician's official approval.

Be sure that the drug schedule, with time and dose, is understood and into
the hospital orders (unless whatever changes are made can be explained).

Be sure that the Sinemet (carbidopa / levodopa) strength is correct.  It
comes as 10 / 100, 25 / 100, 25 / 250 for the standard form, while the long
acting form (Sinemet CR) comes in two strengths, 25 / 100 and 50 / 200.  The
generic formulations of carbidopa / levodopa and Sinemet have the same
colors at the equivalent strengths.

Don't take or give medications on your own.  Let the staff know what is
supposed to be given and when, including "as needed" doses.

Some medication changes can be accepted.  Sometimes drugs need to be
reduced. Often, simplification of scheduling must be made because the
nursing staff cannot deliver drugs exactly on time.  Give the staff some leeway.

In some cases, patients may be taking medicines not stocked in the hospital
pharmacy.  This will always be the case when the patient is enrolled in an
experimental drug protocol.  It is therefore necessary to bring these
medicines in their original bottles and the instructions to the hospital to
insure that doses are not missed.

PD patients who fluctuate ("on" and off " periods ) are usually poorly
understood in the hospital.  They frequently incur the wrath of the staff
who think the patient is trying to be " babied when they turn "off," asking
for help in dressing or eating when they had been sauntering down the
corridor unassisted only a few minutes earlier.  Occasionally dyskinesias,
the writhing movements caused by levodopa overmedication or oversensitivity
are thought to be attention getting tricks rather than involuntary and
unwanted movements. The best provision to solve this problem is an
"in-service" teaching session for the nursing staff. unfortunately, unless
there is a knowledgeable nurse or doctor available to do this, this is not
done.  When this situation does arise, the attending physician should be
informed and asked to educate the staff.  Oftentimes, giving literature on
PD to the staff may be very helpful

You have to keep in mind that the hospital staff wants the patient to be
well cared for. When they "blame" the patient, it is usually from ignorance.
Always assume that the staff want what's best for the patient and that they
can be taught. Teach them. Explain the situation in a supportive manner, and
do not be hostile or take a negative attitude.  "I really appreciate your
efforts, but I think you may have never taken care of a PD patient with my
husband's type of problems before.  He is really different than most of the
PD patients.  Let me exlain his situation and give you some literature to
read."  Do not accuse the staff of being incompetent and uncaring. Ask them
to call the patient's neurologist.

Another suggestion that 1 have is that you bring this article to their
attention.