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1? for HYPERTENSIVE PARKY Date of birth: 06/12/26 Weight: 178 Gender: Male Current 10 medications: UAmantadine (Symmetrel") UVitamin C UAtenolol (Tenormin") UVitamin A UCaffeine (NoDoz", Vivarin") UEthanol ULevodopa; Carbidopa (Sinemet") USelegiline (Eldepryl") UVerapamil (Calan", Isoptin", Verelan") UVitamin E Medical conditions: ohypertension oParkinson's disease oparkinsonism Allergies: None listed in patient record. Drug Interactions Report Levodopa; Carbidopa/Amantadine Concomitant administration of amantadine, benztropine, procyclidine, or trihexyphenidyl with levodopa-carbidopa can enhance the therapeutic effects of levodopa but should not be used in patients with a history of psychosis. Amantadine can increase the efficiency of levodopa by its action on central nerve terminals. Patients who exhibit psychoses should avoid this combination because of the possibility of an increased psychotic effect. Verapamil/Atenolol Concomitant administration of u-adrenergic blocking agents and verapamil can lead to significant AV nodal blockade. This can manifest as heart block, bradycardia, and/or prolonged PR interval. Congestive heart failure or severe hypotension also can occur. u-blockers should not be given to patients receiving verapamil. Verapamil can inhibit the metabolism of some u-blockers, causing additive effects on slowing of AV conduction and depression of blood pressure. In addition, this combination should be avoided in patients with poor ventricular function due to increased negative inotropic effects. While additive effects are possible with all other antiarrhythmics, particular attention should be given to using atenolol in combination with diltiazem, verapamil, or other antiarrhythmic agents (e.g., amiodarone) that possess significant effects on AV nodal conduction. When used with atenolol or other u-blockers, these agents can cause complete AV block. Ethanol/Atenolol Ethanol interacts with antihypertensive agents by potentiating their hypotensive effect. Postural hypotension is a particular danger. Levodopa; Carbidopa/Atenolol Concomitant use of antihypertensive agents with levodopa-carbidopa can result in additive hypotensive effects. Amantadine/Ethanol Ethanol should not be used with amantadine because of the possible increase of CNS effects such as dizziness, confusion, lightheadedness, fainting, or orthostatic hypotension. Selegiline/Levodopa; Carbidopa Administration of levodopa to patients receiving drugs that inhibit monoamine oxidase (MAO) can produce a hypertensive response. While traditional MAOIs such as phenelzine inhibit MAO type A and selegiline is selective for MAO type B, at doses above 30u40 mg/day, this selectivity is lost. Selegiline can increase levodopa-induced dyskinesias, nausea, orthostatic hypotension, confusion, and hallucinations. Reductions in levodopa dosage may be necessary within a few days after the start of selegiline treatment. Even though Parkinson's disease is an indication for both selegiline and levodopa, and these 2 drugs may be administered together safely in some cases, patients should be monitored closely for hypertensive responses, especially if selegiline doses higher than 10 mg/day are used. The adverse effects associated with levodopa, including orthostatic hypotension, confusion, dyskinesias, nausea, and hallucinations, can be exacerbated by concomitant administration of selegiline. Dosages of levodopa should be reduced within 2u3 days after beginning selegiline therapy. Ethanol/Selegiline Cyclic antidepressants interact with ethanol by causing increased CNS depression and resulting increased impairment in psychomotor performance. Acute ingestion of ethanol causes decreased first-pass hepatic metabolism of cyclic antidepressants, while chronic ingestion causes increased hepatic metabolism. In abstinent alcoholics, cyclic antidepressants are cleared more rapidly, and a dosage increase may be required. Delayed gastric emptying due to the anticholinergic effects of cyclic antidepressants can delay absorption of ethanol. Caffeine/Selegiline Caffeine interacts with MAOIs (including furazolidone, procarbazine, and selegiline). Dangerous cardiac arrhythmias or severe hypertension can occur because of the potentiation of caffeine's sympathomimetic effects by MAOIs. Caffeine use should be minimized or avoided during and for 1u2 weeks after discontinuation of any MAOI. Ethanol/Verapamil Ethanol interacts with antihypertensive agents by potentiating their hypotensive effect. Postural hypotension is a particular danger. Levodopa; Carbidopa/Verapamil Concomitant use of antihypertensive agents with levodopa-carbidopa can result in additive hypotensive effects. Additive Adverse Reactions Report 7 of these drugs may cause: onausea/vomiting (ascorbic acid; atenolol; caffeine; ethanol; levodopa/carbidopa; verapamil; vitamin E) 6 of these drugs may cause: oheadache (amantadine; ascorbic acid; caffeine; selegiline; verapamil; vitamin E) 5 of these drugs may cause: odizziness (amantadine; ascorbic acid; atenolol; selegiline; verapamil) 4 of these drugs may cause: odiarrhea (ascorbic acid; atenolol; caffeine; vitamin E) oorthostatic hypotension (amantadine; ethanol; levodopa/carbidopa; selegiline) osinus tachycardia (caffeine; ethanol; selegiline; verapamil) 3 of these drugs may cause: ofatigue (atenolol; verapamil; vitamin E) ohallucinations (amantadine; ethanol; selegiline) oheart failure (amantadine; atenolol; verapamil) ohypotension (atenolol; selegiline; verapamil) oinsomnia (amantadine; caffeine; selegiline) operipheral edema (amantadine; selegiline; verapamil) osinus bradycardia (atenolol; selegiline; verapamil) 2 of these drugs may cause: oanxiety (amantadine; caffeine) oataxia (ethanol; selegiline) oAV block (atenolol; verapamil) oblurred vision (amantadine; vitamin E) oconfusion (amantadine; ethanol) ofever (ethanol; selegiline) oflushing (ascorbic acid; levodopa/carbidopa) ohypertension (ethanol; levodopa/carbidopa) opolyuria (caffeine; levodopa/carbidopa) oseizures (ethanol; selegiline) otremor (caffeine; ethanol) ourinary retention (amantadine; levodopa/carbidopa) oxerostomia (amantadine; selegiline) Costs Report Amantadine (Symmetrel") o200 mg PO qd: $10.00u19.99/mo. Ascorbic Acid (unavailable at this time) Atenolol (Tenormin") o50 mg PO qd: $10.00u19.99/mo. o100 mg PO qd: $20.00u29.99/mo. Beta-Carotene (Solatene") o$30.00u39.99/mo. Caffeine (NoDoz", Vivarin") (unavailable at this time) Ethanol (unavailable at this time) Levodopa; Carbidopa (Sinemet") o10/100 mg PO tid: $40.00u49.99/mo. o25/100 mg PO tid: $40.00u49.99/mo. o25/250 mg PO tid: $50.00u59.99/mo. o50/200 mg (CR) PO bid: $80.00u89.99/mo. Selegiline (Eldepryl") o5 mg PO bid: $100.00u149.99/mo. Verapamil (Calan", Isoptin", Verelan") o80 mg PO tid: $5.00u9.99/mo. o240 mg (SR) PO qd: $30.00u39.99/mo. o180 mg (SR) PO bid: $60.00u69.99/mo. Vitamin E (Aquasol E") (unavailable at this time) Drug Indications/Medical Conditions Match Ascorbic Acid is not indicated for any of the listed medical conditions. Might the patient have iron toxicity, methemoglobinemia, nutritional supplementation, and/or scurvy? Beta-Carotene is not indicated for any of the listed medical conditions. Might the patient have erythropoietic protoporphyria (EPP), nutritional supplementation, polymorphous light eruption, and/or vitamin A deficiency? Caffeine is not indicated for any of the listed medical conditions. Might the patient have drowsiness, fatigue, and/or neonatal apnea? Ethanol is not indicated for any of the listed medical conditions. Might the patient have ethylene glycol poisoning, methanol poisoning, and/or premature labor? Vitamin E is not indicated for any of the listed medical conditions. Might the patient have mastalgia, premenstrual syndrome (PMS), and/or vitamin E deficiency? Atenolol is indicated for the patient's hypertension. Levodopa; Carbidopa is indicated for the patient's Parkinson's disease. Verapamil is indicated for the patient's hypertension. Amantadine is indicated for the patient's Parkinson's disease and parkinsonism. Selegiline is indicated for the patient's Parkinson's disease and parkinsonism. Drugs/Contraindications Warning Precaution: Amantadine in Parkinson's disease Abrupt withdrawal of amantadine should be avoided in patients with Parkinson's disease since it can precipitate symptoms of increased rigidity, confusion, urinary retention, or bulbar palsy. Precaution: Caffeine in hypertension Patients with hypertension should not receive or should minimize their intake of caffeine. Drugs/Allergies Warning No potential drug/allergy warnings were identified. Therapeutic Duplication Alert Verapamil and Atenolol are both antihypertensive agents. Verapamil and Atenolol are both antiarrhythmics. Verapamil and Atenolol are both antianginals.acid; atenolol; caffeine; vitamin E) oyya mo. Selegiline (Eldepryl") o5 mg PO bid: $100.00u149.99/mo. Verapamil (Calan", Is