>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.