Emergency management of patients of parkinson's (pdf, 99kb)

• Make sure they have enough
• Only adjust prescribed medication
patient/carers where possible – dosages are individualised to each person and may not coincide with drug round timings.
• Temperature and respiratory rate.
• Write up first dose as stat.
• Blood pressure lying and standing.
• Dipstick urine.
• If the patient/carers have brought
• Mental test score (eg AMT, MMSE).
usual routine (including self-administration where able).
• Consider placing tablets one
Therefore, put patients with Parkinson’s • Consider dispersible or liquid
continuation of usual medication routines) • AVOID metoclopramide (Maxalon)
• Note cyclizine and ondansetron can
and advice).
• Consider posture for effective swallow
• Check for history of cognitive
• Check for underlying cause (eg
• AVOID haloperidol (Serenace/Haldol)
• Alert to Parkinson’s specialist
• See page 12 for guide for estimating
– if necessary, consider a benzodiazepine.
oral dose, consider:
Administration via NG/NJ/PEG tube
• Assess for any contraindications.
• Insert as per local protocol.
• See page 8 for Preparing Parkinson’s
dispersible preparation4 – monitor as dose frequency may need • proprietary use of each medication.
• For medication given in liquid form,
• Return to usual medication routine
(and routes of administration) as soon as clinically possible.
Use Eldepryl (as also available in liquid systems – can usually be safely omitted temporarily.
feeding systems. Therefore, consider rotigotine patches as Use liquid (generic) version.
Procyclidine (Kemadrin) Use liquid (generic or Arpicolin) version.
Guide for estimating equivalent levodopa 1. Calculate Adjusted Levodopa Equivalent Daily Dose (LEDD): (the above figures refer to each medication’s NB (A) or (B) = 0 if not taking that type 2. Calculate dosage for rotigotine patch • This is a dopamine agonist
analgesic and is not a controlled drug.
• Patients who are established on an
 if increased stiffness/slowness
 if increased confusion/
• For further support, call the APO–
• If adjusted LEDD >350mg, use
rotigotine 16mg and consult with specialist regarding administration of apomorphine.
• For further support, contact the
• This is co-careldopa (levodopa and
• Patients who are established on
continued at the prescribed rate (providing gastric emptying is not • Delirium (acute confusion due
• Chest infection, especially
• Urinary tract infections.
• This involves stimulation of target
or the subthalamic nucleus) through electrodes connected to a • Neuroleptic-like malignant syndrome.
neurostimulator placed under the skin around the chest or stomach area.
• Patients who are established on
DBS need to be maintained on the same routine.
Dr J George, Dr S Manickam, Judith Graham (PDNS) (2007) Emergency assessment of patients with Parkinson’s. North Cumbria Acute Trust Baxter K (2010) Stockley's Drug Interactions: A source book of interactions, their mechanisms, clinical importance and management Pharmaceutical Press; 9th edition British National Formulary – BNF 64 Preoperative fasting for adults to prevent perioperative complications. Cochrane Database Syst Rev 2009; 7; CD005285 Madopar CR. Summary of product characteristics 2009. http://www.
medicines.org.uk/emc/document.aspx?documentid=1707&docType=SPC Brennan, KA, Genever, RW, Managing Parkinson’s disease in surgery. BMJ 2010; 341: c5718 MacMahon, M.J MacMahon, DG Management of Parkinson’s Disease in the acute hospital environment. J R Coll Physicians, Edinb, 2012; 42: 157-62 We’re the Parkinson’s support and research charity. Help us find a cure and improve life for everyone affected by Parkinson’s.
the content of the material we produce.
Parkinson’s UK, November 2013 (RD1249) 2013. Parkinson’s UK is the operating name of the Parkinson’s Disease Society of the United Kingdom. A charity registered in England and Wales (258197)

Source: http://www.parkinsons.org.uk/sites/default/files/publications/download/english/pk0135_emergencymanagement.pdf