From: "Mary Caputi" 
To: "WPPD PHA5590 Students" 
Subject: PHA 5590 Question #29 PD
Date: Sun, 22 Oct 2000 20:29:17 -0400
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 Hello Students!
Question 29 Parkinsons Ds.
A hospitalized patient is taking Sinemet 25/100, 1.5 tabs at bedtime =
only. His wife said that is all he was supposed to take. I looked at his =
other meds and he also received Aricept 10mg qhs at home. The wife =
confirmed the patient had Parkinsons but said that the Aricept was for =
dementia. I asked if it was alzheimers and she said no, just dementia. =
Several family members said that about 1 hour after taking his bedtime =
meds, he stares into space for about an hour. He can answer questions =
and even be made to walk, but he just stares blankly. I suggested that =
this might be due to the Aricept causing increased levels of =
acetylcholine without compensatory dopamine.  Could this be the case, or =
is the patient having a problem with the Sinemet or something else??  =20

=20

Answer: This patient is receiving two drugs at the same time which will =
affect the CNS.  One increases acetylcholine and the other increases =
dopamine.  Though I never found an interaction listed, these two drugs =
are affecting the same=20
system.  This dose of Sinemet at a once daily dose (I would assume for =
restless leg syndrome) would be my candidate of the causative agent.  =
Dopamine acts in the mesolimbic dopamine tract to produce arousal, =
memory and=20
stimulus processing.  Dopamine also acts in the mesocortical dopamine =
tract for cognition and communication.  Knowing these sites of action, =
this may be a rare levodopa/carbidopa ADR.=20




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 Hello Students!
Question 29 =
Parkinsons=20
Ds.
A hospitalized patient is taking Sinemet 25/100, =
1.5 tabs=20
at bedtime only. His wife said that is all he was supposed to take. I =
looked at=20
his other meds and he also received Aricept 10mg qhs at home. The wife =
confirmed=20
the patient had Parkinsons but said that the Aricept was for dementia. I =
asked=20
if it was alzheimers and she said no, just dementia. Several family =
members said=20
that about 1 hour after taking his bedtime meds, he stares into space =
for about=20
an hour. He can answer questions and even be made to walk, but he just =
stares=20
blankly. I suggested that this might be due to the Aricept causing =
increased=20
levels of acetylcholine without compensatory dopamine.  Could this =
be the=20
case, or is the patient having a problem with the Sinemet or something=20
else??   
 
Answer: This patient is receiving two drugs at =
the same=20
time which will affect the CNS.  One increases acetylcholine and =
the other=20
increases dopamine.  Though I never found an interaction listed, =
these two=20
drugs are affecting the same 
system.  This dose of Sinemet at a =
once=20
daily dose (I would assume for restless leg syndrome) would be my =
candidate of=20
the causative agent.  Dopamine acts in the mesolimbic dopamine =
tract to=20
produce arousal, memory and 
stimulus processing.  Dopamine also =
acts in=20
the mesocortical dopamine tract for cognition and communication.  =
Knowing=20
these sites of action, this may be a rare levodopa/carbidopa =
ADR. 

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