Proficient in Parkinson's

Understanding Symptoms, Patient Impact, and Medication Advancements

Educational Objectives

After participating in this activity, pharmacists will be able to:

  • Discuss Parkinson's disease (PD), its common and difficult-to treat symptoms, and current guidelines
  •  Outline new PD medication advancements that improve adherence to PD therapy
  •  Explain treatment approaches for depression, orthostatic hypotension, psychoses, and sleep disturbances in patients who have PD
  •  Describe medication management during the perioperative deep brain stimulation (DBS) placement period

After participating in this activity pharmacy technicians will be able to:

  • Recall common symptoms of Parkinson's disease and the typical medications used to treat them
  • Identify typical and atypical problems associated with Parkinson's disease
  • Recognize when to refer patients to the pharmacist for recommendations

Parkinson image

Session Offered

Release Date: September 15, 2019

Expiration Date: September 15, 2021

Course Fee

Free

Session Codes

19YC52-JTX21 pharmacists
19YC52-VXK88  pharmacy technicians

Accreditation Hours

2.0 hours of CE

Abstract

Parkinson’s disease (PD) is a chronic, progressive illness and the second most common neurodegenerative disease in the United States (U.S.). As the clinical picture of PD worsens, additional medications, increased doses, and increased dosing frequencies are needed to control symptoms. Often considered a movement-related disorder, PD’s non-motor symptoms that do not affect movement directly have a substantial impact on quality of life. Pharmacologic treatment is effective; levodopa is the gold standard. Pharmacy teams should be up-to-date on newer treatments to treat motor and non-motor symptoms and cognizant of PD patients’ ever-changing clinical picture. Clinicians often suggest that patients whose symptoms persist despite careful, appropriate medication management consider surgical options – either ablative surgery or deep brain stimulation (DBS). Most patients will remain on PD medications post-DBS, but many will substantially lower their daily doses. Rarely, a patient may be able to stop medications completely, but pharmacy teams should help set realistic patient expectations. Non-motor symptoms also have a vast impact on quality-of life for PD patients and pharmacy teams should be sure they are adequately addressed.

Accreditation Statements

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission

ACPE UAN:
0009-0000-19-052-H01-P
0009-0000-19-052-H01-T

Grant funding: : Funded by an educational grant from A corda Therapeutics, Inc.

Cost: Free

Initial Release Date: September 15, 2019
Expiration Date: September 15, 2021

To obtain CPE credit, visit the UConn Online CE Center

Use your NABP E-profile ID and the session code 19YC52-JTX21 for pharmacists or 19YC52-VXK88 for pharmacy technicians to access the online quiz and evaluation.

First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Mon- it or within 72 hours of completing the requirements.

For questions concerning the online CPE activities, email joanne.nault@uconn.edu

Faculty

Kelsey Giara, Pharm.D. is a community pharmacist and freelance medical writer based in New Hampshire.

Faculty Disclosure

The author has no actual or potential conflicts of interest associated with this article.

Disclosure of Discussions of Off-label and Investigational Drug Use

This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings

Content

Introduction

Parkinson’s disease (PD) is the second most common neurodegenerative disease in the United States (U.S.). Clinicians diagnose about 60,000 cases of PD annually, and estimates predict that nearly one million people will be living with PD in the U.S. by 2020. It is a chronic illness that generally develops later in life, after age 60, but an estimated 4% of people with PD are diagnosed before age 50.1,2

PD’s cause remains unknown, and no cure exists. One disproportionately affected population offers some clues about one cause of PD. The Chamorro people of Guam are disproportionately afflicted with neurodegenerative diseases like PD; this phenomenon is caused by the food chain. Flying foxes, found predominantly

Reference

Full List of References

1. Parkinson’s Foundation. “Statistics.” Available at: https://parkinson.org/Understanding-Parkinsons/Statistics. Accessed July 2, 2019.

2. Parkinson’s Foundation. “What is Parkinson’s?” Available at: https://parkinson.org/understanding-parkinsons/whatisparkinsons?_ga=2.49871782.1891377654.1560873511-117490568.1560873511. Accessed July 2, 2019.

3. Cox PA, Sacks OW. Cycad neurotoxins, consumption of flying foxes, and ALS-PDC disease in Guam. Neurology.
2002;58(6):956-959.
4. Jankovic J. Parkinson’s disease: clinical features and diagnosis. J Neurol Neurosurg Psychiatry 2008;79:368–376.

5. Zadikoff C, et al. Parkinson’s Foundation. Managing PD MidStride: A Treatment Guide to Parkinson’s Disease. Available at: https://www.parkinson.org/sites/default/files/attachments/Mid Stride.pdf. Accessed July 2, 2019.

6. Lageman SK, Cash TV, Mickens MN. Patient-reported Needs, Non-motor Symptoms, and Quality of Life in Essential Tremor and Parkinson's Disease. Tremor Other Hyperkinet Mov (NY). 2014;4:240.

7. [No author]. “Myths and Misconceptions About Parkinson’s.” Available at: https://parkinsonsdisease.net/basics/mythsmisconceptions-facts/. Accessed July 2, 2019.

8. The Michael J. Fox Foundation for Parkinson’s Research. “Michael’s Story.” Available at: https://www.michaeljfox.org/michaels-story. Accessed July 22, 2019.

9. CBS News. “Muhammad Ali's long struggle with Parkinson's disease.” June 5, 2016. Available at:
https://www.cbsnews.com/news/muhammad-ali-parkinsonsdisease/. Accessed July 22, 2019.

10. Bhattacharyya KB. Adolf Hitler and His Parkinsonism. Ann Indian Acad Neurol. 2015;18(4):387-390.

11. IMDb. “Most Popular Parkinson's Disease Movies and TV Shows.” Available at:
https://www.imdb.com/search/keyword/?keywords=parkinson %27s-disease. Accessed July 22, 2019.

12. Stoker TB, Greenland JC. Parkinson’s Disease: Pathogenesis and Clinical Aspects [Internet]. Brisbane (AU): Codon Publications; 2018 Dec.

13. Gao X, et al. Genetic determinants of hair color and Parkinson's disease risk. Ann Neurol. 2009;65(1):76–82.
14. Perlmutter JS. Assessment of Parkinson Disease Manifestations. Curr Protoc Neurosci. 2009 October; CHAPTER: Unit10.1.

15. Fasano A, Canning CG, Hausdorff JM, Lord S, Rochester L. Falls in Parkinson's disease: A complex and evolving picture.
Mov Disord. 2017;32(11):1524-1536.

16. Yusupov E, Chen D, Krishnamachari B. Medication use andfalls: applying Beers criteria to medication review in Parkinson’s disease. SAGE Open Med. 2017;5(4):205031211774367–7.

17. The Michael J. Fox Foundation for Parkinson’s Research. “Five Fall Prevention Strategies for People with Parkinson’s Disease.” Available at: https://www.michaeljfox.org/news/five-fallprevention-strategies-people-parkinsons-disease. Accessed July 22, 2019.

18. LeWitt PA. Levodopa Therapy for Parkinson’s Disease: Pharmacokinetics and Pharmacodynamics. Mov Disord.
2015;30(1):64-72.

19. Rao SS, Hofmann LA, Shakii A. Parkinson’s Disease: Diagnosis and Treatment. Am Fam Physician 2006;74:2046-54, 2055-6.

20. The Michael J. Fox Foundation for Parkinson’s Research. “FDA Approves Extended Release Levodopa-Carbidopa.” January 8, 2015. Available at: https://www.michaeljfox.org/news/fdaapproves-extended-release-levodopa-carbidopa. Accessed July 1, 2019.

21. Duopa (carbidopa and levodopa) enteral suspension package insert. St. Paul, MN: Smiths Medical ASD, Inc. 2015.

22. Parkinson’s Foundation. “PD and Medication: What’s New?” Available at: https://www.parkinson.org/blog/tips/pd-andmedication-whats-new. Accessed July 2, 2019.

23. Intec Pharma. “AP-CD/LD.” Available at: https://www.intecpharma.com/pipeline/ap-cd-ld/. Accessed July
2, 2019.

24. Mayo Clinic. “Parkinson’s Disease.” Available at: https://www.mayoclinic.org/diseasesconditions/parkinsonsdisease/diagnosis-treatment/drc-20376062. Accessed July 10,
2019.

25. Requip (ropinirole hydrochloride) package insert. Research Triangle Park, NC: GlaxoSmithKline. 2007.

26. Mirapex (pramipexole dihydrochloride) package insert. Ridgefield, CT: Boehringer Ingelheim Pharmaceuticals, Inc. 2007.

27. Neupro (rotigotine transdermal system) package insert. Smyrna, GA: UCB, Inc. 2012.

28. Parkinson’s Foundation. “Prescription Medications.” Available at: https://www.parkinson.org/UnderstandingParkinsons/Treatment/Prescription-Medications. Accessed July 2, 2019.

29. [No author]. Extended-Release Amantadine (Gocovri) for Dyskinesia in Parkinson’s Disease. Med Lett Drugs Ther.
2017;59(1535):198-200.

30. Olson KR. Poisoning & Drug Overdose, 6e New York, NY: McGraw-Hill; 2012.

31. Bortolanza M, et al. Tetracycline repurposing in neurodegeneration: focus on Parkinson’s disease. J Neural Transm (Vienna). 2018;125(10):1403-1415.

32. Hutchinson K, Wick JY. Deep Brain Stimulation and Medication Management in Parkinson's Disease. Consult Pharm.
2016;31(2):73-84.

33. Parkinson’s Foundation. “Exercise.” Available at: https://www.parkinson.org/UnderstandingParkinsons/Treatment/Exercise. Accessed July 2, 2019.

34. Parkinson’s Foundation. “Diet & Nutrition.” Available at:
https://www.parkinson.org/Living-with-Parkinsons/ManagingParkinsons/Diet-and-Nutrition. Accessed July 2, 2019.

35. Gilbert R. “Medications to be Avoided or Used with Caution in Parkinson’s Disease.” American Parkinson Disease Association. March 2018. Available at: https://www.apdaparkinson.org/wpcontent/uploads/2018/05/APDA-Meds_to_Avoid.pdf. Accessed July 7, 2019

36. Pfeiffer RF. Non-motor symptoms in Parkinson's disease. Park. Relat. Disord. 2016;22 (Suppl 1), S119–S122.

37. Parkinson’s Foundation. “Non-Movement Symptoms: Depression.” Available at: https://www.parkinson.org/UnderstandingParkinsons/Symptoms/Non-Movement-Symptoms/Depression. Accessed July 2, 2019.

38. Parkinson’s Foundation. “Non-Movement Symptoms: Anxiety.” Available at: https://www.parkinson.org/UnderstandingParkinsons/Symptoms/Non-Movement-Symptoms/Anxiety. Accessed July 2, 2019.

39. [No author]. “A Guide for Understanding Parkinson’s Disease Psychosis Hallucinations & Delusions.” American Parkinson Disease Association. Available at: https://www.apdaparkinson.org/what-isparkinsons/symptoms/psychosis/. Accessed July 10, 2019.

40. Northera (droxidopa) package insert. Deerfield, IL: LundbeckNA Ltd. 2014.

41. Xeomin (incobotulinumtoxinA) for injection package insert Raleigh, NC: Merz Pharmaceuticals. 2019.

42. Parkinson’s Foundation. “Non-Movement Symptoms: Sleep Disorders.” Available at:
https://www.parkinson.org/UnderstandingParkinsons/Symptoms/Non-Movement-Symptoms/Sleep-Disorders. Accessed July 2, 2019.

43. Parkinson’s Foundation. “Tips for People with Parkinson’s Who Want to Take Over the Counter Medications During Flu Season.” Available at: https://www.parkinson.org/blog/whatshot/over-the-counter-medications-flu-season. Accessed July 2, 2019.

44. Williams-Rice M. App Guides Parkinson’s Disease Patients Through ‘Freezing’. Futurity. April 2018. Available at:
https://www.futurity.org/parkinsons-disease-app-walking1727182/. Accessed July 30, 2019.

45. McCarthy K. Smartphone apps for those living with Parkinson's disease. NueMD. September 2017. Available at:
https://www.nuemd.com/news/2017/09/15/smartphone-appsthose-living-with-parkinsons-disease. Accessed July 30, 2019