Practice tips

• Levodopa is the gold standard for therapy.

• Longer acting levodopa preparations may reduce the 'end of dose' failure effect but remember the possible need for a 'kick start' with short-acting preparations, e.g. first thing in the morning.

• Ensure that a distinction is made between drug-induced involuntary movements and the tremor of Parkinson's disease.

• Keep the dose of levodopa as low as possible to avoid these drug-induced involuntary movements.

• In the elderly with a fractured hip always consider Parkinson's disease (a manifestation of disequilibrium).

• Remember the balance of psychosis and Parkinson's disease in treatment.

• Keep in mind the 'sundown' effect—patients often go psychotic as the sun goes down.

• Don't fail to attend to the needs of the family, who often suffer in silence.

• Bromocriptine and pergolide should be used very cautiously in the elderly because of possible acute psychotic reactions.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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