Mr. Carl, age 62 years old, has been diagnosed with Parkinson’s disease (PD). He lives in
downtown Toronto with his wife of 25 years. His initial symptoms were depression,
monotonous, indistinct speech, stooped posture, loss of energy, and hand tremors. His
physician started him on Sinemet® 300mg/day PO (levodopa-carbidopa combination).
While discussing his medication history with him, you find out that he takes a B-complex
a multivitamin that contains vitamin B6. He also tells you that his wife Sandra has told him to
take some of her phenothiazine (an antipsychotic) since she thinks it may “lift him out of
his depressed mood.”
A year has passed, and his symptoms have worsened when you see Mr. Carl again. He feels
muscle rigidity, fixed facial expressions, slowed movement, arm numbness, and cognitive
difficulty. His physician has changed his Sinemet® to Stalevo® 100 (levodopa-carbidopa-
entacapone combination); he has also added pramipexole (Mirapex ER), a dopamine
agonist, and an antidepressant for his mood disorder.
1.Mr. Carl has some difficulty in understanding how levodopa works. Provide a written
dialogue of what you would say to Mr. Carl regarding the mechanism of action, why is
carbidopa added to the combination, some of the adverse effects, and how they can be
managed?
2. Explain why Mr. Carl’s physician has switched him from Sinemet® to Stalevo® 100 at
his follow-up appointment.
3. Mr. Carl asks if he can continue taking his multivitamin while taking Sinemet®. What
can you tell him about taking the multivitamin while taking levodopa medication?
4.Explain why Mr. Carl’s physician has switched him from Sinemet® to Stalevo® 100 at
his follow-up appointment.
5.Mr. Carl has been instructed to stop taking his wife’s antipsychotic. He is not happy
with this decision, nor is his wife. Mr. Carl’s wife states, “…he is happier now…how
dare you tell him to stop taking the medication!” What is your initial nursing response
to Mr. Carl’s wife? Following your initial reaction, how do you explain to Carl’s why taking his wife’s medication is not a good idea?