Difference between Parkinson's disease and drug-induced parkinsonism

This article discusses the difference between Parkinson's disease and drug-induced parkinsonism, focusing on their pathophysiology and treatment. It also includes a critical analysis of the evidence presented and justification for the answer.

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NURSING CASE STUDY

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Contents
Question 1..................................................................................................................................3
1a. What is the difference between Parkinson's disease and drug-induced parkinsonism?
Think in terms of pathophysiology and treatment.................................................................3
1b. Using your pathophysiology and pharmacology knowledge, do you agree with Tony or
Penny? Your answer must include a critical analysis of the evidence that has been
presented and justification for your answer...........................................................................4
Question 2..................................................................................................................................4
2. Provide a rationale for each of the changes made to her medication.................................4
Question 3..................................................................................................................................6
3a. Is the drug Phentermine a suitable option to help Mrs Morris lose weight, provide a
rationale for your answer.......................................................................................................6
3b. Should Mrs Morris take up running to help with her weight and blood sugar levels?
Provide a rationale for your answer.......................................................................................7
3c. Mrs Morris has type two diabetes and is currently being treated with Glipizide. Explain
the pathogenesis of type two diabetes, and explain how the drug family Glipizide belongs
to can help treat this condition at the cellular level................................................................7
References:.................................................................................................................................8

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Question 1
1a. what is the difference between Parkinson's disease and drug-induced parkinsonism?
Think in terms of pathophysiology and treatment.
Parkinson’s disease is the major result behind the neural dysfunction in the brain. This
will affect the human nervous system slowly. The development of this disease is very slow.
In such cases, people who are suffered from Parkinson’s disease may live a long life but can
never live a healthy life. In such case this will generally affect the motor neurons for which
people will suffer stiffness, speech disorder, unstable motion and movements will become
very slow (Poewe et al., 2017). This kind of disease leads people towards depression, anxiety
and digestive disorder as well. Proper medication can control the damage and destruction.
The medicines must be containing pramipexole, pergolide, ropinirole and bromocriptine.
These chemicals will help the neuron to control the stimulation of the dopamine.
The Parkinsonism is also a neurological disorder. It is kind of similar to Parkinson's
disease as well. But drug-induced Parkinsonism occurs due to excessive use of drugs. The
drugs like cocaine, brown sugar will increase the level of dopamine which is the reason
behind the damage of the nervous system. In such a case, people are suffering from distorted
speech, unstable movement, shaky hands etc. In such case there is no proper medication can
help the patient to be cured unless he or she stops themselves from taking drugs.

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1b. Using your pathophysiology and pharmacology knowledge, do you agree with Tony
or Penny? Your answer must include a critical analysis of the evidence that has been
presented and justification for your answer.
According to the medical history of Mrs Morris, she has been suffering from digestive
disorders from last 12 years. She has been suffering from osteoarthritis from last 20 years.
She is also a patient of diabetes from last 22 years. Apart from that, she has hypertension for
a long time and she becomes anoxic recently. With her detailed diagnostic report, we can see
that her blood pressure is 152 systolic and 100 diastolic. This is considered much higher than
normal. Though she is a patient of type II diabetes still her sugar level in blood is under
controlled. But the potassium level in blood is very high. She has akathisia and tardive
dyskinesia. Those are the preliminary symptoms of Parkinson's disorders. Though she
explained some problems she was facing throughout which are also similar to Parkinson's
disease as well (Poewe et al., 2017). She is struggling to stand still. Her movement becomes
slower than normal. She cannot even cross her legs as well. We can see she has been
suffering from her movement. These are the main symptoms of Parkinson’s disease.
Question 2
2. Provide a rationale for each of the changes made to her medication.
In the past medical history of Mrs Morris, we can see that she has been suffering from
various different problems from the last 30 years. She is a patient of osteoarthritis, type II
diabetes and hypertension as well. She has been suffering from digestive disorder for a long
time. In a recent diagnosis, it can be seen that she is suffering from a peptic ulcer as well. As
she was dealing with various diseases for a long time there is some medicine she had been
taken for a long period of time. She consumed pramin 10 mg which have metoclopramide

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hydrochloride. She had been consuming this as she was suffering from a sleeping problem for
her depression and anxiety issues. She had to take Orudis SR from the last three years. The
chemical composition of this medicine is ketoprofen. She took this medicine daily as she was
suffering from chronic fever and pain in her abdominal area and sometimes in her leg as well.
These medicines are used as a pain reliever. Now the scenario has been changed as she is
diagnosed with peptic ulcer.so the doctors changed the medicines and prescribe her to take
paracetamol osteo 665 mg. This is a high dose of medicine. She took arthrexin 25 mg for her
arthritis problem from last year. The chemical composition of this medicine is indometacin.
This is also a pain reliever but it is used only for reliving the pain of arthritis. In such cases,
she needs to intake a pain killer daily. She needs to rake paracetamol osteo tablet twice in a
day. We have been discussed before that she was suffering from high depression and anxiety
issues. In such cases, she was struggling with having a peaceful sleep. In such a case, she
needs to intake pramin tablet in a day regularly. Now the issue has become larger. She is still
suffering as well as struggling with sleep disorders. Her mental health becomes deteriorated.
Thus the doctor prescribed her to take domperidone 10 mg. She needs to take this medicine
once in a day. In such a case, her medicine becomes stronger than previous. In her recent
blood pressure test, we can see her systolic and diastolic pressure both are extremely high.
Though she was a patient of hypertension still her blood pressure was not that much higher in
previous (Leung et al., 2017). In previous, she took adesan 4 mg. The chemical composition
of this medicine is candesartan. Now as her blood pressure is much higher so her doctor
increases her dose of this medicine. She has been prescribed to take the same medicine from
4 mg to 8 mg. She had been suffering from chronic type two diabetes for a long time. In such
a case, she consumes minidab3 tablet with 5 mg dose daily. now in recent bold sugar test, it
can be seen that her blood glucose level is under control. But still, she has been prescribed to

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take that dose regularly. Moreover, she should be careful about diet and food habits as well.
She cannot consume alcohols as well.
Question 3
3a. Is the drug Phentermine a suitable option to help Mrs Morris lose weight, provide a
rationale for your answer.
In recent checkup, it has been shown that her BMI value is noticeably higher than
normal. This kind of situation comes as she had become bulky and healthy in recent days.
Her weight becomes an issue for her healthy lifestyle. She becomes obese. This will increases
the risk factors of her life day by day. In such cases, the needs to lose her weight as soon as
possible. Obesity is the primary reason behind hypertension and diabetes as well. As we can
see her blood pressure level is much higher thus it is important for her to reduce the weight as
early as she can. In order to the situation, Tony suggested that if she took phentermine daily
she can lose her weight much earlier. This medicine is very effective in such cases but this
medicine has some risky side effects also. This medicine can decrease her appetite and she
can lose her weight very quickly (Verro & Wong, 2015). The primary side effects of this
medicine are constipation, diarrhoea, upset digestive system, vomiting etc. Sometimes a heart
attack or stroke also occurs due to the intake of this medicine. Thus, in my opinion, Mrs
Morris should not take medicines for losing her weight she must go with the idea of which
penny proposed.

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3b. Should Mrs Morris take up running to help with her weight and blood sugar levels?
Provide a rationale for your answer.
In my opinion meditation, yoga and daily exercise is a very effective way of losing
weight. I think Mrs Morris should exercise daily. as per the medical condition, she cannot do
heavy exercises as she is patient of osteoarthritis. In such cases, the needs to do some
freehand exercises daily for at least 1 hour. In such a case, yoga will be very helpful. This
will be helpful for her not losing her weight also with the help of this she can solve her
problems in sleeping due to her unstable mental health condition. Exercise is not enough.
Side by side she needs to take proper food and she needs to follow a proper diet chart as well.
This exercise thing is completely side effect free, whereas she can reduce all of her other
issues with the help of the exercise and meditation procedures. Regular exercise can also her
to reduce her blood sugar level and blood pressure level as well (Leung et al., 2017). The
mind, digestive system and another system will work very effectively. Maybe she can be
cured with her osteoarthritis problems also with the help of the routine exercise.
3c. Mrs Morris has type two diabetes and is currently being treated with Glipizide.
Explain the pathogenesis of type two diabetes, and explain how the drug family
Glipizide belongs to can help treat this condition at the cellular level.
Mrs Morris is suffering from type II diabetes which is called diabetes mellitus for a
long period of time. More than 40 million people around the world have been suffered from
diabetes mellitus. Firstly this kind of situation can be genetic. But some time unhealthy food
habits or social and economic stress and excessive pressure can also be a reason behind this
kind of situation. This disease can be proved as life-threatening if it is not controlled with
proper medication and food habits. This kind of situation appears due to the lack of

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production of insulin from beta cells of our islets of Langerhans. Thus this kind of situation
arose due to the lack of resistance to insulin. This kind of situation actually found to those
people who are generally overweight. The extra amount of fats resist the action of insulin
inside our body (Inzucchi et al., 2015). Thus our muscles, digestive systems, fat cells and
liver cannot use the insulin properly. Thus the glucose level becomes higher into our blood.
Insulin can suppress the excessive enter of glucose into our blood and blood vessels. In such
a scenario, the pancreas cannot work properly to produce insulin and the sugar level into
blood increases. Glipizide can stimulate the action of the pancreas and with the help of this
medicine pancreas, can secrete insulin rapidly. Thus the blood sugar level comes under
control.
References:
Inzucchi, S. E., Bergenstal, R. M., Buse, J. B., Diamant, M., Ferrannini, E., Nauck, M., ... &
Matthews, D. R. (2015). Management of hyperglycemia in type 2 diabetes, 2015: a
patient-centered approach: update to a position statement of the American Diabetes
Association and the European Association for the Study of Diabetes. Diabetes
care, 38(1), 140-149.
Leung, A. A., Daskalopoulou, S. S., Dasgupta, K., McBrien, K., Butalia, S., Zarnke, K. B., ...
& Gelfer, M. (2017). Hypertension Canada's 2017 guidelines for diagnosis, risk
assessment, prevention, and treatment of hypertension in adults. Canadian Journal of
Cardiology, 33(5), 557-576.
Poewe, W., Seppi, K., Tanner, C. M., Halliday, G. M., Brundin, P., Volkmann, J., ... & Lang,
A. E. (2017). Parkinson disease. Nature reviews Disease primers, 3, 17013.

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Verro, P., & Wong, V. S. (2015). Phentermine association with a case of hemorrhagic
posterior reversible encephalopathy syndrome. The neurologist, 19(4), 119-120.