Assignment Task:
Mr. Garcia, A 66-year-old man comes into the medical office for evaluation of a tremor. He has noticed a progressively worsening tremor in his hands for the past 6 months. The tremor is worse when he is resting and improves a little when he reaches for an object or is using his hands. He has noted that it is not as easy to "get going" when he stands up to walk. He takes several small, "shuffling" steps before he can reach his full stride. He has no significant medical history and takes only an aspirin a day. On examination you note that his face is fairly expressionless; he has a pill-rolling-type tremor of his hands at rest and has cogwheel rigidity of his arms.
The primary care provider (PCP) has diagnosed the client with Parkinson's Disease (PD), which is a slowly progressive disease that affects a small area of cells in the mid brain known as the substantia nigra. Gradual degeneration of these cells causes a reduction in a vital chemical known as dopamine. Parkinson's disease belongs to a group of conditions called motor system disorders. Parkinson's and related disorders are the result of the loss of dopamine-producing brain cells. Dopamine is a chemical messenger responsible for transmitting signals within the brain. Parkinson's disease occurs when certain nerve cells, or neurons, die or become impaired. Normally, these neurons produce dopamine. Loss of dopamine causes the nerve cells to fire out of control, leaving patients unable to direct or control their movement in a normal manner.
Mr. Garcia has been receiving treatment for the PD for 6 weeks. He comes to the medical office for a check-up and he reports that he is having trouble with depression and insomnia. When observing the client, you notice that his tremor is still present, and his head is slightly- bobbing to the side when he is sitting still. The PCP orders several additional medications and changes the daily dosages of his current medications to treat the non-intended effects from the medications used to treat PD.
The PCP orders a decrease in the dosages of the PD medications Antipsychotics and Anticholingergics and adds an additional medication that may be beneficial to decrease the side effects (depression and insomnia).
What can the PCP order to treat the head bobbing movement?