HuBio 564: Principles of Pharmacology II
Case Study 6
A 54 year old man begins to notice some trembling of his right hand. This is first noticed when he takes a bottle of milk from the refrigerator, but then seems to also occur when drinking from a glass. You decide that he has Essential tremor.
1. What medications would be indicated for this diagnosis? What side effects might be anticipated? How will you explain the mechanisms of drug action and these anticipated effects to the patient?
Though slight improvement is noted, after a year he notices tremor of that hand when he is walking, and when he is sitting watching television. You now notice some increase in tone at the rest, and slowness of movement in addition to a rest tremor. You change your diagnoses to Parkinson's disease, and you initiate therapy with Pramipexole (Mirapex).
2. What side effects may occur with this medication? How is this drug administered?
He gets some relief of his tremor, but the tremor does not entirely subside, and he begins to also be concerned about slowness of movement that interferes with abilities to button and unbutton. He feels he needs additional medication. You initiate treatment with levadopa.
3. What forms of levodopa are available? Explain which one you choose for this patient and explain why?
After being on carbidopa/levodopa for several years he begins to be concerned about restless movements that occur in his limbs and trunk.
4. What are these movements called, and what can be done to control them?
After several years, the patient begins to notice vivid dreams and even visual hallucinations, where he sees people in his den that prevent him from watching television. These continue even though he tries to reduce his medicines.
5. What would you do in this situation? What will you say to him and his family? Are there medications that can improve hallucinations?
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