Parkinson Dɔnɔ le Kɔdzi: Nusita Sinemet/Levodopa ƒe Bubu le Ɣeyiɣi Dzi Alo Haldol Xɔxɔ Hea Sesẽme Si Wua Ame¶

Woxɔa ame siwo wu 300,000 siwo ŋu Parkinson ƒe dɔléle (PD) le ɖe kɔdzi ƒe sia ƒe ɖe anyidzedze, akɔta ƒe gbagbã, aɖuɖɔtoe me dɔléle, aklãdɔ, alo amekoko siwo wowɔna edziedzi ta, eye Parkinson ƒe Dɔwɔha ƒe dɔdamɔnu ŋuti numekukuwo ɖee fia be Parkinson dɔnɔ 4 le kɔdzi la kpea fu le kuxi siwo woate ŋu axe mɔ na siwo tso kɔdzitike siwo wozãna ɖaa dzi tẽ ɖoɖowɔɖiwo. Le kɔdzixɔ alo Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ si bɔ me la, dɔnɔdzikpɔlawo ƒe ɖoɖo si wowɔna ɖaa ɖe mɔ be woado "atike siwo woano edziedzi" le afi sia afi le gaƒoƒo 1 va ɖo 2 ƒe fesre nu do ŋgɔ na ɣeyiɣi si woɖo ɖi alo le ema megbe (09:00 AM / 13:00 PM / 17:00 PM / 21:00 PM), alo léa atikekui siwo katã woano la ɖe asi keŋkeŋ ("NPO / Nothing by Mouth") esime wòle lalam be woawɔ nu mimi ƒe dodokpɔ alo amekoko.

Le dɔnɔ si ŋu Parkinson ƒe dɔléle si le titina va ɖo esi de ŋgɔ wu si ƒe ahɔhɔ̃ bu eƒe dzɔdzɔme ahɔhɔ̃meka siwo wɔa dopamine ƒe alafa memama 80 gome la, ehe carbidopa/levodopa ƒe agbɔsɔsɔme aɖe ɖe megbe (Sinemet, . Rytary, . Madopar, . Stalevo, . Prolopa) to miniti 30 va ɖo 60 gɔ̃ hã me nye atikewɔwɔ ƒe nɔnɔme kpata. Le gaƒoƒo ɖeka me le agbɔsɔsɔ si wòbu ta la, dɔnɔa ƒe ŋɔti ƒe lãmekawo tsia tsikpe (dopamine-depletion dysphagia), si wɔnɛ be woƒe lãme ʋuʋuna eye wòɖea woawo ŋutɔ ƒe aɖuɖɔ ɖe woƒe lãkusiwo me (aspiration pneumonia), woƒe gbeɖiɖikawo tsina ale be womate ŋu ayɔ kpekpeɖeŋu o, kple woƒe ŋutilã sesẽna zua lifi-pɔmpi ƒe sesẽ si me vevesese le. Nusi gavloe wue nye be woadzudzɔ levodopa zazã kpata gaƒoƒo 12 va ɖo 48, alo atike siwo wozãna edziedzi siwo xea mɔ na dopamine la dodo na dɔnɔa (D2) xɔlawo, abe haloperidol ( .Haldol), metoklopramide ( .Reglan), proklorperazine (Compazine), alo promethazine ( .Phenergan), hea Parkinsonism-Hyperpyrexia Syndrome (PHS), si nye kuxi si le abe ahɔhɔ̃mekawo ƒe dɔléle vɔ̃ɖi ene kple a 40°C+ (104°F+) dzoxɔxɔ, lãmekawo ƒe gbagbã (rhabdomyolysis), ayiku ƒe dɔmawɔmawɔ nyuie, kple ame 4 va ɖo 20 le alafa me ƒe ku. Ne Parkinson dɔnɔ aɖe ƒe lãme sẽ kpata abe ʋuƒo ene, eƒe lãme sẽ, eƒe nu mete ŋu mia nu o, eƒe lãme sẽ, alo eƒe susu trɔ la, ƒo ka na wò nutoa me ƒe xexlẽdzesi kpata (911 le United States kple Canada, . 112 le Europa Dukɔwo ƒe Habɔbɔa katã me la, . 999 le United Kingdom) alo nàbia míaƒe xexlẽdzesi siwo wozãna kpata nyatakakadzraɖoƒe. Ne èdi ame tsitsiwo ƒe kɔdzi ƒe nɔnɔme kpata siwo do ƒome kplii la, kpɔ kɔdzi ƒe alɔ̃madɔmadɔ kple atikewɔwɔ ŋuti nyaʋiʋli na ame tsitsiwo, . dysphagia: tsi tsɛwo ƒe nutete, aspiration pneumonia, kple nuɖuɖu si me wode nuɖuɖui ƒe dedienɔnɔ, kple atike geɖe dzadzra, atikewo ƒe agbɔsɔsɔ fũ, atikeawo ƒe agbɔsɔsɔ si to, kple atikekuiwo ƒe ɖoɖowɔla ƒe vodadawo.

Wɔ esia fifia¶

1. Tsɔ wò lɔlɔ̃tɔ ƒe Parkinson ƒe atikewo katã ɖe woƒe aŋetu gbãtɔ siwo dzi woŋlɔ atikewɔƒe ɖo la me yi Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo Gbɔ, eye nàbia tso ER ɖɔkta gbɔ enumake be wòana "Dɔnɔa ŋutɔ ƒe Atikewo Ðokuisi ƒe Sedede" alo "Ɣeyiɣi Vevie ƒe Ðoɖowɔɖi ƒe Sedede (Le Aɖabaƒoƒo 15 Me le Aƒeme Ɣeyiɣi Tɔxɛwo Me)." Zi geɖe la, Kɔdzi atikedzraƒewo mewɔa esia o stock ŋusẽ tɔxɛwo alo carbidopa/levodopa ƒe atike siwo woɖena ɖe go ɣeyiɣi didi (Rytary, . Sinemet CR, . entacapone, . rasagiline, . rotigotine patches) le ER Pyxis mɔ̃a me, si ana woahe ɖe megbe gaƒoƒo 8 negbe ɖe nètsɔ aƒeme aŋetuawo ɖe asi ko hafi.
2. Kpɔe ɖa be ɖɔkta si xɔe ɖe kɔdzi la ŋlɔ Carbidopa/Levodopa ɖe kɔdzi ƒe kɔmpiuta me abe "TIME-CRITICAL SCHEDULED MEDICATION" ene le dɔnɔa ƒe aƒeme gaƒoɖokui ƒe ɣeyiɣiwo tututu nu (e.g., 07:30, 11:00, 14:30, 18:00, 21:30), GBEÐE abe kɔdzi si wozãna ɖaa "TID / QID" (09:00, 13:00, 17:00, 21:00). Le Centers for Medicare & Medicaid Services (CMS) Hospital Conditions of Participation te la, ele be woado atike siwo woŋlɔ be Ɣeyiɣi Vevie le aɖabaƒoƒo 15 va ɖo 30 me tso ɣeyiɣi si tututu wowɔ ɖe ɖoɖo nu dzi, si agbɔ gaƒoƒo 2 ƒe kɔdzi dɔnɔdzikpɔkpɔ ƒe amenuveve ƒe ɣeyiɣi si woɖo ɖi ŋu.
3. Bia tso ER dɔnɔdzikpɔla kple kɔdzi ƒe atikewɔla si be wòaŋlɔ "DRUG ALLERGY / ABSOLUTE CONTRAINDICATION ALERT" si anɔ anyi ɖaa ɖe elektrɔnik atikewɔwɔ ŋuti nuŋlɔɖi me fifia na Dopamine-Blocking Drugs KAtã: Haloperidol (Haldol), ** .Metoclopramide (Reglan), ** .Prochlorperazine (Compazine), ** .Promethazine (Phenergan), ** .Droperidol (Inapsine), ** .Risperidone (Risperdal), ** .Olanzapine (Zyprexa), kple ** .Aripiprazole (Abilify)**. Atike siawo dede kɔdzi ƒe kɔmpiuta ƒe Allergy Field me zi elektrɔnikmɔ̃ dzi be woatɔ sesĩe ne zãdɔdzikpɔla alo atikewɔla si naa alɔ̃dɔdɔ ame dze agbagba be yeabia Haldol na delirium alo Reglan / . Compazine na ʋuʋudedi le dɔwɔwɔ vɔ megbe.
4. Ne kɔdzia tsɔ dɔnɔa da ɖe "NPO (Nothing by Mouth)" dzi hena amekoko, ER dɔwɔwɔ, alo numimi ƒe screen si do kpo nu la, MÈGAÐE mɔ GBEÐE be woadzo le woƒe dopamine atikeawo dzi ko. Bia tso ɖɔktaa si be wòaɖe gbe na NPO dopamine tɔdzisasrã etɔ̃ siwo le dedie la dometɔ ɖeka enumake:
5. Tiatia A: De ɣeyiɣi kpui aɖe ƒe Nasogastric (NG) Tube eye nàna carbidopa/levodopa** si wogbã enumake (IR) si wogbã ɖe tsi me (never crush extended-release CR/ER pills), ALOO
6. Tiatia B: Na Carbidopa/Levodopa si Wotsɔa Nu Me Katã (Parcopa) si lɔ̃na ɖe aɖe dzi kple aɖuɖɔ, ALOO .
7. Tiatia C: De ŋutigbalẽ me Rotigotine Dopamine Agonist Skin Patch (Neupro) be woalé dopamine ƒe gɔmedzedze ƒe ʋuʋu me ɖe asi esime dɔgboa me mete ŋu ɖoa wo gbɔ o.
8. Ne Deep Brain Stimulation (DBS) implant alo Duopa/Vyalev intestinal/subcutaneous pump le dɔnɔa ŋu la, gblɔe na ER ɖɔkta kple amekola enumake. Mègaɖe mɔ gbeɖe be woawɔ monopolar electrocautery le amekoko me ne mètsɔ DBS neurostimulator la de Surgery Mode me o, mègaɖe mɔ gbeɖe be woawɔ high-field MRI ne mèlé ŋku ɖe dɔnɔa ƒe DBS Device ID Card ŋu o Tesla/coil ƒe seɖoƒe tɔxɛwo, eye mètsi DBS batri gbeɖe o negbe ɖe nèkpɔ kuxi siwo tso dzideƒoname gbɔ koŋ gbɔ hafi.
9. Ta Parkinson ƒe Habɔbɔ si dziɖuɖua da asi ɖo si nye "Kɔdzi ƒe Dedienɔnɔ Ŋuti Mɔfiame / Atikewɔwɔ Ŋuti Nuxlɔ̃amegbalẽvi" (parkinson.org/hospital) eye nàlé Atike Siwo Womezãna O ƒe Agbalẽvi la ɖe kɔdzi ƒe aba ƒe ta tame tẽ.

Nyametsotsoti: Parkinson dɔnɔ aɖe takpɔkpɔ tso esime woge ɖe ER me¶

flowchart TD
    A["Parkinson ƒe Dɔléle Dɔnɔ Va Vana Kɔdzi ER alo Amekoko Do Ŋgɔ Na Dɔwɔwɔ"] --> B["Afɔɖeɖe 1: Asi Dɔnɔ na Aƒeme Atikekui ƒe Aŋetuwo + Bia ‘Ɣeyiɣi-Vevietɔ Aɖabaƒoƒo-Aɖabaƒoƒo ƒe Agbɔsɔsɔme Pɛtɔ’ (Le Aƒeme Ðoɖowɔɖi ƒe Aɖabaƒoƒo 15 Me)"]
    B --> C["Afɔɖeɖe 2: Ŋlɔ ‘Haloperidol, Metoclopramide, Prochlorperazine, Promethazine, Risperidone, Olanzapine’ ɖe EMR ALERGY / NUSIWO WOTSƆ ÐE NU GBƆGBƆ ƑE Nuxlɔ̃ameɖaka me"]
    C --> D{"Ðe Dɔnɔa Ate Ŋu Ami Atikekui Blibowo Dedie Fifiaa?"}
    D -->|"Ẽ: Mimi Intact & Menye NPO o"| E["Na Aƒeme Agbɔsɔsɔme Tsitɔ Le Ɣeyiɣi Dzi (Na Tsi Nanɔ Tsitrenu; Yamenutome Protein Nuɖuɖuwo Didi Aɖabaƒoƒo 30-60 Tso Levodopa Gbɔ)"]
    D -->|"Ao: Dɔnɔ Nye 'NPO' na Amekoko ALOO Choking / Failing Swallow Screen"| F{"Nukatae Womate Ŋu Ami Atikekui Blibowo O?"}
    F -->|"1. Ʋuʋudedi Esi Wohe Woƒe Levodopa ƒe Agbɔsɔsɔ Mamlɛtɔa Hehe Ðe Eme Ta (‘Off-State Dysphagia’) ."| G["Na Carbidopa/Levodopa (Parcopa) si Wono alo Crushed IR Sinemet le Applesauce me -> Gbugbɔ do Swallow kpɔ 45 Mins EMEGBE le 'ON' Nɔnɔme me"]
    F -->|"2. Strictly NPO na Dɔgbo ƒe Mɔxexe, Intubation, alo Amekoko Gã"| H["MÈGATSƆ Dopamine GBEÐE O: De NG Tube na IR Carbidopa/Levodopa Suspension si Wogbã ALOO De Transdermal Rotigotine Patch (Neupro) ."]
    E --> I{"Ðe Dɔnɔa Xɔ Asrã Kpata >38.5°C, Sesẽ si Le Abe Board-Like Rigidity, Tɔtɔ, alo CK Kɔkɔa?"}
    G --> I
    H --> I
    I -->|"Ẽ: Wosusu be Parkinson-Hyperpyrexia Syndrome (PHS) ƒe dɔléle ."| J["ICU KPEKPEÐEŊU: Gbugbɔ dze Levodopa gɔme enumake to NG Tube + IV Fluids + Active Cooling + IV Dantrolene / Oral Bromocriptine dzi"]
    I -->|"AO: Eli ke"| K["Ʋuʋu tso aba dzi 3x/ŋkeke kple PT be nàxe mɔ ɖe orthostatic hypotension kple deconditioning nu"]

Kɔdzitike siwo le dedie kple esiwo ŋu woxe mɔ ɖo na dɔnɔ siwo ŋu Parkinson ƒe dɔlélea le¶

Ta kɔdzi ƒe atikewɔla, atikewɔla, ER dɔnɔdzikpɔla, kple kɔdzi ƒe atikewɔla ɖesiaɖe si le wò lɔlɔ̃tɔ dzi kpɔm alo nàtsɔe afiae:

Nusitae Carbidopa/Levodopa ƒe heheɖemegbe aɖabaƒoƒo 60 hea "Kɔdzi ƒe Downward Spiral" vɛ.¶

Zi geɖe la, kɔdzi dɔnɔdzikpɔla siwo kpɔa dɔnɔ alafa geɖe siwo le atikewɔƒewo katã dzi la menya nusitae Parkinson dɔnɔ aɖe ƒe ƒomea tsia dzodzodzoe ne... 10:00 AM levodopa atikekui la meva ɖo haɖe o 10:45 AM. Ðe "Hospital Dopamine Spiral" me na anyigba dɔnɔdzikpɔla eye nàxɔ fe na dɔnɔdzikpɔla enumake:

1. "Atikewɔwɔ ƒe Fesre" si le Tsitsim le Parkinson ƒe Dɔléle Deŋgɔ me¶

Le Parkinson ƒe dɔlélea ƒe gɔmedzedze la, substantia nigra ahɔhɔ̃meka siwo tsi agbe la gakpɔtɔ sɔ gbɔ be woadzra dopamine ɖo eye woaxe mɔ ɖe atikekui si tsi megbe nu gaƒoƒo 3 alo 4. Kaka Parkinson ƒe dɔlélea naxɔ ƒe 5 va ɖo 10 la, lãmenugbagbevi mawo siwo wodzrana ɖo la nu yi: dɔnɔa ƒe ŋutete be wòaʋuʋu, aƒo nu, ahami nu nɔ te ɖe levodopa ƒe atikekui ɖesiaɖe ƒe aɖabaƒoƒo 90 ƒe agbenɔƒe afã le ʋumenugbagbevi dzĩ me dzi tẽ.

Ne kɔdzi aɖe he atike ƒe agbɔsɔsɔme aɖe ɖe megbe aɖabaƒoƒo 60 la, nudzɔdzɔ ene siwo me afɔku le dzɔna ɖe wo nɔewo yome kabakaba:

1. Aɖabaƒoƒo 45, "Wearing-Off" Ʋuʋudedi, Dzimaɖitsitsi, kple Vevesese ƒe Dystonia: Dopamine ƒe agbɔsɔsɔ le striatum me dzi ɖena kpɔtɔna ŋutɔ. Dɔnɔa xɔa ʋuʋudedi sesẽ le ɖiɖiɖemeɣi, ememe vɔvɔ̃ sesẽ kple dzimaɖitsitsi (si nye atikewo ƒe dopamine-ɖiɖi ƒe dzesi si kɔdzidɔwɔlawo bua vodadatɔe zi geɖe be enye "tagbɔdɔléle ƒe ʋuʋu"), kple afɔbidɛwo, nyiviwo, kple kɔ ƒe ʋuʋu si me vevesese le.
2. Aɖabaƒoƒo 60, "Off-State Dysphagia" (Frozen Swallowing): Aɖuɖɔtoe kple nuɖuɖutome lãmekawo hiã dopamine be wòawɔ ɖeka kple nu mimi ƒe dɔwɔwɔ. Ne dɔnɔa nya ge ɖe "OFF" nɔnɔme me ko la, womegate ŋu mia nu dedie o, si fia be ne dɔnɔdzikpɔla la zɔ aɖabaƒoƒo 90 megbe mlɔeba kple atikekui blibo kplu ɖeka la, dɔnɔa ƒoa nu azɔ le atikekuiawo ta.
3. Aɖabaƒoƒo 75, Nuƒoƒo ƒe Dɔdamɔnu "NPO Mɔ̃": Esi dɔnɔa kɔ akɔta esime wònɔ agbagba dzem be yeami yewoƒe atikekui siwo tsi megbe le "OFF" nɔnɔme me ta la, dɔnɔdzikpɔla tsɔ dɔnɔa da ɖe "Strict NPO (Nothing by Mouth)" dzi eye wòɖe gbe be woawɔ Speech-Language Pathology (SLP) mimi ƒe dodokpɔ hena etsɔ. Esi wònye be dɔnɔa nye NPO fifia ta la, dɔnɔdzikpɔla la xea mɔ na... 14:00 PM, . 18:00 PM, kple 22:00 PM levodopa ƒe agbɔsɔsɔmewo hã.
4. Gaƒoƒo 12 va ɖo 24, Complete Akinetic Freeze, Aspiration Pneumonia, kple Delirium: Ne woxɔ dopamine katã le dɔnɔa si gaƒoƒo 12+ ta la, megate ŋu ʋãna kura o ("tsikpe le aba dzi"), etsɔa woawo ŋutɔ ƒe nu me tsi siwo woƒo ƒu ɖe woƒe lãkusiwo me, xɔa aklãdɔ kple delirium si woxɔ le kɔdzi, eye wòzua spirals yi ŋgɔ Parkinson ƒe dɔléle-Hyperpyrexia ƒe Dɔléle.

2. Alesi woagbã "Swallow Screen NPO Trap" si le abatia to¶

Ne dɔnɔdzikpɔla alo ɖɔkta aɖe gblɔ be: "Fofowò kɔ tsi tsɛ aɖe dzi le ER mimi ƒe dodokpɔ me, eyata enye NPO eye mate ŋu axɔ eƒe Sinemet atikekuiwo o," de nu nyaa me enumake kple dɔdamɔnu etɔ̃ siawo:

• Se 1 (Mègado Parkinson Dɔnɔ ƒe nu mimi kpɔ gbeɖe o ne wole "OFF" Nɔnɔme me): Dodokpɔ na Parkinson dɔnɔ ƒe nu mimi ne wowu enu gaƒoƒo 3 hena levodopa ka ɖe edzi be woado kpo nu. Bia ɖɔktaa be wòana Oral Disintegrating Carbidopa/Levodopa (Parcopa) le aɖe dzi, alo Crushed Immediate-Release (IR) Carbidopa/Levodopa si wotsaka le teaspoon 1 si nye akɔɖu ƒomevi aɖe alo pudding me, lala aɖabaƒoƒo 45 hafi dopamine la natrɔ dɔnɔa ƒe ŋɔti ƒe lãmekawo "ON", eye emegbe na Nuƒoƒo-Gbegbɔdɔŋutinunyala nawɔ nu mimi ƒe dodokpɔ.
• Se 2 (Tɔtrɔ Ðe Eteƒe Dedie Ne Womate Ŋu Agbã Atikekui Siwo Me Woɖea Asi Le Eteƒe Didi O):
• MÈGATU Carbidopa/Levodopa si me woɖea asi le eŋu didi (Sinemet CR / . ER) alo chew Extended-Release Capsules (Rytary) ne dɔnɔa mete ŋu mi atikekui blibowo o. Togbɔ be Rytary woate ŋu aʋu atikekuiwo nyuie eye woatsɔ akɔɖuawo ahlẽ ɖe akɔɖumi dzi evɔ womaɖu dzonuawo o, . Sinemet CR ele be woatrɔ atikekuiwo woazu Immediate-Release (IR) Carbidopa/Levodopa ƒe agbɔsɔsɔ si sɔ (zi geɖe la, woɖea miligram ƒe agbɔsɔsɔme bliboa dzi kpɔtɔna alafa memama 25 va ɖo 30 be woabu IR ƒe nugbagbewo ƒe dɔwɔwɔ si lolo wu eye woadoe enuenu vie) hafi woagbã wo hena NG-mɔ̃.
• Se 3 (Levodopa-to-NG-Tube kple Rotigotine Patch ƒe Trɔtrɔ ƒe Akɔntabubuwo De pɛpɛpɛ):
• Ne Parkinson dɔnɔ aɖe nye NPO vevie na ƒodo ƒe dɔwɔwɔ, dɔgbo ƒe mɔxexe, alo mɔ̃ ƒe yaƒoƒo le ICU la, ele be kɔdzi ƒe atikewɔla kple ahɔhɔ̃ŋutinunyala nabu woƒe Levodopa Equivalent Daily Dose (LEDD) ale be gaƒoƒo zero ƒe dopamine ƒe nutsyɔtsyɔ nabu:
• Nasogastric (NG) Tube Tsi Suspension Protocol: Enumake-Asiɖeɖe le eŋu (IR) Karbidopa/Levodopa ( .25/100 mg) kpetikewo lɔ̃na kabakaba le 30 mL (1 fl oz) ƒe pɔmpi me tsi si ƒe dzoxɔxɔ le xɔme (alo carbonated water/ascorbic acid solution) le miniti 5 me ne wotsɔe ƒo xlãe blewu evɔ mahiã be woagbãe vevie o. Klɔ NG-mɔ̃a kple 30 mL tsi do ŋgɔ na levodopa si me wode tsii la dodo kple emegbe, eye nàbla NG-mɔ̃a be wòano aɖabaƒoƒo 30 va ɖo 45 ya teti le atikeawo dodo ɖesiaɖe megbe ale be dɔgboa naxɔ atike la.
• Rotigotine si wotsɔna tsoa ŋutigbalẽ me (Neupro) Patch Bridge (Ne Womate Ŋu Azã Dɔgboa O): Ne dɔléle si nye paralytic ileus, dɔgbo sue aɖe xe mɔ na dɔnɔa, alo dɔgbo ƒe anastomosis nyitsɔ laa si me NG-tube tsi gɔ̃ hã mate ŋu axɔ o la, bia ahɔhɔ̃ŋutinunyala be wòatsɔ gaƒoƒo 24 ƒe Transdermal Rotigotine Dopamine Agonist Patch (Neupro, si woate ŋu akpɔ le 2 mg, . 4 mg, . 6 mg, kple 8 mg/24 hr patches) be woakɔ ŋutigbalẽ si le abɔta, abɔta, ƒodo, alo ata ŋu (woatrɔ teƒewo gbesiagbe eye woaɖe aluminum-backed patch la ɖa hafi woawɔ MRI scan ɖesiaɖe be ŋutigbalẽa nagafiã o).
• Kpɔ nyuie tso Tube-Feeding Protein Blocking Levodopa Absorption ŋu: Nuɖuɖu me amino acids (protein) ʋlia ho kple levodopa tẽe hena ʋuɖoɖo to dɔgbo ƒe gli kple ʋu-ahɔhɔ̃ ƒe mɔxenu dzi (large neutral amino acid transporter). Ne wotsɔ wò lɔlɔ̃tɔa da ɖe tsi nuɖuɖu le dɔgboa me dzi gaƒoƒo 24 atraɖii (Jevity, . Osmolite, . Ensure) to NG alo PEG mɔ̃ dzi la, protein gbogbo si le mɔ̃a ƒe nuɖuɖu me axe mɔ na woƒe levodopa si wogbã la ƒe alafa memama 70 be wòagaɖo woƒe ahɔhɔ̃ me o, si ana woatsi tsikpe me togbɔ be wole woƒe atikekuiwo xɔm hã. Bia tso atikewɔla kple nuɖuɖuŋutinunyala si be lé mɔ̃a ƒe nuɖuɖu nana ɖe asi aɖabaƒoƒo 60 DO ŊGƆ na eye miniti 30 va ɖo 60 le levodopa ƒe agbɔsɔsɔ ɖesiaɖe si woɖo ɖi megbe (alo atrɔ ɖe bolus ŋkeke/zã ƒe cyclic tube nuɖuɖu siwo ŋu wowɔ ɖoɖo ɖo le levodopa fesrewo ŋu).

Deep Brain Stimulation (DBS) kple Duopa/Vyalev pɔmpi ƒe nɔnɔme kpatawo le kɔdzi¶

Ame tsitsi akpe ewo siwo ŋu Parkinson ƒe dɔlélea le la ɖoa ŋu ɖe ahɔhɔ̃mekawo ƒe dɔwɔwɔ ƒe Deep Brain Stimulation (DBS) (siwo Medtronic, Abbott/St. Jude, alo Boston Scientific wɔ) alo pɔmpi siwo wodona ɖe lãme na ame atraɖii (Duopa carbidopa/levodopa enteral gel to PEG-J tube, alo Vyalev / ** Produodopa Foscarbidopa/foslevodopa dodo ɖe ŋutigbalẽ te gaƒoƒo 24). Ne dɔnɔ aɖe si si mɔ̃ siawo dometɔ ɖeka le ge ɖe Dɔwɔƒe si Kpɔa Nudzɔdzɔ Kpatawo alo Amekokoxɔ me la, kɔdzidɔwɔla siwo menya nu tso mɔ̃awo ŋu o ate ŋu ana ahɔhɔ̃a naxɔ abi le vo me alo ahe dopamine ɖeɖeɖa ƒe kuxi sesẽ aɖe vɛ.

1. Kɔdzi ƒe dedienɔnɔ ŋuti se vevi etɔ̃ siwo ku ɖe Deep Brain Stimulation (DBS) ƒe atike siwo wotsɔ dea ame me ŋu¶

2. Nusi woawɔ ne Duopa (PEG-J) alo Vyalev (Subcutaneous) Infusion Pump dzudzɔ dɔwɔwɔ le ER me¶

• Mègana kɔdzi dɔnɔdzikpɔla natsi Duopa alo Vyalev pɔmpi gbeɖe ne wometsɔ nu me/NG levodopa xɔnametɔdzisasrã enumake o:
• Dɔnɔ aɖe si le Duopa (carbidopa/levodopa enteral suspension) pɔmpi alo Vyalev (foscarbidopa/foslevodopa) pɔmpi si le ŋutigbalẽ te xɔa woƒe gbesiagbe dopamine ƒe alafa memama 100 ɣesiaɣi to pɔmpi ma dzi.
• Ne PEG-J dɔgbo ƒe mɔ̃a xe/ɖe le eme, ne pɔmpia ƒe kasɛtwo vɔ le ER la me, alo ne dɔnɔdzikpɔla la ɖe pɔmpia ɖa hena CT scan eye wòŋlɔ be be yeagadze egɔme ake la, dɔnɔa ƒe ʋumenugbagbeviɣi levodopa ƒe agbɔsɔsɔ dzi ɖena kpɔtɔna va ɖoa zero le aɖabaƒoƒo 60 me.
• Emmediate Rescue Protocol: Klɔ Duopa PEG-J tube si xe la blewu kple tsi dzodzoe to Luer-lock syringe zazã me (never push against hard resistance). Ne pɔmpi alo kasɛt la mele kɔdzi ƒe atikedzraƒe o la, ele be ɖɔktaa nabu dɔnɔa ƒe ŋkeke + ŋdi bolus miligram miligram ƒe levodopa ƒe agbɔsɔsɔme bliboa enumake eye wòana nu me alo NG-tube si sɔ kplii le Carbidopa/Levodopa si woɖena ɖe go enumake gaƒoƒo 2 va ɖo 3 ɖesiaɖe gaƒoƒo bliboa katã vaseɖe esime ƒomea natsɔ pɔmpi kasɛt yeyewo tso aƒeme.

"Parkinson-Hyperpyrexia Syndrome" (PHS / Dopamine Withdrawal Crisis) ƒe dzesidede kple edada .¶

Parkinson-Hyperpyrexia Syndrome (PHS), si woyɔna hã be Akinetic Crisis alo Neuroleptic Malignant-Like Syndrome (NMLS), nye ahɔhɔ̃mekawo ƒe dɔléle kpata si wua ame wu le Parkinson ƒe dɔlélea me. Edzea egɔme ne wodzudzɔ dɔnɔ ƒe dopaminergic atikewo zi ɖeka alo ɖe edzi gaƒoƒo 12 va ɖo 72 (le NPO ƒe nɔnɔme, dɔgbo ƒe dɔwɔwɔ, ICU, alo atikekui ƒe aŋetu siwo bu me), ne dɔlékui alo tsikuɖiɖi xe mɔ na dɔgboa ƒe xɔxlɔ̃, alo ne atike si xea mɔ na dopamine (Haldol, . Reglan) la na.

flowchart TD
    A["Parkinson Dɔnɔa To Levodopa Ŋu >Gaƒoƒo 12 ALOO Exɔ Atike si xea mɔ na Dopamine (Haldol / Reglan / Compazine)"] --> B["Kpɔ Parkinson-Hyperpyrexia Syndrome (PHS) ƒe Dzesi 4 Siwo Dzesi Kpeɖeŋutɔ La Ŋu"]
    B --> C["1. Extreme ‘Lead-Pipe’ Muscular Rigidity & Akinesia (Mete ŋu ʋãa abɔwo, ƒoa nu, alo mia nu o) ."]
    B --> D["2. Dzoxɔxɔ si gbɔ eme / Dzoxɔxɔ sesẽ (38.5°C va ɖo 41.0°C+ / 101.3°F va ɖo 105.8°F+) Womeɖea eme to Dɔlékuiwo ɖeɖeko me o"]
    B --> E["3. Autonomic Instability (Ʋu ƒe sisi ƒe tɔtrɔ le gbe me, tachycardia >110 bpm, fifia fũ) ."]
    B --> F["4. Sidzedze ƒe Tɔtrɔ (Tɔtrɔ, tagbɔdɔ sesẽ, tagbɔdɔ, alɔ̃madɔmadɔ) + Serum Creatine Kinase ƒe Dzidziɖedzi (CK >1,000-10,000 U/L) ."]
    C --> G["ICU ƑE NU KPƆKPƆ KPƆKPƆ KPƆKPƆ ƑE NUÐEÐEŊUTI NUÐEÐEŊUTI"]
    D --> G
    E --> G
    F --> G
    G --> H["1. Gbugbɔ Dopamine Gbugbɔ Enumake: De NG Tube eme eye nàna Crushed Immediate-Release Carbidopa/Levodopa (alo Rotigotine Patch / Apomorphine) ƒe aƒeme ɖoɖowɔɖi si sɔ pɛpɛpɛ ."]
    H --> I["."]
    I --> J["3. Do Dantrolene Sodium (1 va ɖo 2.5 mg/kg IV) ɖe lãme na ame be wòaɖe ƒumeŋuɖui ƒe lãmekawo ƒe sesẽ dzi akpɔtɔ + Oral/NG Bromocriptine (2.5 va ɖo 10 mg TID) ."]

• Nusita Tylenol (Acetaminophen) Madzudzɔ PHS Asrã O: The 40°C (104°F) dzoxɔxɔ si le Parkinson-Hyperpyrexia Syndrome me la tsoa hypothalamic dopamine ƒe vɔvɔ kple ƒumeŋuɖui ƒe lãmekawo ƒe tete si gbɔ eme, si meɖea mɔ ɖe nu ŋu o le ŋutilã bliboa me gbɔ, ke menye dɔdzẽ ƒe cytokines ɖeɖeko o. Dzoxɔxɔ dzi ɖeɖe kpɔtɔ ƒe atike siwo wozãna ɖaa (acetaminophen / . ibuprofen) ado kpo nu negbe ɖe ƒuƒoƒoa gbugbɔ levodopa ɖo te enumake to NG-mɔ̃ dzi, tsɔ avɔ/tsikpe siwo fa miamiamia fa dɔnɔa le gota, tsɔ IV-tsi sesẽwo de eme be wòaɖe myoglobin ɖa le ayiku me, eye wona IV Dantrolene (lãmekawo ƒe gbɔdzɔe nana) alo Bromocriptine (dopamine agonist).

Nutome ƒe xexlẽdzesi siwo ku ɖe nudzɔdzɔ kpatawo ŋu kple dɔwɔƒea ƒe ɖoɖowo¶

Zã ahɔhɔ̃ŋutinunya, kɔdzi dɔnɔwo ƒe dedienɔnɔ, kple nudzɔdzɔ kpatawo taʋiʋli ƒe mɔnu siawo siwo dziɖuɖua da asi ɖo nàtsɔ akpɔ Parkinson dɔnɔ si woxɔ ɖe kɔdzi le miaƒe nutoa me ta:

• United States:
• EMS kpata / Sesẽme sesẽ alo Yameʋuɖoɖo ƒe Ʋuʋu: Yɔ 911.
• Parkinson ƒe Foundation Kpekpeɖeŋunaƒe (Dɔnɔdzikpɔlawo & Kɔdzi ƒe Dedienɔnɔ Ŋuti Nunyala): Ƒo ka na 1-800-4PD-INFO (1-800-473-4636) alo nàwɔ Kɔdzi ƒe Dedienɔnɔ Ŋuti Nuŋlɔɖi ƒe kɔpi le ** .parkinson.org/hospital**. Ne kɔdzidɔdala gbe be yemabia levodopa si xɔa ɣeyiɣi didi o alo bia dopamine mɔxenu si ŋu womeɖe mɔ ɖo o la, Parkinson ƒe Habɔbɔ ƒe Kpekpeɖeŋunaƒe ate ŋu ana dɔdaƒe ƒe agbalẽvi siwo dziɖuɖua da asi ɖo siwo me hatiwo to la wò kɔdzidɔwɔla eye wòatsɔ wò aƒo ka na kɔdzia ƒe Dɔnɔwo Teƒenɔla / Atikewɔlawo ƒe Dɔdzikpɔlagã.
• Amerikatɔwo ƒe Parkinson Dɔléle Habɔbɔ (APDA): Yɔ 1-800-223-2732 (apdaparkinson.org).
• Joint Commission / CMS Kɔdzi Dɔnɔwo ƒe Dedienɔnɔ Nyatoƒoetoto: Ne kɔdzi aɖe xe mɔ na Parkinson ƒe atike si xɔa ɣeyiɣi geɖe togbɔ be ƒomea bia tso esi hã la, bia be woakpɔ abadzivɔ gbɔ enumake kple Dɔdzikpɔƒe ƒe Afɔkuwo Dzikpɔla / Dɔnɔwo Taʋlila kple Aƒeme Ahɔhɔ̃ŋutinunya Ŋuti Aɖaŋuɖoha.
• Canada:
• Nu kpata: Yɔ 911.
• Parkinson Canada ("ACT on Time®" Kɔdzi ƒe Dɔwɔnu): Yɔ 1-800-565-3000 alo sasrãkpɔ ** .parkinson.ca** be nàwɔ ACT on Time® kɔdzitikewo ŋuti nuxlɔ̃amegbalẽvi kple atike siwo tsia aɖuɖɔtoedɔ nu ƒe nɔnɔmetata si le dedie/si mele dedie o ƒe kɔpi (de dzesii be le Canada la, Domperidone [Motilium] kple Ondansetron [ .Zofran] nye atike eve siwo le dedie siwo tsia ʋuʋudedi nu na Parkinson dɔnɔwo, esime Maxolon [metoclopramide] kple Stemetil [prochlorperazine] zazã tsi tre ɖe eŋu kura).
• Fiaɖuƒe Ðeka:
• Nu kpata: Yɔ 999 (alo 111 hena NHS ƒe aɖaŋuɖoɖo kpata).
• Parkinson ƒe UK ("Get It On Time" Dɔwɔna & NHS Elektrɔnik Atikewɔwɔ ƒe Sedede): Ƒo ka na Parkinson ƒe UK Kpekpeɖeŋunaƒe le 0808 800 0303 (parkinsons.org.uk). Le NICE Mɔfiame NG71 (Parkinson ƒe dɔléle le ame tsitsiwo me) kple NHS England Dɔnɔwo ƒe Dedienɔnɔ Ŋuti Nuxlɔ̃amewo te la, wode se na NHS kɔdzi ƒe kakaɖedzidɔwɔƒewo katã be woade atike siwo wua parkinson ƒe hatsotsowo me (co-careldopa / Sinemet, . co-beneldopa / Madopar, . rotigotine patches, . apomorphine) abe Atike Siwo Le Ɣeyiɣi Vevie si wona le aɖabaƒoƒo 30 me tso dɔnɔa ƒe aƒeme ɖoɖowɔɖi dzi, be woaɖe mɔ ɖe Atikewo Ðokuisi (SAM) ŋu le dɔnɔdzikpɔƒea ne woate ŋui, eye woakpɔ Kɔdzi ƒe Parkinson Dɔléle Dɔnɔdzikpɔla Eŋutinunyala (PDNS) le gaƒoƒo 24 me tso esime woxɔe ɖe kɔdzi.
• Europa Dukɔwo ƒe Ðekawɔha:
• Nu kpata: Yɔ 112. Bia kɔdzidɔdala si xɔ wò ɖe kɔdzi be wòaƒo ka na kɔdzi ƒe ahɔhɔ̃ŋutinunyalawo ƒe ƒuƒoƒoa enumake be woatrɔ nu me Madopar / . Sinemet yi atikekui si woate ŋu akaka si me wodea tsii (Madopar Dispersible / LT) to nasogastric tube alo Rotigotine (Neupro) transdermal patch ne wowɔ dɔnɔa be NPO (à jeun / nüchtern).
• Australia kple New Zealand:
• Nu kpata: Yɔ 000 (Australia) alo ** .111** (New Zealand) ƒe agbalẽa.
• Parkinson ƒe Australia ("Xɔe Ðe Ɣeyiɣi Dzi" Kɔdzi ƒe Ðoɖowɔɖi): Yɔ 1800 644 189 (parkinsons.org.au) alo Parkinson ƒe New Zealand le 0800 473 4636 (parkinsons.org.nz). Le Australia kple New Zealand la, wozãa Maxolon (metoclopramide) kple Stemetil (prochlorperazine) geɖe abe dɔnɔdzikpɔʋu gbãtɔ kple ED ƒe atike siwo wua ʋusɔgbɔdɔ ene; gblɔ na kpekpeɖeŋunalawo le dɔnɔdzikpɔʋua me hafi woata atikekui si tsia aɖuɖɔtoeme nu be Parkinson ƒe dɔléle le dɔnɔa ŋu eye ele be woana Ondansetron (Zofran) alo Domperidone ( .Motilium).
• India kple Asia-Pacific:
• Nu kpata: Yɔ 112 alo ** .108. Ne wole Parkinson dɔnɔ aɖe xɔm ɖe kɔdzi Taking Syndopa (levodopa/carbidopa) yi Indiatɔwo ƒe kɔdzi, tsɔ aƒeme strip packs la yi ICU/ward dɔnɔdzikpɔƒe tẽ eye nàfia mɔ ɖɔkta si le afima be wòagadoe gbeɖe o ** .Perinorm (metoklopramide), ** .Stemetil (prochlorperazine), alo ** .Serenace (haloperidol) ** ƒe atike; biabia ** .Emset / . Ondem (ondansetron) alo ** .Domstal (domperidone)** na ʋuʋudedi kple ** .Qutipin (quetiapine)** ne ehiã be woatsɔ atike si naa ame ƒe dzi dzea eme.

Nya siwo wobiaa amewo enuenu¶

Nukatae afɔku le eme ne kɔdzi na dzinyela ƒe Sinemet (carbidopa/levodopa) tsi megbe gaƒoƒo ɖeka?¶

Le Parkinson ƒe dɔléle si sɔ gbɔ va ɖo esi de ŋgɔ wu me la, ahɔhɔ̃a bu ahɔhɔ̃meka siwo wɔa dopamine hedzranae ɖo ƒe akpa gãtɔ, si fia be dɔnɔa ɖoa ŋu ɖe carbidopa/levodopa ƒe atikekui ɖesiaɖe si woɖo ɖi ƒe agbenɔƒe kpui si xɔa miniti 90 ŋu tẽ be wòaʋuʋu, aƒo nu, ahami. Ne kɔdzi dɔnɔdzikpɔla he atike ƒe agbɔsɔsɔme aɖe ɖe megbe miniti 45 va ɖo 60 gɔ̃ hã la, dɔnɔa gena ɖe "OFF" ƒe nɔnɔme sesẽ aɖe me: woƒe ŋɔti me lãmekawo tsia tsikpe ale be woawo ŋutɔ ƒe aɖuɖɔ tsia wo eye womegate ŋu mia atikekuiwo o, woƒe ŋutilã tsia eƒe sesẽme si me vevesese le me, eye agbɔsɔsɔme si woda ɖe edzi ɣeyiɣi didi ate ŋu ahe Parkinsonism-Hyperpyrexia Syndrome si wua ame vɛ.

Kɔdzitike siwo bɔ kawoe MELE be woana dɔnɔ si ŋu Parkinson ƒe dɔlélea le GBEÐE o?¶

Mele be woana atike siwo atso ʋu kple ahɔhɔ̃ ƒe mɔxenu eye woaxe mɔ na titina D2 dopamine xɔlawo dɔnɔ si ŋu Parkinson ƒe dɔlélea le gbeɖe o. Afɔku ƒe hatsotso eve siwo me afɔku le wu le kɔdzie nye atike siwo xea mɔ na dopamine siwo tsia aɖuɖɔtoedɔ nu, vevietɔ Metoclopramide (Reglan / Maxolon), Prochlorperazine (Compazine / Stemetil), Promethazine (Phenergan), kple Droperidol, kple tagbɔdɔlékuiwutike siwo wozãna ɖaa alo esiwo ŋu ŋusẽ le ŋutɔ siwo wonana na kɔdzi ƒe alɔ̃madɔmadɔ, vevietɔ Haloperidol (Haldol), . Risperidone (Risperdal), Olanzapine (Zyprexa), kple Aripiprazole (Abilify) ƒe atike. Na ER dɔnɔdzikpɔla nade atike siawo katã kɔdzi ƒe kɔmpiuta ƒe Allergy/Contraindication aɖaka me enumake ne eva ɖo.

Atike kawoe tsia aɖuɖɔtoe kple ʋunyaʋunyawɔwɔ nu SI le dedie na Parkinson dɔnɔ si woxɔ ɖe kɔdzi?¶

Le ʋuʋudedi kple ʋuʋudedi gome la, kɔdzitike si le dedie wue nye Ondansetron (Zofran), si xea mɔ na serotonin 5-HT3 xɔlawo tsɔ wu dopamine xɔlawo (de dzesii: mègatsɔ Zofran tsaka kple apomorphine o), alo Domperidone le dukɔ siwo mele U.S. o me. Ne Parkinson dɔnɔ si woxɔ ɖe kɔdzi ƒe tagbɔ gblẽ vevie, susumenuwo, alo tɔtɔ si womate ŋu atsɔ afɔɖeɖe siwo menye atikewo o atsɔ afae o la, tagbɔdɔlélawo ƒe atike siwo le dedie koe nye Pimavanserin (Nuplazid), Quetiapine (Seroquel) si ƒe agbɔsɔsɔme le sue, alo Clozapine (Clozaril), elabena womexea mɔ na striatal motor dopamine receptors o.

Nukae wòle be kɔdzi nawɔ ne wotsɔ dzinyela si ŋu Parkinson ƒe dɔlélea da ɖe "NPO (Nothing by Mouth)" dzi hena amekoko alo dodokpɔ si me wodo kpo nu le?¶

Mègaɖe mɔ gbeɖe be kɔdzi ƒe ƒuƒoƒo aɖe nalé Parkinson ƒe atikewo ɖe asi ko alo adzo le wo dzi le esi dɔnɔ aɖe nye NPO ta o. Ne dɔnɔa do kpo nu le nu mimi ƒe dodokpɔ me le esi woƒe levodopa tsi megbe ta la, bia tso ɖɔktaa si be wòana Orally Disintegrating Carbidopa/Levodopa (Parcopa) ɖe aɖe dzi alo wòana Immediate-Release Sinemet si wogbã ɖe akɔɖu teaspoon ɖeka me, lala miniti 45 hafi ŋɔti ƒe lãmekawo natrɔ "ON," eye wòagado woƒe nu mimi kpɔ ake. Ne dɔnɔa nye NPO vevie hena amekoko alo ʋuka si wotsɔ dea ʋuka me la, ele be ɖɔktaa nade ɣeyiɣi kpui aɖe ƒe nasogastric (NG) tube be wòatsɔ carbidopa/levodopa suspension si wogbã enumake si woɖena ɖe go enumake la anae le ɖoɖo nu, alo atsɔ ŋutigbalẽ ƒe akpa si nye transdermal Rotigotine (Neupro) dopamine agonist skin patch asisi ɖe eŋu.

Nukae nye Parkinson-Hyperpyrexia Syndrome (PHS), eye aleke mawɔ akpɔe adze sii?¶

Parkinson-Hyperpyrexia Syndrome (si woyɔna hã be Akinetic Crisis alo Neuroleptic Malignant-Like Syndrome) nye atikewɔwɔ kpata si ate ŋu ade eƒe agbe afɔku me si dona tso eme ne wodzudzɔ Parkinson dɔnɔ ƒe levodopa zazã kpata gaƒoƒo 12 va ɖo 48 alo ne wona atike si xea mɔ na dopamine abe Haldol alo Reglan ene wo. Edze abe Neuroleptic Malignant Syndrome ene: lãmekawo ƒe sesẽ si gbɔ eme abe ʋuƒo ene le ŋutilã bliboa me, dzoxɔxɔ sesẽ si nu sẽ wu Celsius dzidzenu 38.5 va ɖo 41 (Fahrenheit 101.3 va ɖo 105.8), dzi ƒe tsotso kabakaba kple ʋu ƒe sisi kabakaba kple ʋu ƒe sisi si le tɔtrɔm le mɔ gbegblẽ nu, alɔ̃madɔmadɔ alo alɔ̃madɔmadɔ, kple ʋu ƒe sisi le Creatine Kinase (CK) si nu sẽ tso Creatine Kinase (CK) si nu sẽ gbɔ lãmekawo ƒe gbagbã. Ebia be woakpɔ egbɔ enumake le ICU, woagbugbɔ levodopa adze egɔme to NG-mɔ̃ dzi, tsidede ʋu me, avɔ siwo naa fafa, kple dantrolene alo bromocriptine si wodona ɖe ʋu me dzi.

Nukatae dɔnɔdzikpɔla mate ŋu agbã dzinyela ƒe Extended-Release Sinemet CR ƒe atikekuiwo alo atsaka levodopa kple nuɖuɖu siwo me protein sɔ gbɔ ɖo le mɔ̃ me o?¶

Extended-Release Carbidopa/Levodopa tablet (Sinemet CR/ER) gbãgbã gblẽa eƒe matrix si ɖea asi le eŋu blewu, si naa agbɔsɔsɔme bliboa ƒua gbe zi ɖeka eye wòhea dyskinesia si mewɔa tɔtrɔ o vɛ eye mɔ̃a ƒe gbagbã kpata kplɔnɛ ɖo; ke boŋ ele be ɖɔktaa natrɔ nudɔdɔa wòazu Carbidopa/Levodopa ƒe atikekui siwo woɖena ɖe go enumake (IR) hafi woagbãe. Gakpe ɖe eŋu la, nuɖuɖu me protein (amino acid) ʋlia ho kple levodopa tẽ be wòaxɔ ɖe dɔgboa me eye wòato ʋu kple ahɔhɔ̃ ƒe mɔxenu dzi; ne dɔnɔ aɖe le protein si me tsi le ƒe nuɖuɖu nam atraɖii la, ele be woatɔ te mɔ̃a ƒe nuɖuɖua aɖabaƒoƒo 60 do ŋgɔ na levodopa dodo ɖesiaɖe kple aɖabaƒoƒo 30 va ɖo 60 le levodopa dodo ɖesiaɖe megbe ale be atike la nate ŋu aɖo ahɔhɔ̃a gbɔ.

Mɔfiame siwo do ƒome kplii¶

• Kɔdzi ƒe tagbɔdɔléle kple atikewɔwɔ ŋuti nyaʋiʋli na ame tsitsiwo
• Nuɖuɖumadzroame: tsi tsɛwo ƒe ʋuʋu, aklãdɔ si wogbɔna, kple nuɖuɖu si me wode nuɖuɖui ƒe dedienɔnɔ
• Atike geɖe zazã, atikewo ƒe agbɔsɔsɔ fũ, atikeawo ƒe agbɔsɔsɔ si to, kple atikekuiwo ƒe ɖoɖowɔla ƒe vodadawo
• Tɔtɔ kpata le ame tsitsiwo me: silent UTI urosepsis vs. stroke kple nusita dɔnɔ tsitsiwo mekpɔa dzoxɔxɔ o

Dzɔtsoƒewo kple dziɖuɖumegãwo ƒe mɔfiame¶

• Parkinson ƒe Gɔmeɖoanyi: Kɔdzi Belélename ƒe Kafukafunyawo & Kɔdzi Dedienɔnɔ Ŋuti Mɔfiame: Dopaminergic Dozazã Si Vea Ɣeyiɣi Vevie, Atike Siwo Woɖe Mɔ Ðe Emetike/Tagbɔdɔlélenutsitikewo, Kple Perioperative NPO Bridge Protocols (parkinson.org/hospital).
• UK Dukɔa ƒe Lãmesẽ Kple Belélename Ŋuti Nusrɔ̃ƒe (NICE): NICE Mɔfiame NG71: Parkinson ƒe Dɔléle le Ame Tsitsiwo Me, Kɔdzi Xɔxɔ Kpekpeɖeŋu, Levodopa Siwo Woɖena Kpata si Woxe Mɔ Na, Kple NPO Rotigotine/NG Tube Trɔtrɔ.
• Amerikatɔwo ƒe Ahɔhɔ̃ŋutinunya Suku (AAN) & Dukɔwo Dome Parkinson kple Ʋuʋu ƒe Dɔléle Habɔbɔ (MDS): Dɔwɔƒe ƒe Dɔwɔwɔ ƒe Mɔfiamewo hena Parkinson-Hyperpyrexia Dɔléle (Akinetic Crisis) ƒe dzesidede kple ICU Dzikpɔkpɔ.
• Institute for Safe Medication Practices (ISMP): Atikewo ƒe Dedienɔnɔ ƒe Mɔnu Nyui Siwo Woɖo Tae na Kɔdziwo: Mɔxexe Ðe Carbidopa/Levodopa si Vea Ɣeyiɣi Vevie ƒe Asiɖeɖe le Nu Ŋu Kple Mɔxexe Ðe D2 Tsitretsiɖeŋunu Siwo Ŋu Wotsi Mɔ Ðe Nu Ŋu.
• Amerika Ame Tsitsiwo ƒe Dɔlélewo Ŋuti Habɔbɔ (AGS): AGS Beers Criteria® yeyee hena Atike Siwo Ate Ŋu Mesɔ O Zazã le Ame Tsitsiwo Me (Asaƒoƒo na Tagbɔdɔlékuiwutike Siwo Wozãna Typical/Atypical kple Metoclopramide le Parkinson ƒe Dɔléle Me Kpuie).