AKT Question Relating to Parkinson's Disease

The patient's below (1–4) have all had established Parkinson's disease for many years and take an L Dopa preparation (‘Sinemet Plus’—one tablet every 4 hours). Above the patients is a list of options (A – F). Choose one option that is most applicable to the immediate primary care management of each patient. Each option may be used once, more than once or not at all.

Options

Add Bromocryptine

Add Citalopram

Add Haloperidol

Add Quetiapine

Gradual reduction in the dose of L Dopa

Phase in a long-acting preparation of L Dopa

Patients

A 70-year-old woman who has florid visual hallucinations

A 75-year-old man who is just mobile but is suffering from increasing agitation

A 56-year-old woman who is becoming increasingly withdrawn

A 70-year-old man who notices symptoms returning after 2 hours