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Nursing Assignment: Use Of Levodopa To Manage Parkinson’s Disease

Question

Task:
Prepare a nursing assignment presenting a literature review on the topic- use of Levodopa to manage Parkinson’s disease compared to other therapies.

You should define your search terms and data sources and undertake a comprehensive review of the literature around your area of study. The review must have a wide scrutiny that includes both contemporary literature and seminal pieces of work. Critically analyse the literature and write a paper that demonstrates a comprehensive and critical understanding of the literature in your chosen area.

Your literature review should draw on recent, evidence-based literature, using a minimum of 15 scholarly references to support your paper

Answer

Literature Review
Introduction

The current nursing assignment talks about Levodopa which is regarded as the high standard drug treatment to deal with Parkinson’s disease. It has been in clinical use for more than 40 years and has been compared to other obtainable dopaminergic therapies. According to Verschuur et al. (2019), there has been innumerable development in treating Parkinson’s disease. Levodopa is regarded as the most powerful drug for dealing with PD symptoms, yet is allied with substantial complications. The complications include dyskinesias that is levodopa-induced as well as wearing-off effect. The literature review will provide an overview on using Levodopa to manage Parkinson’s disease compared to other therapies. It has been established that compared to other treatments, levodopa involves greatest development in motor operation. In other words, it reduces the progression of disability and brings decrease in mortality.

Levodopa
According to Tai et al. (2019), in order to control PD symptoms such as bradykinesia, levodopa is regarded as the most probable drug. Espay et al. (2018) on the other hand, argued that since levodopa develops motor complications, such as dyskinesias, there has been continuing debate regarding when levodopa therapy is the most suitable in treating PD. The authors further stated that most of the patients have experienced complications after getting treated with levodopa. Liao et al. (2021) stated that the commencement of levodopa treatment is mostly delayed to avoid motor complications. The most common issue that is witnessed by patients taking levodopa is overdue commencement of response. There are diverse types of Dyskinesias that are levodopa-induced. These includes biphasic dyskinesias as well as peak-dose dyskinesias and wearing-off dyskinesias. On the other hand, there are particular PD that takes place in genetic forms which includes PARK8 as well as PARK2. These are associated with elevated risk of levodopa associated motor complications.

Tran et al. (2018) reflected on three diverse strategies that has been developed to improve dyskinesias that are levodopa-induced. The first one is reducing the overall levodopa dosage, the second is using drugs known to treat ameliorate dyskinesias and the third one is surgery. It has been critically analysed that several drugs such as amantadine has been introduced to deal with dyskinesias that are levodopa-induced. This particular drug does not initiate any decrease in the overall levodopa dose. The authors further critically analysed that the above-mentioned strategies have been intended to smoothen the therapeutic quantity of levodopa-associated motor fluctuations. The medication that has been considered as the probable levodopa-induced dyskinesias therapy is known as the new antiepileptic drug. The most concurrent type of motor fluctuation is the wearing off effect that is regarded to be associated with shortening of levodopa’s half-life in the striatum. This takes place due to weakened capacity to stock and shield the striate attentiveness of levodopa.

Parkinson’s disease
Anadvanced nervous system syndrome that impacts movement is regarded as Parkinson’s disease. The symptoms of Parkinson’s diseasestart slowly that initially is barely recognizable in just a single hand. It has been critically analysed that during the initial stages of Parkinson’s disease the face of an individual might show little or hardly any expression. However, the speech might become soft whereas the arms might not swing while walking. Ball et al. (2019) stated that with progression over time, Parkinson’s disease simply becomes worse.

The authors critically examined the fact that although the disease cannot be cured but it can be medically be treated through surgery or levodopa. Exposure to environmental aspects might increase the danger that is related to Parkinson’s disease however, the risk in this case is comparatively small (Tysnes and Storstein, 2017). There are few symptoms of Parkinson’s disease that cannot be treated using dopamine. For treating symptoms like dysphagia, dysarthria, freezing or some axial symptoms the dopaminergic therapy would be ineffective. In such cases, non-dopaminergic therapy is required.

Efficiency of levodopa in treating Parkinson’s disease
Müller (2020) reflected on the fact that there are several enduring as well as large-scale monotherapy trials that are LD-controlled. These are used to treat Parkinson’s disease that imitate a strong comparison between Levodopa as well asdopamine agonists. During the initial stage, treating Parkinson’s disease depends of the sternness of symptoms. In other words, in order to treat high symptomatic impact then levodopa or dopamine agonists is used. Tambasco, Romoli and Calabresi (2018) stated that mostly levodopa treatment in early stages in the form of immunotherapy takes place in younger patients to make them remain physically active as well as employable. In treating Parkinson’s disease, levodopa gets absorbed by the nerve cells in the brain that turns into a chemical dopamine. This in turn gets used to spread messages between the brain partsas well as nerves that regulate movement.

The movement issues get improved mostly by raising the dopamine level using levodopa. Levodopa usually comes in the form of a tablet or liquid that is combined mostly with medication like carbidopa. This treatment in turn restricts the levodopa to break down in the bloodstream before getting into the brain. As a result, the side effects of levodopa such as tiredness, feeling sick as well as dizziness gets decreased. The development of multiple other treatments sometimes limits the medication of levodopa. According to Haddad et al. (2018), triple amalgamation of levodopa in a single tablet provides flexibility thus controlling response fluctuations. The authors have regarded levodopa as the effective agent in treating the motor aspects of Parkinson’s disease. However, the chronic usage related to levodopa is related with the increase of motor complications. There has been innumerable evidence that shows that short half-life of levodopa creates wearing off as well as of motor complications.

Levadopa over other therapies
Levadopa or Carbidopa is considered to be the most effective and widely used drug that can be used to treat Parkinson’s disease. There are other surgical and pharmacologic treatments for Parkinson’s disease (Armstrong and Okun, 2020). However, Levadopa is effective because it treats nausea which the patient is likely to feel. The carbidopa prevents the Levadopa from prematurely converting into dopamine along the bloodstream. Thus, more of it actually reaches the patient’s brain.

As per Liu et al.(2021), the use of monoamine oxidase-B (MAO-B) inhibitors could be an alternative treatment for Parkinson’s disease beside Levadopa. The monoamine oxidase-B (MAO-B) inhibitors increase the dopamine level because the effects of the brain substance or enzyme is blocked by it. They break down the dopamine. After critical analysis it can be said that in most of the cases, Levadopa is used as the drug to effectively treat Parkinson’s disease. This medication is required by the patient. According to Haddad et al.(2018), Levadopa helps in absorption of the drug into the nerve cells of the brain. The drug is further turned into a chemical dopamine. This chemical dopamine is then used for transmitting the messages between the nerve and the various parts of the brain. The levadopa facilitates the control of movements.

As opined by Zhang et al.(2020), through critical analysis of the effectiveness and advantages of the drug, Levadopa, it can be stated that this specific medication helps in correcting the decreased concentrations of striatal DA. With the treatment using levadopa, the symptoms of Parkinson’s disease are alleviated. The drug is preferred over other therapies because it has better results and the quality of life (QOL) of the patient suffering from Parkinsonism improves. Levadopa facilitates replacing the dopamine of the brain, which is the best treatment strategy for Parkinson’s disease. The motor symptoms of the disease are improved through levadopa. As dopamine cannot itself cross the barrier of the blood-brain, it makes it impossible to treat Parkinson’s disease. Therefore, the replacement of the dopamine is required. Levadopa acts as a precursor of the dopamine (You et al., 2018). Its application helps dopamine to cross the barrier of the blood-brain.

As per Miao et al.(2021), levadopa is found to be more effective than the other available alternative treatments of Parkinson’s disease because it is a natural chemical. This chemical passes through the brain of the parkinsonian patient converting into dopamine. Carbidopa (lodosyn) and levadopa are combined. This prevents the early conversion of the levadopa outside the brain into dopamine. This further reduces or prevents the effects of the Parkinson’s disease, one common effect being nausea.

In the initial stage of the Parkinson’s disease, the patients gain huge benefits from the use of levadopa at least twice to thrice in a day as prescribed by the doctor. Levadopa is more effective over other drugs as suggested by Balestrino and Schapira(2020), against rigidity and akinesia. The clinical advantages of using levadopa for the treatment of Parkinson’s disease lasts long during the early stages though the drug has a short half-life of ½ 1.5 hours.

As stated by Hayes(2019), Parkinson’s disease is a progressive disorder of the nervous system. The disease affects the movements in the patient. The symptoms of the Parkinson’s disease start showing up slowly. It could be something as simple as a tremor in one hand of the patient, which is hardly noticeable. However, after the initial tremors the patient starts experiencing slowing down of movements and stiffness. In the early stages, Levadopa is seen to show good results.

The other treatments that are available for the Parkinson’s disease include the oral dopamine agonists ropinirole and pramipexole. These could be considered as primary medications for the Parkinson’s disease. However, these are not great alternatives to Carbidopa/ levadopa. Though oral dopamine agonists ropinirole and pramipexole are efficacious, they are not as effective as Levadopa in treating Parkinson’s disease. The effectiveness of Levadopa is clear from the results it shows after application. According to Combs and Cox(2017), in the year 2003 the US Food and Drug Administration approved the prescription of triple combination tablets for treating Parkinson’s disease. These included levadopa, carbidopa and entacapone to be used as the wearing off end of dose. The levadopa however showed that its application in the form of triple combination tablet as well as separately yielded similar results. This indicates that levadopa and the triple combination tablets are equivalent pharmacokinetics. When critically analysed, it can be seen that the other therapies like pramipexole is not advisable for the treatment of Parkinson’s disease as it has side effects. As opined by Weiss et al (2021), the use of pramipexole leads to dose-dependency. It also causes idiosyncratic peripheral edema. The ergot dopamine agonists are now not used for the treatment of Parkinson’s disease as it could lead to valvular heart disease. The use of dopamine agonists has been banned from medical practice due to its side effects.

Conclusion
The appropriate treatment of the Parkinson’s disease would be to individualise the therapy that is required by the patient. For this disease, no generalised treatment could be prescribed. The aim of the treatment or therapy, be it levadopa or other therapies should be to treat the symptoms that cause the maximum disability in the patient. The therapy that is selected should not be chosen for controlling the symptoms only. The therapy has to be scientifically designed based on rationality and logic. The therapy might need to be changed depending on the progression of the Parkinson’s disease. The patients who are young might need to go for dopaminergic therapy. They require such medications for a longer duration. The young patients cannot be prescribed levadopa though it is the most effective drug for Parkinson’s disease because they can develop the complications from levadopa. These patients need levadopa-free treatment for the disease. These could include dopamine agonists or MAO inhibitors. With time medical science and technology is improving. Therefore, it can be critically evaluated that even though levadopa is one of the most effective therapies, there is no reason to consider it as the best therapy for all patients of Parkinson’s disease in any stage. In the days to come with enhanced understanding of neurodegeneration, better therapies for the treatment of Parkinson’s disease will be developed. With the medication using levodopa, the indications of Parkinson’s disease are lessened. The drug is favoured over other therapies since it has improved results and the quality of life.

References
Armstrong, M.J. and Okun, M.S., 2020. Diagnosis and treatment of Parkinson disease: a review. Jama, 323(6), pp.548-560.

Balestrino, R. and Schapira, A.H.V., 2020. Parkinson disease. European journal of neurology, 27(1), pp.27-42.

Ball, N., Teo, W.P., Chandra, S. and Chapman, J., 2019. Parkinson's disease and the environment. Frontiers in neurology, 10, p.218.

Combs, B.L. and Cox, A.G., 2017. Update on the treatment of Parkinson’s disease psychosis: role of pimavanserin. Neuropsychiatric disease and treatment, 13, p.737.

Espay, A.J., Morgante, F., Merola, A., Fasano, A., Marsili, L., Fox, S.H., Bezard, E., Picconi, B., Calabresi, P. and Lang, A.E., 2018. Levodopa?induced dyskinesia in Parkinson disease: current and evolving concepts. Annals of neurology, 84(6), pp.797-811.

Haddad, F., Sawalha, M., Khawaja, Y., Najjar, A. and Karaman, R., 2018. Dopamine and levodopa prodrugs for the treatment of Parkinson’s disease. Molecules, 23(1), p.40.

Haddad, F., Sawalha, M., Khawaja, Y., Najjar, A. and Karaman, R., 2018. Dopamine and levodopa prodrugs for the treatment of Parkinson’s disease. Molecules, 23(1), p.40.

Hayes, M.T., 2019. Parkinson's disease and parkinsonism. Nursing assignment The American journal of medicine, 132(7), pp.802-807.

Liao, J.Y., Salles, P.A., Shuaib, U.A. and Fernandez, H.H., 2021. Genetic updates on paroxysmal dyskinesias. Journal of Neural Transmission, pp.1-25.

Liu, L., Chen, Y., Zeng, R.F., Liu, Y., Xie, S.S., Lan, J.S., Ding, Y., Yang, Y.T., Yang, J. and Zhang, T., 2021. Design and synthesis of novel 3, 4-dihydrocoumarins as potent and selective monoamine oxidase-B inhibitors with the neuroprotection against Parkinson’s disease. Bioorganic Chemistry, 109, p.104685

Miao, Z., Bai, J., Shen, L. and Singla, R.K., 2021. The Combination of Tradition and Future: Data-Driven Natural-Product-Based Treatments for Parkinson’s Disease. Evidence-Based Complementary and Alternative Medicine, 2021.

Müller, T., 2020. Pharmacokinetics and pharmacodynamics of levodopa/carbidopa cotherapies for Parkinson’s disease. Expert opinion on drug metabolism & toxicology, 16(5), pp.403-414.

Tai, L.C., Liaw, T.S., Lin, Y., Nyein, H.Y., Bariya, M., Ji, W., Hettick, M., Zhao, C., Zhao, J., Hou, L. and Yuan, Z., 2019. Wearable sweat band for noninvasive levodopa monitoring. Nano letters, 19(9), pp.6346-6351.

Tambasco, N., Romoli, M. and Calabresi, P., 2018. Levodopa in Parkinson's disease: current status and future developments. Current neuropharmacology, 16(8), pp.1239-1252.

Tran, T.N., Vo, T.N., Frei, K. and Truong, D.D., 2018. Levodopa-induced dyskinesia: clinical features, incidence, and risk factors. Journal of Neural Transmission, 125(8), pp.1109-1117.

Tysnes, O.B. and Storstein, A., 2017. Epidemiology of Parkinson’s disease. Journal of neural transmission, 124(8), pp.901-905.

Verschuur, C.V., Suwijn, S.R., Boel, J.A., Post, B., Bloem, B.R., van Hilten, J.J., van Laar, T., Tissingh, G., Munts, A.G., Deuschl, G. and Lang, A.E., 2019. Randomized delayed-start trial of levodopa in Parkinson’s disease. New England Journal of Medicine, 380(4), pp.315-324.

Weiss, D., Volkmann, J., Fasano, A., Kühn, A., Krack, P. and Deuschl, G., 2021. Neurology Grand Rounds: Changing gears–DBS for dopaminergic desensitization in Parkinson's disease?. Annals of Neurology.

You, H., Mariani, L.L., Mangone, G., de Nailly, D.L.F., Charbonnier-Beaupel, F. and Corvol, J.C., 2018. Molecular basis of dopamine replacement therapy and its side effects in Parkinson’s disease. Cell and tissue research, 373(1), pp.111-135.

Zhang, X.R., Jiang, Z.Y., Zhang, Z.R., Chen, H.J., Wu, K., He, J.C. and Xie, C.L., 2020. The Advantages of Levodopa-Carbidopa Intestinal Gel for Patients with Advanced Parkinson’s Disease: A Systematic Review. Drug design, development and therapy, 14, p.845.

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