Dopaminergic replacement therapies such as laevodopa and dopamine agonists are a mainstay in the treatment of Parkinson’s disease. As well as motor symptoms such as motor fluctuations and dyskinesias, dopaminergic drugs can cause behavioural adverse effects such as mood fluctuations, psychosis, and impulse control disorders.
Dopamine Dysregulation Syndrome (DDS) is a recently described complication of long-term dopaminergic therapy for Parkinson’s disease. Patients with DDS develop a pattern of addictive and excessive use of dopamine replacement therapy. Medication use is often escalated by the patient without doctor’s advice and the doses taken are in excess of those required to control motor symptoms.
Hoarding of medication and attempts to purchase additional dopaminergic treatment through the internet or by ‘doctor shopping’ is common. It has been suggested the compulsive medication use is due to sensitization of dopamine receptors, causing a progressive increase in the rewarding effects of dopaminergic drugs.
However, unlike psychostimulant users, patients with DDS do not recognize the pleasurable effects from their medication.
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Dopamine Dysregulation Syndrome,
Parkinson's disease,
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Clostridium difficile is a bacterium that can cause diarrhoea that does not improve. Symptoms include watery stool, abdominal pain, and fever. Patients may develop electrolyte imbalance, malnutrition and pressure sores. They may go on to develop more serious abdominal conditions.
Most people colonised with C difficile remain asymptomatic. Research as demonstrated that the organism can be cultured from the stool of 3% of healthy adults and 35% of hospital inpatients. When normal gut flora is disrupted, usually by antibiotic exposure, clinical disease develops in C. difficile colonised people under conditions that favor C. difficile proliferation within the colon.
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Clostridium Difficile,
diarrhoea,
PPI,
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Age-related macular degeneration (AMD) is the leading cause of blindness and severe visual impairment in adults over the age of 50. Neovascular AMD (nAMD) is caused by the growth of abnormal blood vessels under the macular which can cause haemorrhage and scarring, leading to severe vision loss. One of the mediators in the pathogenesis of neovascular AMD is vascular endothelial growth factor-A (VEGF) which facilitates the growth of these leaky blood vessels. New treatments have been developed to target the inhibition of this growth factor.
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Bevacizumab,
Macular degeneration,
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The Australian Advisory Committee on the Safety of Medicines (ACSOM) have received few reports of renal
impairment/failure with IV pamidronate, or oral bisphosphonates risedronate and alendronate, but a significant number with zoledronic acid (31 from a total of 268 reports) are reported. Deterioration in renal function with IV bisphosphonates due to a rapid infusion rate has been suggested, but the reports did not appear to be related to a rapid infusion rate.
Interstitial nephritis was described in three reports. It is important to bear in mind that those who received zoledronic acid were probably more likely predisposed to renal failure secondary to existing co-morbidities (many patients had pre-existing renal impairment or multiple myeloma).
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Bisphosphonates,
kidney,
osteoporosis,
renal,
RGH E-bulletin,
zoledronic acid
