Parkinson’s Specialist Nurse Lauren Hogan is based in Goulburn. The Goulburn Parkinson’s Support Group is an active supporter and funder of Lauren’s role, aided by generous local donors.
When Parkinson’s patient James* was referred to Lauren for a medication review, it quickly became apparent that his continued health and wellbeing would require more than minor changes to the oral drug regimen he was on.
James, 81 years old, was living at home with an elderly relative and experiencing frequent falls despite using a four-wheel walking frame.
“This was happening because James was prescribed five doses of Levodopa every day but was frequently forgetting to take his medication on time or at all. It resulted in fluctuating ‘on’ and ‘off’ periods throughout the day because medication was interrupted, resulting in falls.
“In fact, the situation had become so serious that James’ care team was looking at admission into an aged care facility being the necessary next step for him,” said Lauren.
However, after assessing all the factors, Lauren decided to talk with James’ neurologist and suggest an upgrade of medication to Apomorphine.
He agreed it was worth a try, so Lauren took the lead on switching James’ medication from Levodopa taken orally in multiple doses each day, to Apomorphine which is delivered continuously and subcutaneously (under the skin) throughout the day via a pump.
Apomorphine is a dopamine agonist – a medication that activates the dopamine receptors in the brain.
In Parkinson’s disease dopaminergic neurons that produce the neurotransmitter dopamine in the brain slowly break down and can eventually die. With decreasing levels of dopamine the brain can’t function properly and causes abnormal brain activity, which ultimately leads to the symptoms of Parkinson’s disease.
Dopamine agonists like Apomorphine – which has no relation to the opioid morphine – act directly on the brain’s dopamine receptors and mimic dopamine’s effect.
Lauren started the medication transition by reaching out to the regional nurse from STADA Australia – a speciality prescription pharmaceutical and consumer healthcare company. STADA nurses act as consultants when a patient is starting on Apomorphine.
Working together, the nurses set up an ‘Apomorphine challenge’ – essentially a test run of the new medication where a small dose is administered initially.
The nurses were particularly looking for any sudden drop in blood pressure – sometimes experienced on this medication when a patient stands up from a sitting or lying down position. They also performed tests to evaluate changes in James’ motor symptoms.
James tolerated Apomorphine well, so he was gradually stepped up to a full dose administered throughout the day via a thin needle in his abdomen.
“I believe this was the first implementation of this advanced medication in this region, and we were delighted with the results,” said Lauren.
“The transition to Apomorphine resulted in huge benefits to James’ health and wellbeing.
“He now requires just a half dose of oral Levodopa three times each day, down from the five full doses he required before. There has also been a huge improvement in his motor symptoms, and he is able to move around with his walker more independently and safely.
“Best of all, he’s had no recent falls thanks to the new continuity in delivery of his medication – and he has avoided the immediate need to move to an aged care facility. Family members are also delighted to see the improvement in his condition,” she said.
Specialised neurological nurses are proven to have many benefits for people living with Parkinson’s and their families. The placement of a nurse also assists with the high rates of depression and anxiety associated with Parkinson’s.
Carers and family members also notice significant improvements in their own well-being, with reduced levels of depression. Hospital stays can also be reduced through the intervention of a specialist nurse.
*Name changed for privacy.
