Wednesday, October 9, 2019
A general view of God from a Christian perspective Essay
A general view of God from a Christian perspective - Essay Example I t is clear that these elements continue to haunt the religious When the Bible was compiled. In Parables, Jesus warns about the darkness that may corrupt Christianity. First and foremost is the idea that darkness is everywhere. Light must be created in order to fight the darkness. Similarly, God is all Omni-benevolent but the question of the test must be considered. If salvation was that easy, then all individuals would achieve salvation. The fact is that God himself says that humans will be tested with elements of hunger, warfare, plague in order to re-emphasize the idea of the test. This same notion corrupted Christianity. All these notions became a crucial element where finger pointing leads to power. Power corrupted Christianity because it allowed the elites to took control and dictate resources. In times of despair, individuals that were seeking the truth became the felons. As a matter of fact, many true Christians were persecuted because they stood out for the truth. The few a nd pure that stood against the Church or clergy were at once banished or killed because they were dangerous to the elite. The few those rose up against this notion were persecuted. 3. Violence is a key problem for our current society. Choose one example of violence, describe it and relate this issue to some aspect of a religious perspective. Violence is a huge issue in religion and society because it incites human emotion. In todayââ¬â¢s society school violence has caught the attention of nearly everyone in the United States.
Tuesday, October 8, 2019
Philosophy of Nursing with compassion Essay Example | Topics and Well Written Essays - 250 words
Philosophy of Nursing with compassion - Essay Example Nightingaleââ¬â¢s philosophy includes the four meta-paradigm concepts of Nursing, but the primary focus is on the patient and the environment (Nightingale, 1860/1969). Health is ââ¬Å"not only to be well, but to be able to use well every power we have to use,â⬠(Nightingale, 1969, p. 24) Nursing has been a fascination of mine since I was a little girl. I have a lot of compassion and love for people. My career started at the age of 17; graduating from the High School of Health Professions. I worked 4 years as a Nurse Aide, 10 years as a LVN, and now 22 years as a RN. I look at the patients I care for with a heart as if they were my family members; giving excellent care. I feel God gave me a gift to share and take care of others. Philippians 2:4 states ââ¬Å"Let each of you look not only to his own interest, but also to the interests of others. (Holy Bible King James Version).Ephesians 4:32 states ââ¬Å"Be kind to one another, tender hearted, forgiving one another, as God in Christ forgave us.â⬠(Holy Bible King James Version) I recently had tragedy in my own life and was a bit heartbreaking. My husband died from a cardiac arrest on dialysis in October 2014. Being a dialysis nurse I questioned coming back to dialysis and even nursing profession. After 3 months to heal and go through my grief, I now realize this where God wants me to be and be more effective. The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety. (ANA, 2001, p. 18) Historically from the era of Florence Nightingaleââ¬Ës philosophy focused on the primarily on the patient and their environment, with the nurse controlling the environment to enhance the recovery of the patient. The ANA code of ethics for nurses was developed as a guide to responsibility care for patients in a manner that reflected quality in nursing care and the ethical obligations
Monday, October 7, 2019
Pulmonary Rehabilitation Essay Example | Topics and Well Written Essays - 250 words
Pulmonary Rehabilitation - Essay Example To achieve this objective, Rochester (2008) analyzes various relevant secondary sources. The researcher finds the need for preoperative pulmonary rehabilitation for patients preparing for lung transplantation or LVRS because such patients are medically complex and have exercise limitations and that these surgical procedures present substantial preoperative complications and risk of mortality. Despite its ventilating limitation, it was found that this procedure improves peak work rate, walk distance, muscle strength, maximum oxygen consumption and quality of life. However, the researcher could not determine whether it increases surgery survival, surgery tolerance and adherence to medication. The research documents postoperative benefits of pulmonary rehabilitation including hastening recovery and optimizing functional status. There are no formal guidelines for pulmonary rehabilitation but the research suggests strength exercise training, alternating high and low intensity training and stretching and chest mobility exercises among others. The findings give scientific evidence of effectiveness, safety and feasibility of pulmonary rehabilitation for patients seeking to undergo or recovering from lung transplantation or LVRS. However, the patients should be monitored to ensure that they do not show any signs of undesirable events. Appropriate safety precautions should be taught during training. Rochester (2008) proposes the need for future investigation of whether lung transplantation and LVRS outcome could be improved by improving symptom management and exercise
Sunday, October 6, 2019
In depth alnalysis of El Mariachi Essay Example | Topics and Well Written Essays - 1250 words
In depth alnalysis of El Mariachi - Essay Example It is all about a young mariachi (a wandering musician or a singing guitar player) who gets caught in a web of mistaken identity. The plot of mistaken identity has been used in many films, like in Alfred Hitchcockââ¬â¢s North by Northwest. Rodriguez again uses this plot in El Mariachi. El Mariachi arrives in a small dusty town of Mexico to start a new life. His only interest and his dream is his music. But he soon realizes that this is not easy when he gets mistaken for a criminal named Azul, a drug lord who is being chased by a rival named Moco, as both wear black and carry a guitar case. The only difference is that while one carries a guitar in his case the other carries a machine gun. The mistaken identities result in the rivals trying to kill El Mariachi. In the meantime El Mariachi falls in love with Domino. Moco is also in love with this woman. By the time the true identities are known, Moco comes to know that Domino and El Mariachi are in love. In a fit of rage Moco kills D omino and shoots off the hand of the mariachi. After this when Moco laughs in El Mariachis face, El Mariachi kills him. The story is set in a small Mexican town and the director shows how drug dealers can control a small town. The movie has a well-written script. It is full of action, but not very flashy. Hal Hinson (1996) in Washington Post has rightly said, "Rodriguez has boiled the art of filmmaking down to its visceral, kinetic essence. In "El Mariachi" everything is expressed in terms of action, pure and simple." The plot is simple, but universal at the same time. The story may be fictional but the characters and also the atmosphere is typical of Northern Mexico. From the scene of the turtle walking across till the end all the scenes are fascinating and enjoyable. Through a series of fierce gun battles and astonishing car chases, Rodriguez does manage to maintain a fast and furious pace. The bullets fly thick and fast and the action does not let up one
Friday, October 4, 2019
Database Applications Research Paper Example | Topics and Well Written Essays - 500 words
Database Applications - Research Paper Example Arnisted2 (2001) categorizes and differentiate these softwares as family software and business software depending upon contact information, medical records, hobbies, educational records, wish lists, diary, journal, etc. Groupware, also called as collaborative software, is an elementary component of a field of study known as Computer-Supported Cooperative Work or CSCW3. A few examples can be listed as Microsoft Exchange, MediaWiki, WetPaint, and ClassroomLive2.0 and so on. 2) What kinds of things do groupware users do with data? How does that data have to be treated? In general there are three functions of groupware, enabling human to converse, transact and collaborate the ââ¬Ëinformation and knowledgeââ¬â¢ (also termed as data), about self and others. Groupware users use data into several ways and for several purposes including sharing, analyzing, creating, discussing, debating, planning, summarizing, concluding, etc. Since data is a unique significant aspect for human individu al/group identity, this must be used and shared with utmost care. This can be used for semantic purposes, and, sometimes, can be misused too. Ample privacy and security of the data should be of prime concern while treating with this data. 3) Who pays the costs of groupware deployment? Who receives the benefits? Groupware can be freeware or shareware or authoring.
Memorandum Mandatory Use of Turkish Language Essay Example for Free
Memorandum Mandatory Use of Turkish Language Essay This Memorandum aims to provide brief information on (i) provisions and restrictions imposed by the Law on Mandatory Use of Turkish Language by Economic Enterprises numbered 805 and dated 10 April 1926 (the ââ¬Å"Law No. 805â⬠) on Turkish and foreign enterprises; (ii) consequences of non-compliance with the Law No. 805; and (iii) application of the good faith principle in the light of the precedents of the Turkish Supreme Court of Appeals (the ââ¬Å"Court of Appealsâ⬠). A. SCOPE OF THE LAW NO. 805 The Law No. 805 is applicable to all Turkish and foreign enterprises with respect to transactions listed in Articles 1 and 2 of the Law No. 805; however, application of the Law No. 805 differs depending on the nationality of the enterprise. 1. Turkà ±sh Enterprà ±ses In accordance with Article 1 of the Law No. 805, ââ¬Å"Any type of companies and enterprises which have Turkish nationality shall use Turkish language in all kinds of transactions, agreements, correspondences, accounts and books within Turkeyâ⬠. According to Article 1 of the Law No.805, each company and enterprise a the Turkish nationality is obliged to keep any kind of transaction, records and books and execute all agreements and make all communications with each other in Turkish language within the territory of Turkey. Accordingly, the only exclusion for the obligation of the use of Turkish language in transactions and communications of Turkish companies and enterprises is the case where such transactions and communications are executed/performed outside the territory of Turkey. In that respect, it is clear that an agreement to be executed between two or more Turkish companies should be prepared and signed in Turkish language, or if it is preferred to be executed in a foreign language, to be accompanied with a Turkish version which shall prevail in the event of discrepancy. There are several court decisions in this respect. In one of its judgments, the Court of Appeals has upheld that the parties, in the text of the agreement may refer to non-Turkish (international) terms and/ or clauses, only if (i) these terms cannot be replaced by a counterpart in Turkish; and (ii) the parties are obliged to include such terms in the agreement. However, it has also underlined by the Court of Appeals that this rule is valid only for terms and expressions either with no counterpart in Turkish or which cannot be written in Turkish. Similarly, in a later decision, the Court of Appeals has ruled that if the parties are both Turkish then all agreements must be executed in Turkish; although international terms and expressions may be incorporated into a Turkish agreement as a special condition. In this decision, the Court of Appeals has not accepted the usage of a maturity clause which was drafted in English language in an agreement executed in Turkish language since such maturity clause could easily be drafted in Turkish language as well. 2. Foreà ±gn enterprà ±ses In accordance with Article 2 of the Law No. 805, ââ¬Å"This obligation applies to foreign companies and enterprises only in their communications, transactions and relations with the Turkish institutions and persons and for the documents, books and records which must be submitted to governmental offices and government officers.â⬠Pursuant to Turkish legislation, a foreign enterprise is a duly incorporated legal entity that has its registered office outside of Turkey. For foreign enterprises, as stated above, the requirement of Turkish language usage is limited only to (i) transactions, correspondences and communications with persons and legal entities subject to Turkish laws; and (ii) documents, books and records which will be presented to Turkish authorities. In contrast with Article 1 of Law No. 805, Article 2 of the Law No. 805 has a narrower a scope of obligation to use Turkish language. The wording ââ¬Å"agreementâ⬠is willingly not stated in Article 2 on purpose. In other words, the Law No. 805 does not specifically refer to agreements under the provision concerning foreign entities. This omission indicates that the Law No. 805 allows the execution of an agreement between a foreign entity and a Turkish entity in a foreign language. There are several court decisions with respect to Article 2 of the Law No. 805. In a decision by the 11th Circuit of the Court of Appeals, the Court of Appeals has upheld that all accounts and books have to be in Turkish language, when submitted to the relevant Turkish authorities. Otherwise, they do not have any validity before Turkish courts. The Court of Appeals has come to a similar conclusion summarizing that Turkish enterprises may enter into agreements with foreign enterprises in any language since Article 2 of the Law No. 805 specifically lists instances where foreign enterprises are prohibited from using a foreign language and this list does not include agreements. Accordingly, the Court of Appeals has concluded that agreements may be executed in any foreign language, where one of the parties is a foreign enterprise and the other is Turkish. According to this decision, an agreement executed in a foreign language between a foreign company and a Turkish company is valid and binding on the parties pursuant to and under Turkish laws. However, under Article 4 of the Law No.805, the parties are compelled to use Turkish language in all correspondences with respect to the agreement, although the agreement is allowed to be drafted in a foreign language. B. CONSEQUENCES OF NON-COMPLIANCE WITH THE LAW NO. 805 Pursuant to Article 7 of the Law No. 805, any party violating the related provisions is imposed to a judicial fine of at least 100 days. The Turkish Penal Code numbered 5237 has regulated the judicial fine provisions and accordingly the judicial fine for one day shall be determined between TL 20 ââ¬â TL 100 depending on (i) severity of violation; (ii) specific and economic conditions of persons; and (iii) discretion of judges. C. GOOD FAITH PRINCIPLE Pursuant to Article 2 of the Turkish Civil Code, raising a good faith claim is possible regarding the conflicts in an agreement. While deciding on the validity of the good faith claims, the determination shall be made on a case-to-case basis. In terms of disputes regarding non-compliance with the Law No. 805, there is not a definite provision for the application of the good faith principle and we have not come across any judgment of the Court of Appeals regarding the good faith claims has raised with respect to the application of the Law No. 805. However, with respect to the general provisions regarding the good faith claims, by analogy, the following solution may apply to conflicts on the mandatory use of Turkish language in agreements. In the event that the parties have carried out their performances to the fullest extent, considering that the agreement is valid, the agreement, itself, should be considered valid, as well. The Court of Appeals, in one of its judgments, has stated that if parties have carried out their obligations under a contract for a long time, it would be a violation of the good faith principles to claim that the related contract is invalid. Similarly, the Assembly of Civil Chambers of the Court of Appeals has ruled in a former decision that the right to raise a good faith claim is restricted when the party raising the claim is acting against the good faith principle. Although the aforementioned judgment does not directly refer to a dispute under the Law No. 805, the following conclusion could be drawn: when one or both of the parties is awaring (or shall be aware) of the mandatory use of Turkish language requirement and the aware party (or parties) disregards this rule on purpose, they should not be able to rely on a good faith claim regarding the language of the agreement.
Thursday, October 3, 2019
Symptoms and Treatment of Parkinsons Disease
Symptoms and Treatment of Parkinsons Disease Parkinsonââ¬â¢s disease Parkinsonââ¬â¢s disease is a progressive neurologic disorder affecting the brain centers that are responsible for control and regulation of movement. It is characterized by bradykinesia (slowness of movement), tremor, and muscle stiffness or rigidity (Katzung, Mastes, Trevor, 2012). The major lesion appears to result in a loss of pigmented neurons, particularly those in the substantia nigra of the brain. The substantia nigra is a collection of midbrain nuclei that project fibers to the corpus striatum. One of the major neurotransmitters in this area of the brain, and in other parts of the central nervous system, is dopamine, which has an important inhibiting function in the central control of movement (Brunton, Chabner, Knollman, 2011). Although dopamine normally exists in high concentration in certain parts of the brain, in Parkinsonââ¬â¢s disease it is depleted in the substania nigra and the corpus striatum. Depletion of dopamine levels in the basal ganglia is associated with bradykinesia, rigidity, and tremors (Brunton, Chabner, Knollman, 2011). Regional cerebral blood flow is reduced in patients with Parkinsonââ¬â¢s disease, and there is a high prevalence of dementia. Biochemical and pathologic data suggest that demented patients with Parkinsonââ¬â¢s disease may have coexistent Alzheimerââ¬â¢s disease (Connelly Fox, 2012). In the majority of patients, the cause of the disease is unknown. Arteriosclerotic Parkinsonism is seen more frequently in older age groups. It may follow encephalitis, poisoning, or toxicity (manganese, carbon monoxide), or hypoxia, or may be drug induced. The disease most frequently attacks persons in their fifties and sixties and is the second most common neurologic disorder of the elderly (Brunton, Chabner, Knollman, 2011). The clinical manifestations of Parkinsonââ¬â¢s disease are impaired movement, muscle rigidity, tremor, muscle weakness, and loss of postural reflexes. Early signs include a stiffening of the extremities and a wax-like rigidity in the performance of all movements. The patient has difficulty in initiating, maintaining, and performing motor activities, and experiences some delay in carrying out normal activity (Kofman). As the disease progresses, the tremor begins, frequently in one hand and arm, then the other, and later in the head, although the tremor may remain unilateral. The tremor is characteristic: it is a slow, turning motion (pronation-supination) of the forearm and the hand, and motion of the thumb against the fingers as if rolling a pill between the fingers. It increases when the patient is concentrating or feels anxious (Connelly Fox, 2012). Other characteristics of the disease affect the face, stature, and gait. There is loss of normal arm swing. Eventually, the rigid extremities become weaker. Since there is limited movement in the muscles, the face has so little expression that it is said to be masklike (with infrequency of blinking), a feature that can be recognized at a glance (Connelly Fox, 2012). There is a loss of postural reflexes, and the patient stands with head bent forward and walks as if in danger of falling forward. Difficulty in pivoting and loss of balance may lead to frequent falls (Katzung, Mastes, Trevor, 2012). Frequently, these patients show signs of depression, and it has not been established whether the depression is a reaction to the disorder or related to a biochemical abnormality. Mental manifestations may appear in the form of cognitive, perceptual, and memory deficits. A number of psychiatric manifestations (personality changes, psychosis, dementia, confusion) are particularly common among the elderly (Kofman). Complications from immobility (pneumonia, urinary tract infection) and the consequences of falls and accidents are major causes of death (Kofman). Early diagnosis of Parkinsonââ¬â¢s disease can be difficult, as the patient can rarely pinpoint when symptoms started. Often someone close to the patient notices a change such as stooped posture, stiff arm, a slight limp, or tremor. Handwriting changes may be an early diagnostic clue. The diagnosis of Parkinsonââ¬â¢s disease can usually be made with certainty when there is evidence of tremor, rigidity, and bradykinesia (Brunton, Chabner, Knollman, 2011). The results of the patientââ¬â¢s history and neurological examination are carefully evaluated. Without treatment Parkinsonââ¬â¢s disease progresses over ten to fifteen years to a rigid, akinetic state in which patients are incapable of caring for themselves (Brunton, Chabner, Knollman, 2011). The availability of effective pharmacological treatment has altered the prognosis of Parkinsonââ¬â¢s disease; in most cases, functional mobility can be maintained for many years. Life expectancy of adequately treated patients is increased substantially (Brunton, Chabner, Knollman, 2011). The presence of dysphagia is associated with shorter survival times. Motor impairment of the muscles in the throat impairs swallowing and poses a risk for aspiration pneumonia. Other complications of Parkinsonââ¬â¢s disease include sleep disorders, sexual dysfunction, bowel and bladder complications, and sensory problems, such as the loss of smell (Kofman). There is no cure for Parkinsonââ¬â¢s disease. Treatment mainly relies on replacing dopamine with focus on controlling symptoms and improving quality of life (Katzung, Mastes, Trevor, 2012). Because Parkinsonââ¬â¢s disease symptoms are due to a deficiency of the brain chemical dopamine, the brain drug treatment help increase dopamine levels in the brain. Levodopa, usually in combination with carbidopa, is the standard drug treatment (Katzung, Mastes, Trevor, 2012). For patients who do not respond to levodopa, dopamine agonists may be prescribed. Physical therapy is an important part of Parkinsonââ¬â¢s disease treatment. Rehabilitation can help improve balance, mobility, speech and functional abilities. No treatment method has been proven to change the course of the disease. For early disease, with little or no impairment, drug therapy may not be necessary (Kofman). There is no cure for Parkinsonââ¬â¢s disease, but medications, physical therapy, and surgical interventions can help control symptoms and improve the quality of life (Connelly Fox, 2012). The goals of treatment are to relieve disabilities and balance the problems of the disease with the side effects of the medications. A number of issues must be considered in choosing a medication for treatment. These include the effectiveness of the medication, the side effects of the medication, and the loss of effectiveness over time (Brunton, Chabner, Knollman, 2011). Levodopa (L-dopa) has been used for years and is the gold standard for treatment. L-dopa increases brain levels of dopamine. It is probably the most effective drug for controlling symptoms and is used in all phases of the disease. The standard preparations, Sinemet and Atamet, combine levodopa with carbidopa, a drug that slows the breakdown of levodopa. Levodopa is better at improving motor problems than dopamine agonists but increases the risk of involuntary movements. Effectiveness tends to decrease after four to five years of use (Brunton, Chabner, Knollman, 2011). Dopamine agonistsââ¬â¢ drugs mimic dopamine to stimulate the dopamine system in the brain. The drugs included are pramipexole (Mirapex), ropinirole (Requip), bromocriptine (Parlodel), and rotigotine (Neupro) (Katzung, Mastes, Trevor, 2012). Monoamine oxidase B inhibitors may have some mild benefits in initial therapy; they include selegiline (Eldepryl) and rasagiline (Azilect), and they slow the breakdown of dopamine that occurs naturally in the brain and dopamine produced by levodopa (Katzung, Mastes, Trevor, 2012). Entacapone (comtan) is a catechol-o-methyl transferase (COMT) inhibitor that helps to prolong the effects of levodopa by blocking an enzyme that breaks down dopamine (Brunton, Chabner, Knollman, 2011). Medications to treat other symptoms associated with Parkinsonââ¬â¢s disease include antidepressants. Tricyclicââ¬â¢s, particularly Amitriptyline (Elavil), studies indicate that the use of SSRIs may worsen symptoms. Anti-psychotics include clozapine and quetiapine help with psychotic symptoms seen with Parkinsonââ¬â¢s disease (Brunton, Chabner, Knollman, 2011). The cholinesterase inhibitor drugs donepezil (Aricept) and rivastigmine (Exelon) are used to treat Alzheimerââ¬â¢s disease and are sometimes used for Parkinsonââ¬â¢s disease. The benefits are small and may not be noticed. Daytime sleepiness and fatigue may be treated with modafinil (Provigil) a drug used to treat narcolepsy or methylphenidate (Ritalin) may be considered for fatigue. Glycopyrrolate, scopolamine, and injections of botulinum toxin may be used to relieve drooling symptoms (Brunton, Chabner, Knollman, 2011). Advanced Parkinsonââ¬â¢s disease poses challenges for the patient and caregivers. Eventually, symptoms such as stooped posture, freezing, and speech difficulties may no longer respond to drug therapy. Surgery (deep brain stimulation) may be considered. Patients become increasingly dependent on others for care and require assistance with daily tasks. The goal of treatment for advanced Parkinsonââ¬â¢s disease should be on providing safety, comfort, and quality of life (Brunton, Chabner, Knollman, 2011). The toxic effects of Levodopa with carbidopa are considerable. Dyskinesia, the ability to control muscles, can take many forms, most often uncontrolled flailing of the arms and legs or chorea, rapid and repetitive motions that can affect the limbs, face, tongue, mouth, and neck (Brunton, Chabner, Knollman, 2011). Hypotension is a common problem during the first few weeks of therapy. Cardiac arrhythmias and gastrointestinal difficulties are common, with the potential of gastric bleeding. Levodopa can cause disturbances in breathing function, but may benefit patients with upper airway obstructions. Hair loss and mental and psychiatric side effects including confusion, extreme emotional states, especially anxiety, vivid dreams, visual and auditory hallucinations, sleepiness, and effects on learning are other side effects of levodopa (Connelly Fox, 2012). Levodopa causes fewer psychiatric side effects than other drugs including anticholinergics, selegiline, amantadine, and dopamine ago nists. Psychiatric side effects often occur at night, therefore, some doctors recommend reducing the evening dose (Connelly Fox, 2012). Monoamine Oxidase B (MAO-B) inhibitors block monoamine oxidase B, an enzyme that degrades dopamine. Selegiline was commonly used in early onset disease in combination with L-dopa for maintenance (Brunton, Chabner, Knollman, 2011). Concerns of the significant side effects have been raised. Azilect, a newer MAO-B Inhibitor, is used alone during early stage Parkinsonââ¬â¢s disease and in combination with L-dopa for moderate to advanced Parkinsonââ¬â¢s disease. Side effects of MAO-B inhibitors include orthostatic hypotension, hypertension if combined with drugs that increase serotonin levels, such as many antidepressants (Brunton, Chabner, Knollman, 2011). A dangerous increase in blood pressure may occur if patients eat foods rich in the amino acid tyramine, while taking selegiline or rasagiline, and for two weeks after stopping the medications. Patients should avoid foods such as aged cheeses, processed lunch meats, pickled herring, yeast extracts, aged red wine, draft beers, sa uerkraut, and soy sauce (Connelly Fox, 2012). Dopamine agonists stimulate dopamine receptors in the substantia nigra. Dopamine agonists are effective in delaying motor complications during the first years of treatment (Katzung, Mastes, Trevor, 2012). Newer dopamine agonists, Mirapex (pramipexole) and Requip (ropinirol) are the most commonly prescribed. Mirapex appears to work better and have fewer side effects than requip. Side effects include nausea, vomiting, constipation, headache, nasal congestion, nightmares, hallucinations, and psychosis. Bromocriptine is the only ergot dopamine agonist approved for treatment in the US (Connelly Fox, 2012). Apomorphine is a dopamine agonist used as a rescue drug in people having on-off effects severe enough to require going off L-dopa for a few days. Because it causes severe nausea and vomiting, it must be taken with an anti-emetic. Rotigotine (Neupro) is a once daily transdermal patch to treat early and advanced stage Parkinsonââ¬â¢s disease (Connelly Fox, 2012). Catechol-O- Methyl Transferase Inhibitors (COMT Inhibitors) increase concentrations of existing dopamine in the brain. Entacapone (Comtan, Stalevo) is the current standard COMT inhibitor. It improves motor fluctuations related to weaning off effects. The side effects include involuntary muscle movement, confusion, hallucinations, nausea, vomiting, insomnia, headache, urinary retention, cramps, diarrhea, less common constipation, susceptibility to respiratory infection, sweating and dry mouth (Brunton, Chabner, Knollman, 2011). A major concern is reports of death from liver damage in patients taking tolcapone (Tasmar) and is recommended only for patients unable to tolerate other drugs. Entacapone does not appear to have the same effects on the liver and does not require the same monitoring (Katzung, Mastes, Trevor, 2012). Anticholinergic drugs were the first used in the treatment for Parkinsonââ¬â¢s disease. They are used only for control of tremors in early stages (Brunton, Chabner, Knollman, 2011). Side effects are dry mouth, nausea, urinary retention, blurred vision, and constipation. They can increase heart rate and constipation. They may cause mental problems including memory loss, confusion, and hallucinations (Brunton, Chabner, Knollman, 2011). Amantadine stimulates the release of dopamine and may be used with early mild symptoms. Side effects include swollen ankles, and mottled skin, visual hallucinations. Overdose can cause serious and life-threatening toxicity (Brunton, Chabner, Knollman, 2011). References Brunton, L., Chabner, B., Knollman, B. (2011). Goodman Gilmans: The pharmacological basis of therapeutics (12 ed.). McGraw-Hill. Connelly, B., Fox, S. (2012, December). Drug treatments for the neuropsychiatric complications of Parkinsons disease. Retrieved from Medscape.com: http://www.medscape.com/viewarticles/777166 Katzung, B., Mastes, S., Trevor, A. (2012). Basic clinical pharmacology (12 ed.). McGraw-Hill. Kofman, O. (n.d.). Complications of therapy in Parkinsons disease. CKP-MFC, 12, 87-91. Retrieved from http://www.ncbi.nih.gov/pmc/articles/pmc2153537
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