Quick Orderset for Physicians

A list of recommendtions for physicians to consider in admission orderset for a patient with Parkinson's disease, Lewy Body disease, or atypical Parkinsonism including MSA, PSP.

Resuming home medications

1. Please resume home medications for Parkinson as soon as possible.

2. If the patient is NPO with high risk for aspiration, consider replacement of with equivalent dose of “Parcopa” (sublingual carbidopa levodopa), or place a NG/ DH tube tube as soon as possible to continue Parkinson medications via tube.

3. In patients with NG/DH, Rytary capsule (extended release carbidopa-levodop) should be switched to the equivalent dose of Sinemet 25/100 that can be given via tube.

Rytary to Sinemet 25/100 conversion formula: total daily dose of Rytary divided by 2= total daily dose of Sinemet 25/100; divide the total daily dose in 3-4 times a day]

4. Avoid food or tube feeding 1 hour before and 1 hour after administration of carbidopa-levodopa.

Management of delirium and hallucinations

5. Please evaluate for any underlying systemic infection, dehydration, or metabolic abnormality, causing altered mental status.

6. Please consider Rivastigmine patch 4.6mg daily for fluctuation in mental status, delirium, sundowning in patients with cognitive impairment.

7. Safe medications for Parkinson psychosis/ hallucinations:

  • Pimavanserin (Nuplazid) 34mg nightly
  • Quetiapine (Seroquel)
  • Clozapine (Clozaril)
  • Check QTc/ EKG

8. AVOID all other antipsychotic medications, including Haldol or Risperidone.

9. Aspiration precautions. Keep the head of the bed elevated up to 1 hour after feeding.

10. Constipation care as needed: Docusate senna, Miralax, Magnesium Citrate PRN

11. Fall precautions, check for orthostatic hypotension

12. Physical therapy/Occupational therapy/Speech and swallow evaluation order soon after admission for care and disposition planning.