Parkinson's medicine timing — GPhC CRA MCQ
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Correct answer: B — Keep the person-specific administration times and redesign the supply system around them
Keep the person-specific administration times and redesign the supply system around them: Parkinson’s medicines are time critical; the dispensing system and rounds should support the prescribed schedule rather than changing clinically important times for convenience. Move every dose by up to two hours because modified administration times are clinically equivalent: Delays or bunching can worsen mobility and swallowing and are not automatically equivalent. Combine the two closest doses into one larger standard-round dose: Dose consolidation changes levodopa exposure and can cause both off periods and dyskinesia. Omit the least convenient dose and monitor mobility for one week: A care-home operational problem is not a justification for unprescribed dose omission. Change to once-daily co-careldopa without involving the Parkinson’s team: There is no simple once-daily equivalent and regimen changes require specialist review.
Reference: NICE NG71: Parkinson’s disease in adults: https://www.nice.org.uk/guidance/ng71/chapter/recommendations; NHS SPS: managing inadvertent delays in Parkinson’s medicines: https://www.sps.nhs.uk/articles/managing-inadvertent-delays-in-medication-for-parkinsons-disease/; BNF: co-beneldopa: https://bnf.nice.org.uk/drugs/co-beneldopa/