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This is known as first pass metabolism, which can result in considerable loss of activity for some drugs on first pass through the liver.
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Drugs used to treat Parkinsons disease aim to replace dopamine; stimulate dopamine receptors or the release of remaining dopamine; reduce breakdown of dopamine or reduce excessive parasympathetic activity.
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Mrs Coopers daughter asks you if her mothers condition is likely to get worse, how quickly, and if there is anything else that can be done if it does. What can you tell her about this and is there anything else you could advise the patient and her family about.
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However, warts may be painful, often look ugly, and cause embarrassment in which case treatment may be appropriate.
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Lamotrigine is similar in action to phenytoin. It appears to work on sodium ion channels to cause inhibition of the release of excitatory amino acids.
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