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Apomorphine is a potent dopamine receptor agonist used in advanced disease. It has to be administered by subcutaneous injection and causes such severe nausea and vomiting that an antiemetic has to be administered for two days prior to treatment. Dopamine receptor agonists have similar, but less severe, central side effects to levodopa. Amantadine stimulates release of dopamine from nerve terminals and reduces the re-uptake of dopamine. Rigidity, hypokinesia and tremor are all improved.

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He admits to having hypertension, for which he is being treated, but also says he has not seen his GP for to arrange this visit to the podiatrist. His current drug therapy has not changed for the past five years. There also appears to be significant ankle oedema, which has worsened since Mr Buckley retired Mr Buckleys current drug therapy is propranolol Discuss the treatment of this patient using the questions below as a guide. They are intended to stimulate discussion not limit debate.

Griseofulvin has to be taken for at least four weeks and because the drug may be teratogenic, it must not be used in during pregnancy, or in the month before conception or by prospective fathers six months prior to conception. Common adverse effects of oral griseofulvin are diarrhoea, nausea, vomiting, headache and photosensitivity. Griseofulvin enhances the effects of alcohol and reduces the effectiveness of oral contraceptive pills.

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