Slide Presentation from the AHRQ 2007 Annual Conference

The Prescribing Cascade (continued)

Flowchart showing "The Prescribing Cascade"

Metoclopramide leads to Extrapyramidal Effects, which leads to the prescription of Levodapa Rx

Notes:

Let me give you some specific examples. The first study involves the drug metoclopramide. Since metoclopramide first became available as a gastric motility agent, there have been numerous reports in the literature of unwanted extrapyramidal side effects including drug-induced parkinsonian symptoms. Idiopathic Parkinson's Disease is certainly seen with greater frequency in older patients. However, it would be very problematic if drug-induced parkinsonian symptoms were misinterpreted as Parkinson's Disease. Levodopa therapy is relatively specific to the treatment of idiopathic Parkinson's Disease. So, in this study we employed levodopa therapy as a proxy for the occurrence of this event.