A complete IHP 310 Module 5 chart review milestone on Parkinson disease and metoclopramide: chart timeline, pathophysiology of dopamine loss, drug mechanisms, a medication judgment table, safer alternatives, documentation gaps and references. Searches like "ihp 310 module 5 assignment", "ihp310 module 5 patient chart review milestone" and "ihp 310 module 5 example" land here.
The IHP 310 Module 5 example, in full
The Refill That Undid the Levodopa: A Chart Review of Metoclopramide in a 74-Year-Old Woman With Parkinson Disease
[Student Name]
Southern New Hampshire University
IHP 310: Pathophysiology and Pharmacology Concepts
Module Five Final Project Milestone
[Instructor Name]
[Date]
The organization, setting and figures below are a composite written as a model document. No real employer, client, colleague or patient is described.
The Refill That Undid the Levodopa: A Chart Review of Metoclopramide in a 74-Year-Old Woman With Parkinson Disease
Chart Timeline
The table below lists the relevant entries in Mrs. Lindqvist's record.
Table 1
Timeline of Chart Entries for Mrs. Lindqvist
| Date | Entry |
|---|---|
| Six years ago | Parkinson disease diagnosed by neurology; carbidopa-levodopa started |
| Three months ago | Neurology visit: mild tremor and slowness; walks independently; no falls |
| Ten weeks ago | Urgent care visit for nausea after a viral illness; metoclopramide 10 mg three times daily prescribed for 7 days |
| Eight weeks ago | Patient calls primary care for refill; metoclopramide renewed for 30 days with two refills |
| Four weeks ago | Two falls at home; family reports she is stiffer and slower |
| This week | Primary care visit: marked rigidity, shuffling gait, reduced facial expression |
Reading the Timeline
Mrs. Lindqvist is a composite 74-year-old retired music teacher who had been stable on carbidopa-levodopa. Her motor symptoms worsened over the weeks after a short antiemetic prescription became a long-term one, without a documented reason for continuing it. Neither the urgent care note nor the refill note records her Parkinson diagnosis in the assessment. The chart shows a medication started for a week and renewed for three months by a clinician who did not see the patient.
Pathophysiology of Parkinson Disease
In Parkinson disease, the neurons of the substantia nigra that make dopamine die off gradually, which project to the striatum and help control movement. When dopamine signaling in this pathway falls, patients develop slowness of movement, rigidity, resting tremor and, later, balance problems and falls. Symptoms usually appear only after a large share of these neurons has been lost, so patients depend heavily on whatever dopamine signaling remains and on medications that replace it (Armstrong & Okun, 2020).
How the Drugs Act
Levodopa, a dopamine precursor, passes the blood-brain barrier, where neurons turn it into dopamine and signaling in the motor pathway is partly restored. Carbidopa blocks the conversion of levodopa to dopamine outside the brain, which allows more levodopa to reach the brain and reduces nausea caused by dopamine in the bloodstream. Metoclopramide blocks dopamine D2 receptors. It relieves nausea by acting on the chemoreceptor trigger zone and speeds stomach emptying, but because it crosses into the brain it also blocks D2 receptors in the striatum. In a patient whose motor function depends on limited dopamine signaling, that blockade works directly against levodopa and produces drug-induced parkinsonism on top of the disease.
Medication Judgments
The table below judges each medication in the chart.
Table 2
Medication Judgments for Mrs. Lindqvist
| Medication | Judgment | Basis |
|---|---|---|
| Carbidopa-levodopa | Appropriate; continue | Core treatment for motor symptoms |
| Metoclopramide | Inappropriate; stop | Dopamine blocker listed to avoid in Parkinson disease; also advised against for more than 12 weeks in older adults |
| Alternative for any ongoing nausea | Consider ondansetron, extra carbidopa, or taking levodopa with a small snack | Treat nausea without blocking brain dopamine |
Guideline Support
The American Geriatrics Society Beers Criteria list metoclopramide among drugs older adults should avoid unless used for gastroparesis for a limited time, and they identify antiemetics that block dopamine, including metoclopramide, prochlorperazine and promethazine, as drugs to avoid in people with Parkinson disease because they can worsen symptoms (2023 American Geriatrics Society Beers Criteria Update Expert Panel, 2023). The criteria also warn about the risk of movement disorders, including tardive dyskinesia, with prolonged metoclopramide use. The review's judgment therefore rests on both mechanism and a widely used national standard.
Drug-Induced Parkinsonism and the Chance of Recovery
Among older adults, medicines are a frequent and often overlooked cause of parkinsonian symptoms, and dopamine receptor blockers, including antipsychotics and antiemetics such as metoclopramide, are the usual culprits (Shin & Chung, 2012). In people without Parkinson disease, symptoms often resolve within weeks to months after the drug is stopped, although recovery can take longer in some patients. In someone who already has Parkinson disease, the drug adds to an existing deficit, so the worsening can be abrupt and severe. The practical implication for Mrs. Lindqvist is hopeful but uncertain: much of her decline may reverse after metoclopramide is stopped, but the team should not assume her disease has suddenly progressed, nor that recovery will be immediate. Her neurologist should reassess her after several weeks off the drug before changing her long-term plan.
Consequences Beyond the Chart
The error has consequences that a chart review should name. Two falls in a 74-year-old with Parkinson disease raise the risk of hip fracture, head injury and loss of confidence that leads to less walking and further decline. Her family has taken time off work to help at home. If a fracture occurs, the cost of one inappropriate refill could include surgery, rehabilitation and possibly a move to assisted living. Framing the finding this way helps a health care manager see why a small documentation change, such as requiring review before renewing drugs on a high-risk list, deserves attention and resources.
Recommendations
Metoclopramide should be stopped and her motor symptoms reassessed over the following weeks, since drug-induced worsening often improves after the blocking drug is removed. Her neurologist should be informed and should decide whether levodopa needs adjustment. If nausea persists, a non-dopamine-blocking antiemetic or measures to reduce levodopa-related nausea should be used. Her fall risk should be addressed immediately with a home safety review, physical therapy focused on gait and balance, and a review of footwear and night lighting. Finally, the chart itself needs correction: Parkinson disease should be on every problem list the urgent care and primary care teams see, and refills of drugs flagged in the Beers Criteria should require review of the patient's conditions rather than automatic renewal.
Conclusion
Mrs. Lindqvist's decline followed a dopamine-blocking antiemetic that counteracted her levodopa and was renewed without review. The chart review links the timeline to the pathophysiology of dopamine loss and the mechanisms of both drugs, judges each medication against a national standard and identifies the documentation gaps that allowed the error to persist. These are the building blocks of the complete final project analysis, which will add her other conditions and a full medication reconciliation across all of her prescribers.
References
2023 American Geriatrics Society Beers Criteria Update Expert Panel. (2023). American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 71(7), 2052-2081. https://doi.org/10.1111/jgs.18372
Armstrong, M. J., & Okun, M. S. (2020). Diagnosis and treatment of Parkinson disease: A review. JAMA, 323(6), 548-560. https://doi.org/10.1001/jama.2019.22360
Shin, H.-W., & Chung, S. J. (2012). Drug-induced parkinsonism. Journal of Clinical Neurology, 8(1), 15-21. https://doi.org/10.3988/jcn.2012.8.1.15
How this IHP 310 Module 5 example is structured
A chart review follows the record, so the paper begins with a dated timeline of entries that reveals when the decline started. The pathophysiology of Parkinson disease follows, focused on the dopamine pathways that both the disease and the drugs act on. The mechanism of each relevant drug comes next, then a table judging every medication in the chart. The review ends with recommendations for treatment and for the documentation gaps that allowed the problem to continue.
Get IHP 310 Module 5 written to your instructions
Upload your IHP 310 milestone guidelines, the rubric and the patient record assigned to you. A chart review of that record comes back within 24 to 48 hours, with your first sample free. The paper above is an original model document written by our desk, not a submitted student paper and not an official Southern New Hampshire University document.
IHP 310 Module 5 questions, answered
What does the IHP 310 final project milestone ask?
Milestones for the final project commonly ask students to review part of a patient record: summarize the conditions, explain their pathophysiology, identify the medications and their mechanisms, and assess whether treatment is appropriate. Later milestones build these parts into the complete analysis.
Why is metoclopramide a problem in Parkinson disease?
Metoclopramide blocks dopamine D2 receptors, including in the brain's motor pathways. Parkinson disease is caused by loss of dopamine in those pathways, so blocking the remaining dopamine signaling can worsen stiffness, slowness and tremor and counteract levodopa.
What can treat nausea in someone with Parkinson disease?
Options depend on the cause. Nausea from levodopa often improves when it is taken with a small snack or when extra carbidopa is added. Antiemetics that do not block dopamine in the brain, such as ondansetron, are generally preferred over dopamine blockers. A prescriber should choose based on the whole medication list.