Plot
In the 1990s, Jamie (Gyllenhaal), who works at an electronics store, is fired for sleeping with his manager's girlfriend. After his parents find out and criticize Jamie for leaving medical school, his wealthy brother Josh (Josh Gad) offers to find him a job as a medical representative. Jamie goes to work for Pfizer and tries to get doctors to prescribe Zoloft and Zithromax. He is rebuffed constantly much to the dismay of his partner Bruce (Oliver Platt), who sees Jamie as his ticket to the "big leagues" of Chicago. Bruce tells Jamie if he can get Dr. Knight (Hank Azaria) to prescribe Zoloft instead of Prozac, all the other doctors will follow his lead. Jamie uses his skills as a womanizer to gain access to Dr. Knight.
Jamie meets one of Knight's patients, Maggie Murdock (Hathaway), who suffers from early onset Parkinson's disease. Jamie arranges a date with her, which lasts only 10 minutes before they return to her apartment and have sex.
In the hospital parking lot, Jamie is confronted and beaten up by the top-selling Prozac rep Trey, also one of Maggie's lovers, who warns Jamie to stay away from her and the doctors. That night, Jamie goes to Maggie's apartment, and they start having sex but Jamie is unable to get an erection. Maggie teases him that he should use the new erection drug, Viagra, that his company has developed. Jamie starts selling Viagra, which becomes very popular with the doctors and helps Jamie and Maggie's sex life.
Jamie tries to convince Maggie to have a fuller relationship with him, but she refuses. The next day, Maggie is helping senior citizens onto a bus bound for Canada to get cheap prescription drugs when Jamie shows up. They argue about their relationship and she leaves. Jamie waits in the parking lot, and the next day when the bus comes back, Maggie is touched that he waited and tells him she will have a relationship with him.
Jamie asks Maggie to go to a medical conference with him in Chicago. She accepts and while at the conference is invited to a Parkinson's convention across the street. She is moved by the people and their stories. She asks Jamie to come over and join her and he meets a man whose wife is in the final stages of the disease. Jamie asks for advice about Maggie, and the man tells him to run. This shakes Jamie. After the convention, Maggie tells him how much she loves him.
Jamie starts researching Parkinson's and pushing Knight for information on specialists. He starts taking Maggie to a specialist and paying for her to have tests done. At one office Jamie becomes upset because their appointment was rescheduled after they had flown in to see the doctor. While Jamie is yelling at the receptionist, Maggie walks out. They fight and Maggie says there is no cure. Maggie sees that Jamie can only love her with the hope that one day there will be a cure, and so she breaks up with him.
Some time later, Jamie goes to meet Bruce for dinner and runs into Maggie, who is on a date. Bruce shows up and says that Jamie has been promoted to the Chicago office. Jamie goes home and starts to pack but realizes he wants to be with Maggie and goes to the diner where she works. Her boss tells him she has left for Canada to obtain drugs and Jamie goes off after her. Jamie flags down the bus Maggie is on. Maggie gets off and says that Jamie has five minutes to talk. He tells Maggie about how she makes him a better person, that he loves her and needs her. She starts to cry and says she will need him more. The film ends with Maggie and Jamie living together with Jamie refusing the Chicago promotion, and enrolling in Medical School.
NURSING FACTS & INFORMATION
Sertraline hydrochloride (trade names Zoloft and Lustral) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It was introduced to the market by Pfizer in 1991. Sertraline is primarily used to treat major depression in adult outpatients as well as obsessive–compulsive, panic, and social anxiety disorders in both adults and children.
Sertraline has been approved for the following indications: major depression, obsessive-compulsive disorder (OCD), posttraumatic stress disorder (PTSD), premenstrual dysphoric disorder (PMDD), panic disorder and social phobia (social anxiety disorder).
Fluoxetine (also known by the tradenames Prozac, Sarafem) is an antidepressant of the selective serotonin reuptake inhibitor (SSRI) class. It is manufactured and marketed by Eli Lilly and Company. In combination with olanzapine it is known as symbyax.
Fluoxetine is approved for the treatment of major depression (including pediatric depression), obsessive-compulsive disorder (in both adult and pediatric populations), bulimia nervosa, panic disorder and premenstrual dysphoric disorder
PARKINSON’S DISEASE – (degenerative disease) chronic progressive disorder of the CNS characterized by degeneration of the dopamine producing cells in the substantia nigra of the midbrain and basal ganglia (areas of gray matter in both hemispheres which is involved in the extrapyramidal tract) IRREVERSIBLE, IDIOPATHIC
A. PREDISPOSING FACTORS
1. Poisoning
Lead (ANTIDOTE: Ca EDTA – heavy metal antagonist)
Carbon Monoxide decreased capacity of hemoglobin to carry oxygen cherry red skin color
2. Arteriosclerosis
3. Hypoxia – inadequate tissue perfusion
4. Encephalitis
5. Drugs
Reserpine (Serpasil)
Methyldopa (Aldomet) – has anti HPN properties
Haloperidol (Haldol) – anti-psychotic
Phenothiazides – anti-psychotic
PHENERGAN – only anti-psychotic with anti-emetic properties
B. CLINICAL MANIFESTATION
1. PILL ROLLING TREMORS of the extremities – first sx
2. Bradykinesia – second sx
3. Rigidity (“cogwheel type”) – third sx
4. Stooped posture, SHUFFLING GAIT, propulsive gait
5. Overfatigue
6. Mask-like facial expression, decreased blinking of the eyelids
7. Difficulty in rising from sitting position
8. Quiet monotone speech
9. Mood lability depression suicide
10. Increased salivation, drooling type
11. Autonomic changes
Increased sweating and lacrimation
Seborrhea
Constipation
Decreased sexual capacity
C. NURSING MANAGEMENT (palliative)
1. Administer medications as ordered
Anti-Parkinsonian Agents increase dopamine relieves rigidity (CAPABLES!)
Levodopa (L-dopa) – short acting dopaminergic
Amantadine HCl (Symmetrel) – long acting dopaminergic
Carbidopa (Sinemet) – long acting dopaminergic
INSTRUCT CLIENT TO AVOID FOODS RICH IN VITAMIN B6--PYRIDOXINE (Cereals, organ meat, green leafy vegetables) – reverses therapeutic effect of levodopa
Anti-cholinergics – relieves tremors
Artane and Cogentin
Antihistamine – relieves tremors
Diphenhydramine HCl (Benadryl)
Bromocriptine HCl (Parlodel)
2. Maintain side rails to prevent injuries related to falls
3. Prevent complications of immobility
4. Maintain good nutrition. Provide dietary intake that is low in protein in AM and high protein at night to induce sleep
TRYPTOPHAN – induces sleep
5. Assists in passive ROM exercises to prevent contractures. Q4h for proper body alignment.
6. Increased OFI is encouraged and increased Fiber in the diet for constipation
7. Ambulate with assistance
8. Assist in STEROTAXIC THALAMOTOMY
COMPLICATIONS: SUBARACHNOID HEMORRHAGE, ENCEPHALITIS, CEREBRAL ANEURYSM
