Which clinical manifestation is a serious adverse effect of carbidopa-levodopa therapy in patients with Parkinson's disease? Select all that apply, One, some, or all responses may be correct. $$ \square $$ Orthostatic hypotension $$ \square $$ Tachycardia and palpitations $$ \square $$ Nausea, vomiting, and anorevia $$ \square $$ Nightmares, depression, and hallucinations $$ \square $$ Bobbing, facial grimacing, and rocking movements

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Carbidopa-levodopa therapy is a cornerstone treatment for Parkinson's disease, but it is associated with several potential adverse effects. Among the options provided, the following are considered serious adverse effects:

1. **Orthostatic Hypotension**  
   - **Explanation:** This condition involves a significant drop in blood pressure upon standing, which can lead to dizziness, fainting, and an increased risk of falls. It is a well-recognized adverse effect of carbidopa-levodopa therapy due to its impact on the autonomic nervous system.

2. **Nightmares, Depression, and Hallucinations**  
   - **Explanation:** These psychiatric symptoms can severely affect a patient's quality of life and may require additional intervention. Hallucinations and confusion are particularly concerning as they can lead to impaired judgment and increased caregiver burden.

3. **Bobbing, Facial Grimacing, and Rocking Movements (Dyskinesias)**  
   - **Explanation:** These involuntary movements, known as dyskinesias, can interfere with daily activities and are often dose-dependent. They represent a significant complication of long-term carbidopa-levodopa therapy.

**Less Serious or Less Common Adverse Effects:**

- **Tachycardia and Palpitations:** While possible, these are less commonly emphasized as serious adverse effects directly attributable to carbidopa-levodopa therapy.
  
- **Nausea, Vomiting, and Anorexia:** These are common side effects but are generally manageable and considered less serious unless they lead to significant dehydration or weight loss.

**Selected Serious Adverse Effects:**

- $$ \checkmark $$ Orthostatic hypotension  
- $$ \checkmark $$ Nightmares, depression, and hallucinations  
- $$ \checkmark $$ Bobbing, facial grimacing, and rocking movements

**Final Answer:** All except the second (tachycardia and palpitations) are serious adverse effects.

- Orthostatic hypotension
- Nightmares, depression, and hallucinations
- Bobbing, facial grimacing, and rocking movements
Orthostatic hypotension, nightmares, depression, hallucinations, and bobbing, facial grimacing, and rocking movements are serious adverse effects of carbidopa-levodopa therapy in Parkinson's disease.

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