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

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