Alzheimer's & Parkinson's - Ch. 26

*What problem is a possible adverse effect of memantine (Namenda) for Alzheimer's disease?* a.Seizures b.Tachycardia c.Severe hypertension d.Peripheral neuropathy

*ANS: A* Adverse effects of memantine include shortness of breath, seizures, and hallucinations.

*Which common initial symptom suggests that a patient may be developing Parkinson's disease?* a.Pill-rolling tremor b.Muscle rigidity c.Stooped posture d.Stumble-run walk

*ANS: A* For many patients with Parkinson's disease, the initial symptom is a coarse, rhythmic tremor of the hand while the hand is at rest, also called pill-rolling tremor.

[15] *Which statement made by a patient with Alzheimer's disease indicates the need for additional teaching?* a."When I have been taking donepezil for 6 weeks I should regain my memories." b."The only way to be sure that I have Alzheimer's disease is by autopsy after I die." c."Even with medication, eventually I will need total care to prevent complications." d."The rivastigmine I am taking may slow down the progression of my symptoms."

*ANS: A* No drug has been developed that will protect neurons from the changes that occur with Alzheimer's disease. Drug treatments can temporarily slow the progression of symptoms in some patients. The drugs do not cure the disease and a patient should not expect to regain lost function. The only way to definitively diagnose this illness is by seeing the plaques and tangles in the brain on autopsy after death.

*Which drug for Parkinson's disease is not recommended for breastfeeding mothers because it stops the production of breast milk?* a.Rasagiline (Azilect) b.Bromocriptine (Parlodel) c.Carbidopa (Sinemet) d.Tolcapone (Tasmar)

*ANS: B* Although Parkinson's disease is very rare in women of childbearing age, bromocriptine (Parlodel) is usually not recommended during pregnancy or breastfeeding. It stops the production of breast milk.

*How do cholinesterase/acetylcholinesterase inhibitors work for treatment of Alzheimer's disease?* a.Protecting the neurons from the changes that occur with Alzheimer's disease. b.Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses. c.Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain. d.Increasing the amount of white matter surrounding neurons to prevent the formation of "tangles."

*ANS: B* Cholinesterase/acetylcholinesterase inhibitors reduce the activity of the enzyme acetylcholinesterase that breaks down acetylcholine in the synapses of neurons. This action keeps levels of acetylcholine higher. These drugs are used for early to moderate stages of Alzheimer's disease and their effects are temporary.

*Which problem is a common side effect of most drugs used to treat Parkinson's disease?* a.Asthma b.Hypotension c.Constipation d.Weight gain

*ANS: B* The most common side effects of drugs to treat Parkinson's disease are dizziness, nausea, and hypotension.

*Which is the common underlying pathophysiology of both Alzheimer's disease and Parkinson's disease?* a.Both are neurodegenerative diseases. b.Both are forms of dementia. c.Both involve interrupted transmission of nerve impulses. d.Both are primarily caused and directly related to environmental factors.

*ANS: C* Alzheimer's disease is a form of dementia. Parkinson's disease is a neurodegenerative disease. Both illnesses involve interrupted nerve impulse transmissions.

*Which symptom is often the earliest to occur in a patient with Alzheimer's disease?* a.Difficulty solving simple math problems b.Problems performing simple tasks c.Mild forgetfulness d.Inability to read

*ANS: C* Alzheimer's disease symptoms begin very slowly. In the early stage, the first symptom is mild forgetfulness, which is sometimes confused with age-related memory changes.

*How does memantine (Namenda) work for treatment of Alzheimer's disease?* a.Protecting the neurons from the changes that occur with Alzheimer's disease b.Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses c.Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain d.Increasing the amount of white matter surrounding neurons to prevent the formation of "tangles"

*ANS: C* Memantine (Namenda) blocks the amino acid glutamate at N-methyl-D-aspartate receptors in the brain, preventing overstimulation (overstimulation of these receptors damages neurons and appears to be one cause of Alzheimer's disease). It can be effective in helping modify dementia (temporarily) in some patients with moderate-to-severe Alzheimer's disease.

*Which problem is a major symptom of Parkinson's disease?* a.Memory loss b.Urinary retention c.Abnormal gait d.Nausea/vomiting

*ANS: C* The four major symptoms of Parkinson's disease are tremor at rest, rigidity, bradykinesia (slow movements and difficulty starting to move), and abnormal gait.

*Which statement about Alzheimer's disease is true?* a.The causes of Alzheimer's disease are known but not treatable. b.Physical deterioration occurs before intellectual deterioration. c.The onset of the disorder is sudden and dramatic. d.It is the most common form of dementia.

*ANS: D* Alzheimer's disease is a progressive and incurable condition that destroys brain cells, with gradual loss of intellectual abilities such as memory and extreme changes in personality and behavior. It is the most feared and common form of dementia. Alzheimer's disease is the most common form of dementia.

*Which problem is a common side effect of donepezil (Aricept) for treatment of Alzheimer's disease?* a.Weight gain b.Hypertension c.Constipation d.Nausea/vomiting

*ANS: D* The most common side effects of cholinesterase/acetylcholinesterase inhibitors are nausea, vomiting, diarrhea, stomach cramps, headaches, dizziness, fatigue, weakness, insomnia, and loss of appetite (anorexia).

*Which drug used to treat Parkinson's disease is a COMT inhibitor?* a.Rasagiline (Azilect) b.Bromocriptine (Parlodel) c.Carbidopa (Sinemet) d.Tolcapone (Tasmar)

*ANS: D* Tolcapone is a COMT inhibitor. Rasagiline is an MAO-B inhibitor while carbidopa and bromocriptine are dopaminergic/dopamine antagonists.

*Which drug used to treat Parkinson's disease is a pure dopamine agonist?* a.Trihexyphenidyl (Artane) b.Tolcapone (Tasmar) c.Selegiline (Zelapar) d.Rotigotine (Neupro)

*ANS: D* Trihexyphenidyl is an anticholinergic drug. Tolcapone is a COMT inhibitor. Selegiline is a MAO-B inhibitor. Only rotigotine is a pure dopamine agonist.

*For which patient do you watch most closely for symptoms of Alzheimer's disease?* a.35-year-old with Down syndrome b.50-year-old with a whiplash injury c.60-year-old with hypertension d.75-year-old with a smoking history

*ANS: D* While whiplash and head injuries, hypertension, smoking, and high cholesterol all increase the risk for Alzheimer's disease, age is the greatest risk factor for development of Alzheimer's disease. A patient with Down syndrome has an increased risk by age 50 to 60 years.