Chapter 47: Drug Therapy for Parkinson's Disease and Anticholinergics

An 80-year-old patient has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What patient education should be provided? A. "Anticholinergics increase mental alertness." B. "It is safe to take Sudafed for a cold." C. "Avoid high environmental temperatures." D. "You may experience urinary incontinence."

"Avoid high environmental temperatures." Anticholinergic drugs decrease sweating and may cause heat stroke. The patient should be instructed to avoid high environmental temperatures. Anticholinergic agents will decrease mental alertness. Sudafed will produce anticholinergic effects and should not be administered. Anticholinergic agents produce urinary retention, not incontinence.

A patient with long-standing Parkinson's disease has been prescribed entacapone (Comtan). The patient asks the nurse to describe exactly how this medication works. Which of the following responses is most appropriate? A. "It increases the metabolism of levodopa in the bloodstream." B. "Entacapone is best given parenterally to relieve symptoms." C. "Entacapone inhibits COMT so that dopamine is active for a longer time." D. "It increases the amount of dopamine that your brain creates."

"Entacapone inhibits COMT so that dopamine is active for a longer time." Entacapone is a COMT inhibitor. COMT plays a role in brain metabolism of dopamine. Entacapone is administered orally, not parenterally. Entacapone does not increase the metabolism of dopamine in the bloodstream. It inhibits the metabolism of levodopa in the blood stream. Entacapone is 90% excreted in the biliary tract and feces and 10% in the urine.

The physician has ordered scopolamine transdermally for motion sickness. Which of the following statements by the patient indicates an understanding of the medication's administration guideline? A. "I will use it when I am sick to my stomach." B. "I will change the patch every 3 days." C. "I will change the patch every 4 hours." D. "I will place it on my chest each morning."

"I will change the patch every 3 days." Scopolamine is used for motion sickness. The disk (Transderm-V) protects against motion sickness for 72 hours. The scopolamine patch is applied behind the ear, not to the chest. The patch is used prior to the patient experiencing nausea. The patch is not changed every 4 hours.

The nurse is teaching a woman who has Parkinson's disease about the dietary implications of her upcoming treatment with levodopa/carbidopa. What should the nurse teach this patient? A. "Dairy products will make this medication ineffective, so make sure you don't take them at the same time." B. "If possible, try to eat extra protein when you're taking this medication." C. "It's important to take this medication on a full stomach so that it doesn't make you nauseous." D. "Most people find that it's best to take this medication at bedtime, provided you haven't snacked in the evening."

"It's important to take this medication on a full stomach so that it doesn't make you nauseous." Levodopa/carbidopa is administered with or just after food or following a meal to reduce nausea and vomiting. Levodopa/carbidopa is not administered with a high-protein diet. Dairy products do not interfere with pharmacokinetics.

A patient with Parkinson's disease is being treated with rasagiline (Azilect). This medication inhibits the metabolism of dopamine by monoamine oxidase. Which of the following foods should the patient be instructed to avoid? A. Ham and rye bread B. Roast beef and horseradish C. Cheddar cheese and Polish sausage D. Dairy products

Cheddar cheese and Polish sausage Cheddar cheese and Polish sausage are high in tyramine, which produces a life-threatening reaction of hypertension when combined with rasagiline. The other listed foods are not high in tyramine.

A patient has been diagnosed with chronic obstructive pulmonary disease. The patient is to be administered tiotropium bromide (Spiriva HandiHaler). The patient's creatinine level is 25. What is the patient at risk for developing? A. Hepatotoxicity B. Central nervous system depression C. Drug toxicity D. Pneumonia

Drug toxicity The patient has an elevated creatinine level. Tiotropium bromide is eliminated by the renal system, and patients with moderate to severe renal dysfunction should be carefully monitored for drug toxicity.

A woman is admitted to the emergency department with a diagnosis of sinus bradycardia. The patient has been prescribed atropine 0.5 mg IV. How often can atropine be administered? A. Every 3 to 5 minutes B. Every 6 hours C. Every 24 hours D. Every 30 minutes

Every 3 to 5 minutes Atropine 0.5 mg should be administered IV every 3 to 5 minutes and may be repeated up to 3 mg. Atropine can be administered every 24 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be administered every 6 hours, but this administration is not the recommended therapy for bradycardia. Atropine can be given in 30 minutes, but this administration is not the recommended therapy for bradycardia.

A patient has been administered atropine for sinus bradycardia. Which of the following symptoms is noted with large doses of atropine? A. Pallor B. Flushing C. Incontinence D. Edema

Flushing Large doses of atropine cause facial flushing because of dilation of blood vessels in the neck. Pallor, edema, and incontinence are not caused by dilation of blood vessels in the neck.

A patient has developed symptoms of rigidity and bradykinesia. Which of the following medications has been linked to secondary parkinsonism? A. Haloperidol B. Valproic acid (Valproate) C. Psyllium hydrophilic mucilloid (Metamucil) D. Furosemide (Lasix)

Haloperidol Drugs that deplete dopamine stores or block dopamine receptors, including the older antipsychotic drugs (phenothiazines and haloperidol), reserpine, and metoclopramide, can produce movement disorders such as secondary parkinsonism. Furosemide does not deplete dopamine stores. Psyllium does not deplete dopamine stores. Valproic acid does not deplete dopamine stores.

A patient is suffering from urinary urgency and frequency. Which of the following medications will assist in treating the patient's symptoms of urinary frequency? A. Hyoscyamine (Anaspaz) B. Belladonna tincture C. Homatropine hydrobromide D. Ipratropium (Atrovent)

Hyoscyamine (Anaspaz) Hyoscyamine (Anaspaz) is a belladonna alkaloid used in genitourinary disorders characterized by spasm, increased secretion, and increased motility. Belladonna tincture is used for GI disorders because of its antispasmodic effect. Homatropine hydrobromide is used as an eyedrop to produce mydriasis and cycloplegia. Ipratropium (Atrovent) is used to treat rhinorrhea.

A patient with myasthenia gravis is experiencing rhinorrhea. Which of the following medications should not be administered to the patient? A. Fexofenadine (Allegra) B. Ipratropium (Atrovent) C. Nedocromil sodium (Tilade) D. Azelastine hydrochloride (Astelin)

Ipratropium (Atrovent) Ipratropium (Atrovent) is administered for rhinorrhea, but is contraindicated in patients who have been diagnosed with myasthenia gravis because of its anticholinergic effects. Azelastine hydrochloride (Astelin), fexofenadine (Allegra), and nedocromil sodium (Tilade) are not contraindicated for patients with myasthenia gravis.

A patient is administered atropine to increase the heart rate. What is the action of atropine? A. It provides long-acting antihistamine blockage. B. It exacerbates the parasympathetic vagal stimulation. C. It blocks cell wall synthesis of gram-negative bacilli. D. It blocks the parasympathetic vagal stimulation.

It blocks the parasympathetic vagal stimulation. Moderate to large doses of atropine increase the heart rate by blocking parasympathetic vagal stimulation. The exacerbation of the parasympathetic vagal stimulation is opposite the effect of atropine. The blockage of histamine is seen with the antihistamine medications, not anticholinergic agents. Atropine does not block cell wall synthesis.

A patient is scheduled for a hemithyroidectomy. She has been prescribed an anticholinergic agent prior to surgery. Why is it important to administer the anticholinergic agent in the preoperative phase? A. It relaxes the detrusor muscle. B. It will decrease gastric motility. C. It will prevent tachycardia. D. It will decrease respiratory secretions.

It will decrease respiratory secretions. In preoperative patients, the nurse assesses for diminished secretions, particularly when an anticholinergic is administered for head and neck surgery. The administration of an anticholinergic agent will not prevent tachycardia. Anticholinergic agents do decrease gastric motility, but this rationale is not a reason for administration in the preoperative phase. The anticholinergic agents cause relaxation of the detrusor muscle, but this rationale is not the reason for administration of the medication in the preoperative phase.

A patient is being treated for Parkinson's disease and has been prescribed both levodopa (L-dopa) and carbidopa (Lodosyn). Why is this course of combination treatment most effective? A. Levodopa decreases the toxic effects of carbidopa to reduce the extrapyramidal reaction. B. Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa. C. Carbidopa increases the peripheral breakdown of levodopa to hasten its onset and peak. D. Levodopa and carbidopa, when combined, enhance voluntary movement to improve gait.

Levodopa restores dopamine and carbidopa decreases peripheral breakdown of levodopa. Levodopa restores dopamine levels and, in combination with carbidopa, decreases the peripheral breakdown of levodopa and allows more to reach the brain. Levodopa does not decrease the toxic effects of carbidopa to reduce the extrapyramidal reaction. Carbidopa does not increase the peripheral breakdown of levodopa to increase its effectiveness. Levodopa and carbidopa combined do not exacerbate abnormal voluntary movement to increase gait.

The physician orders benztropine mesylate (Cogentin). What disease process would contraindicate the administration of this anticholinergic medication? A. Diabetes mellitus B. Myocardial infarction C. Narrow-angle glaucoma D. Hyperparathyroidism

Narrow-angle glaucoma Narrow-angle glaucoma will result in increased intraocular pressure, and the patient should not receive the anticholinergic agent. Patients who suffer from diabetes mellitus, myocardial infarction, or hyperparathyroidism can normally be administered anticholinergic agents.

A patient who suffers from Parkinson's disease is being treated with levodopa/carbidopa. Which of the following disorders will result in the discontinuation of this drug based on a disease-related contraindication? A. Narrow-angle glaucoma B. Human papillomavirus C. Human immune deficiency virus D. Transient ischemic attacks

Narrow-angle glaucoma Since levodopa can dilate pupils and raise intraocular pressure, it is contraindicated in narrow-angle glaucoma. Levodopa is not contraindicated in patients with human immune deficiency virus. Levodopa is not contraindicated in patients with human papillomavirus. Levodopa is not listed as a contraindication with TIAs.

A 60-year-old male patient has developed a tremor of the right hand with a pill-rolling motion. Upon interviewing the patient, he states he sustained several head injuries playing football. Based on this information, what do you suspect the patient is suffering from? A. Parkinson's disease B. Seizure disorder C. Degenerative joint disease D. Amyotrophic lateral sclerosis

Parkinson's disease Parkinson's disease is a chronic, progressive, degenerative disorder of the central nervous system characterized by resting tremor, bradykinesia, rigidity, and postural instability. The patient is not experiencing degenerative joint disease. The patient is not showing signs of symptoms of a seizure disorder. The patient has rigidity with tremors, not the signs of muscle weakness that are found in amyotrophic lateral sclerosis.

A patient with Parkinson's disease has been prescribed rasagiline. When educating this patient on this medication, which herbal supplement has the potential to produce hyperpyrexia and death with rasagiline? A. Dextromethorphan B. St. John's wort C. Garlic D. Ginger

St. John's wort Rasagiline administered with the herbal supplement St. John's wort will enhance the stimulation of serotonergic receptors to cause hyperpyrexia and death. Dextromethorphan can produce the same reaction but is not an herbal supplement. Ginger and garlic are herbal supplements but will not produce hyperpyrexia and death.

A patient has been administered chlorpromazine (Thorazine) for many years to treat his psychotic disorder. He has recently developed extrapyramidal symptoms related to long-term administration of this drug. Which of the following medications can be administered to assist in relieving these symptoms? A. Darifenacin (Enablex) B. Trihexyphenidyl (Trihexy) C. Diazepam (Valium) D. Trospium chloride (Sanctura)

Trihexyphenidyl (Trihexy) Trihexyphenidyl (Trihexy) is used in the treatment of parkinsonism and extrapyramidal reactions caused by antipsychotic drugs. Valium is a benzodiazepine and is not used for this purpose. Darifenacin is used for the treatment of overactive bladder. Trospium chloride (Sanctura) reduces the tone of the smooth muscle in the bladder.

A 77-year-old male patient with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone (Stalevo). Prior to starting this course of treatment, the nurse must ensure that A. the patient has completed an anticholinergic challenge in a clinical setting. B. the patient has a prognosis for complete recovery from Parkinson's disease. C. the patient has committed to having weekly blood work drawn for the next 2 months. D. the patient's existing dose of levodopa has been reduced.

the patient has completed an anticholinergic challenge in a clinical setting. Patients whose medication regime is being changed to Stalevo should be administered levodopa and the adjunctive entacapone. The levodopa dose should be adjusted prior to the conversion to Stalevo therapy. Weekly blood work and the completion of an anticholinergic challenge are not necessary. Complete recovery from Parkinson's disease is not a realistic goal.