Drugs Used in the Management of Specific Neurodegenerative Disorders

A nurse administers oral carbidopa-levodopa to a patient who has tremors caused by Parkinson's disease. The nurse would expect to see the medication effect in which time frame?

5 hours The duration of action of carbidopa-levodopa is 5 hours. For this reason, the medication is administered several times per day (three to four times) for a continuous effect.

Which instruction is most important for the nurse to include when teaching a patient who has been prescribed sustained-released carbidopa-levodopa?

Watch for adverse effects like dizziness and drowsiness." Adverse effects of carbidopa-levodopa include dizziness and drowsiness, which can lead to orthostatic hypotension and falls. Safety is the highest priority.

The nurse is providing education to a patient taking carbidopa-levodopa. Which statement by the nurse correctly explains why the patient should take this medication with low-protein foods?

"High-protein foods interfere with transportation of this medication to the central nervous system." High-protein foods interfere with the transportation of the medication to the central nervous system. Patients taking carbidopa-levodopa should limit their intake of dietary protein.

Which statement related to carbidopa-levodopa and symptoms of dyskinesia would the nurse include in patient teaching?

"It may take weeks or months before your symptoms are controlled." Symptoms may take weeks or months to be controlled in patients taking carbidopa-levodopa. This is related to transportation of levodopa to the CNS and the continual changes that are required within the brain as circulating levels of dopamine increase.

A family member states, "My father complains of an upset stomach after taking rivastigmine." Which response by the nurse is appropriate?

"Make sure he takes the medication with food." Administering rivastigmine with food enhances absorption and reduces gastrointestinal (GI) effects. Taking the medication with food can help to alleviate the symptom of upset stomach.

A patient taking an antihypertensive drug and carbidopa-levodopa tells the nurse that he or she is applying for a job that involves operating heavy machinery. Which information would the nurse share with the patient?

"These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery." Taking an antihypertensive in combination with carbidopa-levodopa can result in hypotension. Patients taking both medications should use caution when operating heavy machinery. The patient should be advised to determine the effects of the combination of medications before using heavy machinery.

Which foods would the nurse instruct a patient who is taking selegiline to avoid?

Aged cheeses Red wine Bananas Foods high in tyramine such as aged cheeses should be avoided to prevent hypertensive crisis.

Rivastigmine must be used with caution in patients with which condition?

Asthma Rivastigmine can cause bronchoconstriction by the activation of muscarinic receptors in the lungs. This medication must be used with caution in patients with asthma.

The nurse is preparing to administer rivastigmine to a patient. The prescription states to administer 8 mg b.i.d. The pharmacy sends four 2-mg tablets for the morning dose. Which action would the nurse take?

Call the health care provider for a prescription change. The maximum dose of rivastigmine is 6 mg b.i.d. The nurse would contact the health care provider for clarification of the prescription

Which statement about the mechanism of action of carbidopa is accurate?

Carbidopa has no therapeutic effect on its own. Carbidopa has no therapeutic effect of its own; it is used to enhance the effects of levodopa. By combining carbidopa with levodopa, more levodopa becomes available for use within the brain to reduce symptoms.

Which statement about carbidopa-levodopa is accurate?

Carbidopa-levodopa should not be stopped abruptly. Discontinuing use of carbidopa-levodopa abruptly can result in rebound parkinsonism. Patients should titrate slowly off of the medication in the event the medication needs to be discontinued to avoid a sudden increase in symptoms that may impair quality of life or function.

Which phrase describes a correct therapeutic goal for treatment of Parkinson's disease?

Improve the patient's ability to carry out activities of daily living

To evaluate the effectiveness of dopaminergic agents, the nurse would assess for which condition?

Improvement in balance The effectiveness of dopaminergic agents is evaluated by their control of parkinsonism symptoms. An improvement in balance, gait, and mobility indicates controlled parkinsonism symptoms.

A nurse is evaluating the effectiveness of a patient's drug regimen for Alzheimer's disease. Which assessment finding by the nurse would indicate that the drug is effective?

Improvement in mental status Ongoing evaluation of controlled Alzheimer's disease symptoms helps determine if an increase in dosage or change in medication is needed. An improvement in mental status from the baseline assessment indicates the medication is having a therapeutic effect.

Which description of the therapeutic effect of rivastigmine is accurate?

Improves memory Rivastigmine improves memory in patients with mild to moderate Alzheimer's disease.

A patient has been taking carbidopa-levodopa for many years. During assessment, the nurse finds that the patient presents with hand tremors, drooling, and a mask-like facial expression. Which action would the nurse anticipate incorporating into the plan of care?

Increase in medication dosage Ongoing evaluation of controlled Parkinson's disease symptoms helps the health care provider determine if an increase in dosage or change in medication is needed. After many years of use, carbidopa-levodopa may lose its overall effectiveness. The symptoms are consistent with disease progression, necessitating an increase in the medication dosage.

Which effect may occur when theophylline and rivastigmine are administered together?

Increased risk for theophylline toxicity Rivastigmine can increase the effects of theophylline and increase the patient's risk for theophylline toxicity. Theophylline has a narrow therapeutic range, and administering another medication that increases circulating theophylline can raise the theophylline level to a toxic range. The patient should be educated about signs of theophylline toxicity such as tachycardia.

Which factor in a patient's health history is most important for the nurse to consider with regard to treatment for Alzheimer's disease using rivastigmine?

Liver disease A cumulative drug effect of rivastigmine is likely to occur in an older adult patient with liver disease or dysfunction; therefore rivastigmine should be used cautiously in this patient. Rivastigmine can also cause hepatotoxicity, and this risk would be increased in patients with underlying liver disease.

Which statement is accurate about the pharmacodynamics of topical rivastigmine?

Onset of action is 0.5 to 1 hour. The onset of action for topical rivastigmine is 0.5 to 1 hour, and the medication lasts 24 hours.