Chapter 14: Drugs Used to Treat Neurodegenerative Disorders

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee.

ANS: A Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high tyramine content.

The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baseline assessment of the patient's: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs.

ANS: A, B, D, E Premedication assessment prior to apomorphine therapy should include baseline vital signs, patient's degree of mobility, alertness, and orientation to name, place, and time. It is not necessary to assess intellectual ability prior to apomorphine therapy.

Parkinson's disease has which characteristic symptom(s)? (Select all that apply.) a. Muscle tremors b. Posture alterations c. Muscle flaccidity d. Tachycardia e. Slow body movement

ANS: A, B, E Symptoms of Parkinson's disease include muscle tremors, posture and equilibrium alterations, and slow body movement or bradykinesia. Muscle flaccidity is not a symptom of Parkinson's disease. Symptoms of Parkinson's disease do not include alterations in heart rate.

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient's response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain.

ANS: B Dosage must be adjusted according to the patient's response and tolerance. Entacapone may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic effects of levodopa. Entacapone does not increase the production of dopamine in the brain.

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications.

ANS:A When administered orally, dopamine does not enter the brain. Levodopa does cross into the brain and is metabolized into dopamine. Dopamine is not available as an oral medication. The half-life of levodopa is approximately 50 minutes; the half-life of dopamine is approximately 4 days. Dopamine does not react with medications.

Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D

ANS: B Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to 10 mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore are not restricted. The ingredients in multivitamins, however, must be assessed. Vitamins A, C, and D do not affect therapy with levodopa.

The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching? a. "This medication will help slow the development of symptoms." b. "I will place the tablet on my tongue before breakfast." c. "I may need to use a stool softener for constipation." d. "I should not push the tablet through the foil."

ANS: B Selegiline orally disintegrating tablets should be taken in the morning before breakfast, without liquid. This medication is used to slow the development of symptoms and progression of disease. Constipation is a common adverse effect that may require the use of stool softeners. Patients should not attempt to push selegiline orally disintegrating tablets through the foil backing. Patients should peel back the backing of one or two blisters (as prescribed) with dry hands and gently remove the tablet(s).

Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitations

ANS: B When initiating levodopa therapy, orthostatic hypotension may occur. Although generally mild, patients may experience dizziness and weakness. Symptoms usually resolve within 1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic hypotension increases the risk for injury in Parkinson's patients because they are also experiencing alterations in gait patterns. Although nausea, vomiting, anorexia, and depression are adverse effects of levodopa, they do not contribute to a risk for falling. Tachycardia and palpitations are not common adverse effects of levodopa.

Which cholinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

ANS: C Anticholinergic drugs will reduce the severity of tremors and drooling in patients with Parkinson's disease. Anticholinergics are most useful when used in combination with levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics have little effect on rigidity or on postural abnormalities.

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of: a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium.

ANS: C Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising rasagiline serum levels and potentially causing significant hypertension. Dextromethorphan, levodopa, and Valium are not related to significant hypertensive changes when used in conjunction with rasagiline.

What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? a. Slows the deterioration of dopaminergic nerve cells. b. Inhibits the relative excess of dopaminergic activity. c. Reduces the destruction of dopamine in peripheral tissues. d. Enhances the cholinergic symptoms of Parkinson's disease.

ANS: C Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This significantly increases the amount of dopamine available to reach the brain. Entacapone, when used with carbidopa levodopa therapy, results in more constant dopaminergic stimulation. Entacapone is not effective when used alone. Entacapone does not affect the nerve cells but blocks enzymes that break down levodopa. Parkinson's disease is characterized by a relative deficit of dopaminergic activity. Entacapone does not affect cholinergic symptoms of Parkinson's disease.

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

ANS: C Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide, pramipexole, and ropinirole. These are described as "sleep attacks," including daytime sleep. Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines. Tardive dyskinesia is a dystonic adverse effect of neuroleptic drugs such as phenothiazines. Akathisia, associated with neuroleptic drugs used in the treatment of mental disorders, is characterized by motor restlessness accompanied by increased nervous or restless movement. The syndrome may also occur when anti-Parkinson drugs are reduced or discontinued.

What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease? (Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors is permanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness.

ANS: C, D, E, F Apomorphine has no opioid activity, is commonly injected by a reusable multidose pen, and may cause nausea, vomiting, or sleepiness. Apomorphine brings temporary relief from hypomobility. Apomorphine must not be administered intravenously. It may crystallize in the vein and form a thrombus or embolism.

The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for a reduction in medication dosage by the healthcare provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness

ANS: D Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered. Constipation is an expected adverse effect of this medication. Brownish orange urine is an expected adverse effect of this medication. Drowsiness is an expected adverse effect that occurs when therapy is initiated.

The nurse is teaching a patient with Parkinson's disease about levodopa. Which statement by the nurse is accurate regarding drug administration? a. "Take this medication in between meals." b. "Take this medication at bedtime to prevent dizziness." c. "Take this medication when your tremors get worse." d. "Take this medication with food or antacids to reduce GI upset."

ANS: D Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in divided doses with food or antacids to decrease gastrointestinal (GI) irritation. Levodopa should be taken with food. Levodopa must be taken on a regular schedule as prescribed to provide therapeutic results.