Drugs for Parkinson's Disease EAQ
What is the goal of pharmacologic therapy in the treatment of Parkinson's disease (PD)? A. Balance cholinergic and dopaminergic activity in the brain B. Increase the amount of acetylcholine at the presynaptic neurons C. Reduce the amount of dopamine available in the substantia nigra D. Block dopamine receptors in presynaptic and postsynaptic neurons
A. Balance cholinergic and dopaminergic activity in the brain Parkinson's disease results from a decrease in dopaminergic (inhibitory) activity leaving an imbalance with too much cholinergic (excitatory) activity. With an increase in dopamine, the neurotransmitter activity becomes more balanced, and symptoms are controlled.
A patient has elected to use rasagiline as a monotherapy treatment for Parkinson's disease (PD). Which teaching statement by the nurse is incorrect? A. "It is important to avoid tyramine-containing foods." B. "Rasagiline may cause insomnia, so keep a log of your sleeping habits." C. "You may be at increased risk for malignant melanoma, so have regular skin checks." D. "You may experience side effects such as headache, arthralgia, dyspepsia, depression, and flu-like symptoms."
B. "Rasagiline may cause insomnia, so keep a log of your sleeping habits." Unlike selegiline, rasagiline does not cause insomnia. Rasagiline may pose a risk of hypertensive crisis and hence patients should be instructed to avoid tyramine-containing foods. Rasagiline may increase the risk of malignant melanoma, a potentially deadly cancer of the skin. Periodic monitoring of the skin is recommended. Side effects are headache, arthralgia, dyspepsia, depression, and flu-like symptoms.
Which inhibitory neurotransmitter is involved in Parkinson's disease? A. Oxytocin B. Dopamine C. Adrenaline D. Acetylcholine
B. Dopamine Dopamine is the inhibitory neurotransmitter involved in Parkinson's disease. The disease is characterized by low concentrations of dopamine. Acetylcholine is an excitatory neurotransmitter that counteracts the effects of dopamine. The adrenergic glands on the kidney release adrenaline. Oxytocin is released by the pituitary gland; it is a not a neurotransmitter.
A patient with Parkinson's disease is treated with levodopa [Parcopa]. During the follow-up visit, the nurse finds that the patient is having an on-off phenomenon caused by the medication. Which findings would likely cause the nurse to come to this conclusion? A. Sudden increase in respiratory rate B. Uncontrollable voluntary movements C. Frequent delusions and hallucinations D. Suicidal intentions and aggressive behavior
B. Uncontrollable voluntary movements Many patients tend to have on-off phenomena when they are taking a dopamine medication such as levodopa [Parcopa]. On-off phenomena are characterized by the increase and decrease of dopamine levels. This fluctuation causes dyskinesia, in which the patient has impaired voluntary movements. Levodopa [Parcopa] does cause suicidal intentions and aggressive behavior, but this is not related to the on-off phenomenon. Levodopa [Parcopa] does not alter the respiratory rate because it does not affect pulmonary function. The on-off syndrome is related to the efficacy of the drug; it is unrelated to delusions and hallucinations.
A patient with Parkinson's disease is prescribed pramipexole [Mirapex] along with levodopa/carbidopa [Sinemet]. Which symptom is most likely a manifestation of an adverse effect of these drugs when given together? A. Diarrhea B. Wheezing C. Dyskinesia D. Headache
C. Dyskinesia When pramipexole is combined with the levodopa component in Sinemet, patients are most likely to experience symptoms of dyskinesias, such as dyskinesia (head bobbing) and orthostatic hypotension. The other effects are not common responses to these drugs.
Which medication is contraindicated in a patient receiving selegiline [Eldepryl] for Parkinson's disease? A. Lisinopril [Zestril] B. Ranitidine [Zantac] C. Meperidine [Demerol] D. Aspirin [Bayer Aspirin]
C. Meperidine [Demerol] Concomitant administration of a monoamine oxidase-B (MAO-B) inhibitor such as selegiline [Eldepryl] with meperidine [Demerol] is contraindicated because it can cause serotonin syndrome as a result of enhanced serotonin activity in the brain. Administration of lisinopril [Zestril], ranitidine [Zantac], or aspirin [Bayer Aspirin] is not contraindicated.
Why is levodopa the mainstay of treatment for a patient with Parkinson's disease? A. It enhances dopamine release. B. It impairs dopamine breakdown. C. It promotes dopamine synthesis. D. It provides a dopamine precursor.
D. It provides a dopamine precursor. Levodopa is a biologic precursor of dopamine that must be combined with carbidopa so the brain can use it to synthesize dopamine; it is the only agent that acts in this manner. Other dopaminergic agents increase the brain's dopamine by stimulating its release, directly and indirectly; inhibiting enzymes that degrade it; and stimulating its synthesis.
The nurse assesses a patient who is receiving combination therapy of entacapone [Comtan] and selegiline [Eldepryl]. What should the nurse do to assess for adverse effects due to the medications? Select all that apply A. Check the patient's urine reports. B. Record the patient's blood pressure. C. Frequently assess the patient's pulse rate. D. Check the patient's blood glucose concentrations. E. Assess the patient's serum creatinine concentrations.
A, B, C Entacapone [Comtan] is a catechol O-methyltransferase (COMT) inhibitor, and selegiline [Eldepryl] is a type B monoamine oxidase inhibitor (MAOI). Both drugs are used to treat Parkinson's disease. Entacapone [Comtan] is excreted through urine and may discolor it. COMT inhibitors interact with MAOIs and reduce catecholamine metabolism, resulting in adverse effects such as tachycardia, cardiac dysrhythmia, and hypertension. Therefore, the nurse has to record the patient's blood pressure and frequently assess the pulse rate. Hypoglycemia is not associated with the medications prescribed to the patient. Therefore, assessing the patient's blood glucose concentrations may not help to identify whether the patient has adverse effects of the drug. Assessing serum creatinine concentrations helps to identify renal failure. However, the medication does not alter creatinine concentrations.
Which symptoms are associated with Parkinson's disease? Select all that apply. A. Rigidity B. Tremors C. Seizures D. Tachycardia E. Bradykinesia
A, B, E Bradykinesia, or slowing down of movements, is a prominent symptom of Parkinson's disease. Tremors occur because of involuntary contractions of the muscles. Rigidity occurs as a result of resistance to passive movement. Tachycardia and seizures are not symptoms of Parkinson's disease. Tachycardia may not be caused by the degeneration of the substantia nigra because this brain area does not regulate heart function. Seizures are not associated with depleting concentrations of dopamine.
The nurse is caring for a patient who has been prescribed entacapone [Comtan] to reduce the on-off effects of carbidopa-levodopa [Sinemet]. What should the nurse do to assess for any adverse effects in the patient? Select all that apply. A. Check the patient's urinalysis reports. B. Check the patient's cholesterol levels. C. Observe for any abnormal movements. D. Frequently record the patient's temperature. E. Assess the patient for vomiting and diarrhea.
A, C, E Entacapone [Comtan], which is a catechol ortho-methyltransferase (COMT) inhibitor, shows its effects immediately, so it is used to reduce the on-off effects of carbidopa-levodopa [Sinemet]. The adverse effects of entacapone [Comtan] include gastrointestinal (GI) upset, dyskinesia, and urine discoloration. Therefore, the nurse should check the patient's urine reports for any change in the color of urine. The nurse should also observe the patient for any abnormal movements to confirm the presence of dyskinesia. The nurse should also assess the patient for the symptoms of vomiting and diarrhea to determine the extent of any GI upset. Hyperpyrexia and hyperlipidemia are not adverse effects of entacapone [Comtan]. Therefore, recording temperature and checking blood cholesterol reports may not be necessary.
The nurse is caring for a patient with Parkinson's disease. The nurse finds that the primary healthcare provider has prescribed selegiline [Eldepryl] to the patient to treat depression. Which order for selegiline [Eldepryl] is correct? A. Administer 5 mg of selegiline [Eldepryl] twice a day. B. Administer selegiline [Eldepryl] along with 1.5 oz of cheese. C. Administer 12 mg of selegiline [Eldepryl] if the patient is delirious. D. Administer meperidine [Demerol] followed by selegiline [Eldepryl].
A. Administer 5 mg of selegiline [Eldepryl] twice a day. The required dosage of selegiline [Eldepryl] is <10 mg daily; hence the nurse may receive the instruction to administer a daily dose of 10 mg of selegiline [Eldepryl] (5 mg twice a day). Delirium is an adverse effect associated with selegiline [Eldepryl]. Higher doses of selegiline [Eldepryl] worsen the symptoms of delirium. Meperidine [Demerol] is contraindicated in patients taking selegiline [Eldepryl] because of well-known drug interactions such as delirium and muscle rigidity. Eating cheese along with taking the drug may result in the "cheese effect" caused by the presence of tyramine in cheese.
Which statement should the nurse include in the teaching plan for a patient being started on levodopa/carbidopa [Sinemet] for newly diagnosed Parkinson's disease? A. Change positions slowly. B. Carbidopa has many adverse effects. C. Take the medication on a full stomach. D. The drug may cause the urine to be very diluted.
A. Change positions slowly. Postural hypotension is common early in treatment, so the patient should be instructed to change positions slowly. Administration with meals should be avoided, if possible, because food delays the absorption of the levodopa component. If the patient is experiencing side effects of nausea and vomiting, administration with food may need to be considered. The levodopa component in Sinemet may darken the color of the urine. Carbidopa has no adverse effects of its own.
A primary healthcare provider has prescribed a monoamine oxidase inhibitor (MAOI) to a patient, along with carbidopa-levodopa [Sinemet]. What should the nurse anticipate as the reason for suggesting this combination therapy with an MAOI? A. It increases the efficacy of carbidopa-levodopa [Sinemet]. B. It increases the safety of carbidopa-levodopa [Sinemet]. C. It decreases the urinary retention associated with carbidopa-levodopa [Sinemet]. D. It decreases the gastrointestinal upset associated with carbidopa-levodopa [Sinemet].
A. It increases the efficacy of carbidopa-levodopa [Sinemet]. Carbidopa-levodopa [(Sinemet]) is prescribed for the treatment of Parkinson's disease. During long-term levodopa therapy, patients may become insensitive to the medications. Therefore, to increase the efficacy of the treatment, monoamine oxidase inhibitors (MAOIs) are prescribed as an adjuvant drug. MAOIs do not affect the gastrointestinal effects of carbidopa-levodopa [(Sinemet]), do not enhance the metabolism and elimination of carbidopa-levodopa [(Sinemet]), and may not affect the safety of the drug. MAOIs have no effect on the urinary system and may not decrease the risk of urinary retention associated with carbidopa-levodopa [(Sinemet]).
A patient is diagnosed with Parkinson's disease. The nurse finds that the patient is taking vitamin B 6 supplements. Which drug can be safely administered to the patient? A. Ropinirole [Requip] B. Alprazolam [Xanax] C. Pilocarpine [Salagen] D. Carbidopa-levodopa [Sinemet]
A. Ropinirole [Requip] The patient should be prescribed an antiparkinson drug, such as ropinirole [Requip], to help relieve the early and late symptoms of Parkinson's disease. This drug does not interact with vitamin B 6 supplements. Alprazolam [Xanax] is a benzodiazepine prescribed for anxiety. Pilocarpine [Salagen] is a drug prescribed to treat dry mouth in patients with Sjögren's syndrome. Carbidopa-levodopa [Sinemet] also is prescribed for Parkinson's disease, but it interacts with pyridoxine (vitamin B 6).
Which drug is used as an adjunct therapy with carbidopa-levodopa [Sinemet] to treat Parkinson's disease? A. Selegiline [Eldepryl] B. Entacapone [Comtan] C. Benztropine [Cogentin] D. Amantadine [Symmetrel]
A. Selegiline [Eldepryl] Selegiline [Eldepryl] is a selective type B monoamine oxidase inhibitor that is useful as adjunct therapy with carbidopa-levodopa [Sinemet] to decrease fluctuating symptoms. Amantadine (Symmetrel) is useful for reducing muscle tremors and rigidity. Benztropine [Cogentin] is useful as a secondary drug for treating symptoms such as muscle tremors and rigidity. Entacapone [Comtan] is also used along with carbidopa-levodopa [Sinemet], but it is not used as an adjuvant drug. However, it is useful to cure the on-off phenomenon caused by carbidopa-levodopa [Sinemet] therapy.
The healthcare provider orders amantadine 100 mg PO daily. Amantadine 10 mg/mL syrup is available. How many milliliters will the nurse administer? A. 1 mL B. 10 mL C. 100 mL D. 0.1 mL
B. 10 mL The available concentration of amantadine is 10 mg/mL. The ordered dose of 100 mg would equal 10 mL of syrup; 100 mg/10 = 10 mL.
The nurse is caring for a patient who has Parkinson's disease who has been prescribed amantadine [Symadine]. After assessing the patient's vital signs, the nurse notes that the patient has developed adverse effects of the medication. The nurse instructs the patient to slowly change position when getting up from sitting or lying down. Which adverse effect did the nurse find? A. Ataxia B. Dizziness C. Dyskinesia D. Difficulty breathing
B. Dizziness Amantadine [Symadine] causes dizziness. Therefore, a patient with Parkinson's disease should be instructed to change positions slowly to avoid a sudden decrease in blood pressure and dizziness. Ataxia, dyskinesia, and difficulty breathing are not adverse effects of amantadine [Symadine].
A patient is experiencing constant impairment of voluntary actions after taking levodopa [Dopar]. Which medication should the nurse expect the primary healthcare provider to prescribe? A. Ropinirole [Requip] B. Entacapone [Comtan] C. Benztropine [Cogentin] D. Amantadine [Symmetrel]
B. Entacapone [Comtan] Entacapone [Comtan] is a catechol O-methyltransferase inhibitor (COMT), which is used along with levodopa [(Dopar]) for reducing the on-off effects caused by the fluctuations of dopamine. Ropinirole [(Requip]) is a nondopamine receptor agonist. It can be used in early and late Parkinson's disease, and it delays the need to prescribe levodopa [(Dopar]). Since the patient is already taking levodopa [(Dopar]), this medication may not be effective. Amantadine [(Symmetrel] is a dopamine modulator that helps release dopamine from the vesicles in the presynaptic nerve fibers. The drug does not stabilize the concentration of dopamine and hence cannot be used to treat the on-off syndrome. Benztropine [Cogentin] is an anticholinergic drug that blocks the cholinergic receptors and increases the effect of adrenergic drugs. It cannot help maintain stable dopamine levels in patients experiencing the on-off phenomenon.
The nurse is caring for a patient who has Parkinson's disease who has been prescribed selegiline [Emsam]. The nurse instructs the patient to avoid wine and cheese. Which food-drug interaction is the nurse trying to prevent? A. Hypertrophy B. Hypertension C. Hyperglycemia D. Hyperthyroidism
B. Hypertension Selegiline [Emsam] is a selective monoamine oxidase inhibitor that, when taken with foods such as cheese or beer, can cause the "cheese effect." This effect is characterized by high blood pressure. Therefore, the patient taking selegiline [Emsam] should avoid eating cheese. Selegiline [Emsam] medication does not cause any type of organ enlargement or hypertrophy because it does not affect cell regulation and division. Hyperthyroidism is not seen in the cheese effect caused by selegiline [Emsam] because it does not alter thyroid hormone levels. Blood glucose is not affected by eating yogurt along with selegiline [Emsam] because it does not affect glucose regulation. Therefore, the food-drug interaction may not cause hyperglycemia.
The nurse is assessing a patient who has recently been diagnosed with Parkinson's disease and who was prescribed tolcapone [Tasmar]. As a precaution with this particular medication, what should the nurse assess for? A. Bruising B. Liver function C. Kidney function D. Mood fluctuations
B. Liver function Tolcapone [Tasmar] is a catechol O-methyltransferase (COMT) inhibitor prescribed for the treatment of Parkinson's disease. It should be used with caution in patients with liver failure because it impairs hepatic functioning and worsens the symptoms. In these patients, drug dose should be adjusted and liver function should be monitored. Tolcapone [Tasmar] is not associated with mood fluctuations, bruising, or kidney failure, so the nurse would not need to monitor for these conditions in this patient.
A patient with a history of Parkinson's disease treated with selegiline [Eldepryl] has returned from the operating room after an open reduction of the femur. Which physician order should the nurse question? A. Docusate 100 mg orally daily B. Meperidine 50 mg IM every 4 hours as needed for pain C. Decaffeinated tea, gelatin cubes, and ginger ale when alert D. Acetaminophen 650 mg every 6 hours as needed for temperature
B. Meperidine 50 mg IM every 4 hours as needed for pain Selegiline can have a dangerous interaction with meperidine leading to stupor, rigidity, agitation, and hyperthermia; therefore, this order should be questioned. Foods that contain tyramine should be restricted, but there is no contraindication for the fluids that have been ordered. Docusate and acetaminophen are not contraindicated for use with selegiline.
Which enzyme is inhibited by the anti-Parkinson drug selegiline [Eldepryl]? A. Cholinesterase B. Monoamine oxidase C. Superoxide dismutase (SOD) D. Catechol O-methyltransferase (COMT)
B. Monoamine oxidase Selegiline [Eldepryl] is the selective inhibitor of the monoamine oxidase enzyme. Selegiline [Eldepryl] does not show any action on the catechol O-methyltransferase (COMT) enzyme. Selegiline [Eldepryl] does not bind to cholinesterase, the enzyme useful in breaking down cholinergic neurotransmitters. Superoxide dismutase (SOD) is an enzyme that has antioxidant activity and is useful in the prevention of Alzheimer's disease. Selegiline [Eldepryl] does not alter levels of the SOD enzyme.
The nurse is caring for a patient who has Parkinson's disease and has been prescribed an antiparkinson medication. During the course of the treatment, the patient reports urine discoloration and stomach upset. Which antiparkinson medication was prescribed to the patient? A. Ropinirole [Requip] B. Tolcapone [Tasmar] C. Benztropine [Cogentin] D. Amantadine [Symmetrel]
B. Tolcapone [Tasmar] Tolcapone [Tasmar] is a catechol O-methyltransferase (COMT) inhibitor. Inhibition of the enzyme COMT helps to prolong the duration of action of dopamine. However, the drug causes adverse effects, such as discolored urine and gastrointestinal upset. Patients who are treated with ropinirole [Requip] may experience gastrointestinal upset and dizziness as side effects. Adverse effects of amantadine [Symmetrel] include dizziness and insomnia. Adverse effects of benztropine [Cogentin] include hyperthermia, tachycardia, and dizziness.
The nurse is assessing a patient who was recently diagnosed with Parkinson's disease. The patient's medical records show the presence of liver failure. Which drug is contraindicated in the patient? A. Ropinirole [Requip] B. Tolcapone [Tasmar] C. Pramipexole [Mirapex] D. Amantadine [Symmetrel]
B. Tolcapone [Tasmar] Tolcapone [Tasmar] is an anti-Parkinson drug that is contraindicated in patients with liver failure. Tolcapone [Tasmar] is a catechol O-methyltransferase (COMT) inhibitor and gets metabolized in the liver and may cause liver toxicity. Ropinirole [Requip] is a nondopamine receptor agonist and is not contraindicated in liver failure. Pramipexole [Mirapex] is a direct-acting dopamine receptor agonist. It does not affect liver function and is not contraindicated in liver failure. Amantadine [Symmetrel] is an antiviral drug that is used in the treatment of moderate Parkinson's disease but is not contraindicated in liver failure.
The nurse is caring for a patient with Parkinson's disease who has been prescribed carbidopa-levodopa [Sinemet]. Which statement, if made by the patient, indicates a need for further teaching? A. "It's common to feel heart palpitations on this medication." B. "I will come to a standing position slowly to avoid getting dizzy." C. "I will take this medication with a high-protein meal to avoid nausea." D. "I will take this medication on an empty stomach to achieve the maximum effect."
C. "I will take this medication with a high-protein meal to avoid nausea." Amino acids, found in protein, compete with carbidopa-levodopa [Sinemet] for absorption from the intestine and for transport across the blood-brain barrier; therefore, patients should not take carbidopa-levodopa [Sinemet] with a high-protein meal. Orthostatic hypotension is a common side effect of this medication, and the patient should come to a standing position slowly. The medication should be taken with food to avoid nausea but not a high-protein meal. Heart palpitations are not uncommon on this medication, but the healthcare provider should be alerted to this side effect.
The healthcare provider orders entacapone 400 mg PO every 6 hours. The nurse notes that the total dose given in a 24-hour period would be what amount? A. 800 mg B. 1400 mg C. 1600 mg D. 3200 mg
C. 1600 mg The answer "1600 mg" is correct because 24 hours divided by 6 doses equals 4 doses of 400 mg; 400 mg times 4 doses equals 1600 mg.
Which class of drugs is administered to treat on-off phenomenon in a patient with Parkinson's disease? A. Dopamine modulators B. Anticholinergic drugs C. Catechol O-methyltransferase (COMT) D. Indirect-acting dopamine receptor agonists
C. Catechol O-methyltransferase (COMT) Catechol O-methyltransferase (COMT) drugs are useful for treating the on-off phenomenon in Parkinson's disease, which is caused by fluctuations in dopamine concentrations. These drugs inhibit the enzyme catalyzing the breakdown of catecholamines, thereby maintaining uniform concentrations of dopamine. Dopamine modulators are useful in case of depleted dopamine concentrations. Indirect-acting dopamine receptor agonists bind to the dopaminergic receptors irrespective of the concentrations of dopamine. Anticholinergic drugs enhance the dopaminergic effects of the central nervous system, thus reducing the parkinsonian symptoms. They do not affect dopamine concentrations.
The nurse observes that a patient has severe dyskinesia and tremors in the fingers. The patient reports uneven leg movements at night that disturb his or her sleep. Which medication does the nurse expect the primary healthcare provider to prescribe? A. Combination of meperidine [Demerol] and selegiline [Emsam] B. Combination of amantadine [Symmetrel] and benztropine [Cogentin] C. Combination of ropinirole [Requip] and carbidopa-levodopa [Sinemet] D. Combination of entacapone [Comtan] and carbidopa-levodopa [Sinemet]
C. Combination of ropinirole [Requip] and carbidopa-levodopa [Sinemet] The patient has severe dyskinesia and tremors in the fingers, which indicate that the patient has Parkinson's disease. The patient reports sleep disturbed by uneven leg movements. This condition is called restless leg syndrome. Carbidopa-levodopa [Sinemet] is used to treat Parkinson's disease, and ropinirole [Requip] is used to treat restless leg syndrome. Meperidine [Demerol] is an analgesic drug that is used to reduce severe pain. Amantadine [Symmetrel] interacts with benztropine [Cogentin], which is an anticholinergic drug, and results in anticholinergic poisoning. Entacapone [Comtan] and carbidopa-levodopa [Sinemet] are used to treat parkinsonism but not restless leg syndrome.
The nurse is assessing a patient with Parkinson's disease who has been prescribed levodopa [Sinemet] and selegiline [Emsam]. The nurse advises the patient to avoid drinking red wine and beer. What is the most probable reason for giving such instructions? A. Red wine and beer decrease blood pressure. B. Red wine and beer decrease dopamine levels. C. Red wine and beer interact with selegiline [Emsam]. D. Red wine and beer decrease the efficiency of levodopa [Sinemet].
C. Red wine and beer interact with selegiline [Emsam]. Red wine and beer contain tyramine. Selegiline [Emsam] interacts with tyramine, increasing catecholamine concentrations and inhibiting the activity of the drug. This is called the "cheese effect." Therefore, the patient must be advised to avoid drinking red wine and beer. Red wine and beer increase the concentration of serotonin and dopamine; they do not decrease dopamine concentrations. Red wine and beer do not interact with levodopa [Sinemet] because they do not affect levels of monoamino oxidase. Red wine and beer may cause hypertensive crisis and increase blood pressure.
A family member asks the nurse about amantadine. Which statement by the nurse is the most helpful in explaining the use of amantadine? A. "Amantadine works rapidly and does not lose its effectiveness." B. "Amantadine works slowly over time but can lose its effectiveness in 3 to 6 months." C. "Amantadine was developed as an antiviral agent but is now used for treatment of Parkinson's disease (PD)." D. "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications."
D. "Amantadine is not as effective as some other medications, so it is not a first-line treatment, but it may be used in addition to other medications." Amantadine is not considered a first-line agent. However, the drug may be helpful for managing dyskinesias caused by levodopa. Amantadine was developed as an antiviral agent, but this response is not helpful to explain the use of the medication to the family member. Medication effects develop rapidly—often within 2 to 3 days—but are much less profound than with levodopa or the dopamine agonists. Furthermore, effects may begin to diminish within 3 to 6 months.
A patient with Parkinson's disease who takes levodopa/carbidopa [Sinemet] comes to the clinic for a semiannual physical examination. Which question is the most important for the nurse to ask? A. "Have you had your flu vaccine?" B. "Have you noticed any swelling in your feet?" C. "Have you noticed any changes in your stool?" D. "Are you having vivid dreams or hallucinations?"
D. "Are you having vivid dreams or hallucinations?" Patients taking levodopa/carbidopa [Sinemet] are at increased risk for the psychiatric side effects of levodopa, including visual hallucinations, vivid dreams, nightmares, and paranoid ideation. The other questions are not directly related to problems that are likely to occur with this drug.
A primary healthcare provider has prescribed entacapone [Comtan] to a patient diagnosed with Parkinson's disease. The nurse is teaching the patient's caregiver about the administration of the drug. Which statement made by the caregiver indicates the need for additional education? A. "I may give milk and yogurt to the patient daily." B. "I will encourage the patient to exercise regularly." C. "I will include a high amount of cereals in the patient's diet." D. "I will administer the drug when the patient has an empty stomach."
D. "I will administer the drug when the patient has an empty stomach." Entacapone [Comtan] is a drug that should be taken with a meal to minimize gastrointestinal upset. Therefore, the caregiver should not give the drug when the patient has an empty stomach. Patients with Parkinson's disease need to exercise because their motor abilities are diminished. Milk products do not interfere with entacapone [Comtan], so it is safe to administer them. Grains contain a high amount of fiber, which helps to prevent constipation. Therefore, cereals should be included in the patient's diet.
A patient with Parkinson's disease who has been positively responding to drug treatment with levodopa/carbidopa [Sinemet] suddenly develops a recurrence of symptoms. Which explanation by the nurse is appropriate? A. "You should try to keep taking your medication at the current dose. These effects will go away with time." B. "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." C. "You have apparently developed resistance to your current medication and will have to change to another drug." D. "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect."
D. "This is called the 'on-off' phenomenon. Your healthcare provider can change your medication regimen to help diminish this effect." Patients who have been taking levodopa/carbidopa for a period of time may experience episodes of symptom recurrence. Adding other medications to the drug regimen can help minimize this phenomenon.
A patient with Parkinson's disease and comorbid depression is prescribed selegiline [Emsam]. What should the nurse do when administering the medication to the patient? A. Dissolve the drug in 250 mL of water before administration. B. Ask the patient to chew the drug properly before swallowing. C. Ask the patient to keep the drug under the tongue for 5 minutes. D. Apply the transdermal patch of the drug on the patient's upper arm.
D. Apply the transdermal patch of the drug on the patient's upper arm. Selegiline [Emsam] is a type B monoamine oxidase inhibitor (MAOI) that is used to treat major depressive disorder. Selegiline [Emsam] is available as a transdermal formulation. Therefore, the nurse should apply the transdermal form of the drug to the patient's skin using a dry, smooth area of skin. The nurse should ask the patient to chew the medication when administering the buccal form of the drug (eg, Zelapar). Sublingual formulations of medications should be kept under the tongue. Therefore, the nurse would not ask the patient to keep the medication under the tongue. Dissolving the drug in 250 mL of water is useful for oral forms of drugs that require more time to disintegrate.
The nurse is caring for a geriatric patient. During the assessment, the nurse finds that the patient has tremors in the fingers, a mask-like facial expression, and bradykinesia. Which drug would the nurse expect the primary healthcare provider to prescribe to the patient? A. Modafinil [Provigil] B. Bromocriptine [Parlodel] C. Methylphenidate [Ritalin] D. Carbidopa-levodopa [Sinemet]
D. Carbidopa-levodopa [Sinemet] Tremors in the fingers, mask-like facial expressions, and bradykinesia are symptoms of parkinsonism. The patient should be prescribed anti-Parkinson's drugs such as carbidopa-levodopa [Sinemet] to relieve the symptoms. This medication increases dopamine levels and reduces tremors and bradykinesia. Modafinil [Provigil] stimulates the central nervous system, is prescribed for the treatment of narcolepsy, and induces wakefulness. Bromocriptine [Parlodel] is a direct-acting dopamine agonist prescribed to younger patients. Since the patient is older, he or she will not be prescribed. Methylphenidate [Ritalin] is a stimulant prescribed for attention-deficit/hyperactivity disorder (ADHD).
What is the main anatomic area of the brain that is affected in a patient with Parkinson's disease? A. Thalamus B. Cerebellum C. Globus pallidus D. Substantia nigra
D. Substantia nigra The substantia nigra is a part of the extrapyramidal system, which is involved in motor function, including posture, muscle tone, and smooth muscle activity. Dopamine depletion in this area causes Parkinson's disease. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The thalamus is the relay station for brain impulses. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with Parkinson's disease.
