PHarmacology ch 23
Which enzyme is inhibited by the anti-Parkinson's drug selegiline (Eldepryl)? 1 Catechol ortho-methyltransferase 2 Monoamine oxidase 3 Cholinesterase 4 Superoxide dismutase (SOD)
Monoamine oxidase Selegiline (Eldepryl) is the selective inhibitor of the monoamine oxidase enzyme. Selegiline (Eldepryl) does not show any action on the catechol ortho-methyltransferase enzyme. Selegiline (Eldepryl) does not bind to cholinesterase, the enzyme useful in breaking down cholinergic neurotransmitters. 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.
What findings will the nurse anticipate while assessing a patient with Parkinson's disease? Select all that apply. 1 Hypertension 2 Facial pain 3 Muscle rigidity 4 Weakness (bradykinesia) 5 Resting tremor
3 Muscle rigidity 4 Weakness 5 Resting tremor The classic symptoms of Parkinson's disease include bradykinesia, a forward gait/trunk posture, muscle rigidity, weakness, and resting tremor. Hypertension and facial pain are not considered classical symptoms of Parkinson's disease.
A patient is diagnosed with Parkinson's disease. The nurse finds that the patient is taking vitamin B6 supplements. Which drug can be safely administered to the patient? 1 Alprazolam (Xanax) 2 Pilocarpine (Salagen) 3 Ropinirole (Requip) 4 Carbidopa-levodopa (Sinemet)
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 B6 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 B6).
The patient is scheduled to begin treatment with carbidopa-levodopa (Sinemet). A family member tells the nurse that the patient has a history of undergoing treatment for narrow-angle glaucoma. What is the highest priority action on the part of the nurse? Contact the health care provider with this information. Reassure the family that this will not affect the patient's treatment. Contact the pharmacist since the dosage will need to be decreased. Contact the pharmacist since the dosage will need to be increased.
Contact the health care provider with this information. Glaucoma is known to be a contraindication to use of carbidopa-levodopa (Sinemet). Adjusting the dosage will not change this fact.
A patient with Alzheimer's disease has been prescribed rivastigmine (Exelon). The nurse is teaching the patient's family about the medications. Which statement made by a family member indicates the need for additional teaching? 1 "The patient should take the medication on an empty stomach." 2 "The patient may not have immediate improvement in cognition." 3 "The patient should take eight glasses of water daily." 4 "The patient should include brown rice in the diet."
"The patient should take the medication on an empty stomach." Cholinergic medications such as rivastigmine (Exelon) should be given with meals to minimize gastrointestinal upset. Cognition will not be improved immediately after administering the drug. It takes about 6 weeks for rivastigmine to improve cognitive ability and provide relief from symptoms of dementia. Fluids and fibers can be given normally unless contraindicated in the patient. Therefore, the patient can include 8 glasses of water and brown rice in the daily diet.
The patient has been started on donepezil (Aricept). The patient's family member notifies the nurse that the patient fainted at home. What is the highest priority action on the part of the nurse? Reassure the family member that this is an expected side effect of the medication. Instruct the family member not to administer any further doses of the drug. Notify the health care provider; the patient may need to be taken off the drug. Instruct the family member to call if the patient continues to exhibit fainting episodes.
Notify the health care provider; the patient may need to be taken off the drug. Donezepil (Aricept) is known to cause slow heartbeat and fainting. The health care provider should be notified because the patient may need to be taken off the medication. It is beyond the nurse's scope to take the patient off a drug.
The patient has been diagnosed with Alzheimer's disease and has been forgetting the location of objects in addition to having difficulty finding the word to use in conversation. The patient has been started on donepezil (Aricept). The patient is most likely in which stage of the disease process? Very mild Mild Moderate Moderately severe
Very mild Donepezil (Aricept) can be used in all stages of Alzheimer's disease. The symptoms noted will occur in the very mild stage of Alzheimer's disease.
The nurse is teaching the patient being treated with an anticholinergic about dietary changes that might be necessary. What is the highest priority instruction for the patient? "Do not drink milk while on this medication." "Increase your intake of fatty foods while on this therapy." "Do not eat carbohydrates with this medication." "Increase your intake of fluids while on this medication."
"Increase your intake of fluids while on this medication." The patient should be encouraged to ingest foods high in fiber and increase fluid intake to prevent constipation. There is no need to restrict milk or carbohydrates or to increase the intake of fatty foods.
The nurse is caring for a patient who has Parkinson's disease who has been taking amantadine (Symmetrel) for more than a year. The nurse observes that despite taking the medication, the patient has muscle stiffness and slowed movements. Which drug can be prescribed in this situation? 1 Meperidine (Demerol) 2 Benztropine (Cogentin) 3 Bromocriptine (Parlodel) 4 Pilocarpine hydrochloride (Salagen)
Bromocriptine (Parlodel) Amantadine (Symmetrel) is generally indicated during the initial stage of Parkinson's disease. It is usually effective for only 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and muscle rigidity. Bromocriptine (Parlodel), an ergot alkaloid, should be prescribed to the patient to provide relief from the symptoms. Meperidine (Demerol) is an analgesic drug used to reduce severe pain. Benztropine (Cogentin) and pilocarpine hydrochloride (Salagen) are anticholinergic drugs that interact with amantadine (Symmetrel) and result in anticholinergic poisoning. These medications do not help reduce muscle stiffness.
The nurse is teaching a patient with parkinsonism who is prescribed rivastigmine (Exelon). Which information does the nurse include in the teaching plan? 1 The initial dose is 4 mg, twice per day. 2 Gastric distress is a common side effect. 3 Food increases the absorption of the medication. 4 Tobacco may decrease the clearance of the medication.
Gastric distress is a common side effect. Rivastigmine (Exelon) is an acetylcholinesterase (AChE) inhibitor that is used in the treatment of parkinsonism. Gastric distress such as nausea, vomiting, constipation, and gastrointestinal bleeding occur as side effects of rivastigmine therapy. The initial dose of rivastigmine is 1.5 mg b.i.d. Presence of food decreases the absorption of the medication. Tobacco increases the clearance of the medication.
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). The nurse's best response is based on understanding that ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease. both drugs have the same pharmacodynamic and side effect profiles. carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine.
ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. Ropinirole (Requip) is a newer antiparkinson drug that directly stimulates specific dopamine receptors. Because the drug itself is not dopamine, there are fewer side effects related to peripheral dopamine levels than are noted with carbidopa-levodopa.
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond? 1 "Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa." 2 "Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease." 3 "Both drugs have the same pharmacodynamic and side effect profiles." 4 "Carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine."
"Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa." Ropinirole is a newer antiparkinson drug that directly stimulates specific dopamine receptors. It is more specific for the receptors associated with parkinsonian symptoms, the D2 family. This in turn may have more specific antiparkinsonian effects, with fewer adverse effects associated with generalized dopaminergic stimulation.
The primary health care provider prescribed carbidopa-levodopa (Sinemet) to a patient with parkinsonism. Which should the nurse tell the patient to help ensure a desired outcome? 1 "You should eat a low-protein diet." 2 "You should void before taking the medication." 3 "You should know that the medication may cease sweating." 4 "You should know that the medication controls symptoms within 4 to 6 days."
"You should eat a low-protein diet." Carbidopa-levodopa (Sinemet) is a dopamine antagonist used in the treatment of parkinsonism. Patients on carbidopa-levodopa (Sinemet) should eat a low-protein diet, because high-protein diets will interfere with the transport of the medication to the central nervous system (CNS). Voiding before taking the medication is required for anticholinergics, because they cause urinary retention. Carbidopa-levodopa (Sinemet) results in dark-colored perspiration and usually stains the clothing. Carbidopa-levodopa (Sinemet) controls the symptoms of parkinsonism within 1 to 4 weeks.
The patient is currently on a treatment regimen that includes selegiline (Eldepryl) therapy. What information is most important for the nurse to teach the patient about this medication? "This medication will cure your disease." "This medication is used when other drugs do not work." "This medication blocks breakdown of dopamine." "You will need to restrict your intake of certain foods and drinks."
"You will need to restrict your intake of certain foods and drinks." This medication may inhibit monoamine oxidase (MAO)-A, an enzyme that promotes metabolism of tyramine in the gastrointestinal tract. If not metabolized, ingestion of foods high in tyramine, such as aged cheese, red wine, and bananas, can cause a hypertensive crisis. This is the most important information the nurse needs to teach the patient.
The nurse is assessing a patient with excessive salivation and abdominal cramps. During the assessment the nurse finds that the patient has been taking rivastigmine (Exelon) for a long time for memory enhancement. What other complications would the nurse find in the patient? Select all that apply. 1 Orthostatic hypotension 2 Hypoglycemia 3 Bronchoconstriction 4 Dyspnea 5 Hypothyroidism
1,3,4 Long-term use of cholinergic drugs such as rivastigmine (Exelon) may cause cholinergic crisis. Excessive salivation and abdominal cramps are the early symptoms of cholinergic crisis. If the patient continues to use the medication, other complications may occur, such as orthostatic hypotension due to the decrease in the amount of fluids in the body. Bronchoconstriction is caused due to contraction of the bronchioles and smooth muscles. Due to bronchoconstriction, the patient has breathing difficulty and dyspnea. Cholinergic drugs do not affect insulin regulation; neither do they decrease the thyroid hormone levels. Therefore, this drug does not cause hypoglycemia or hypothyroidism.
The patient has begun treatment with ropinirole (Requip) and complains to the nurse of feeling excessively drowsy. What does this symptom indicate to the nurse? 1 An anaphylactic reaction to the medication 2 An overdosage of the medication 3 An insufficient dosage of the medication 4 An expected side effect of the medication
An expected side effect of the medication
The patient has begun treatment with ropinirole (Requip) and complains to the nurse of feeling excessively drowsy. What does this symptom indicate to the nurse? An anaphylactic reaction to the medication An overdosage of the medication An insufficient dosage of the medication An expected side effect of the medication
An expected side effect of the medication Glaucoma is known to be a contraindication to use of carbidopa-levodopa (Sinemet). Adjusting the dosage will not change this fact.Drowsiness at frequent intervals is known to be a side effect of the medication. Drowsiness is not indicative of an anaphylactic reaction, overdosage, or underdosage.
The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa (Sinemet). What information does the nurse use as a basis for the teaching plan? Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. Giving both drugs together minimizes side effects. Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.
Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery.
The nurse is developing a teaching plan for a patient prescribed carbidopa-levodopa (Sinemet). What information does the nurse use as a basis for the teaching plan? 1 Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. 2 Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. 3 Giving both drugs together minimizes side effects. 4 Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.
Carbidopa decreases levodopa's conversion in the periphery, increasing the amount of levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal side effects caused by dopamine in the periphery. Giving the drugs together does not enhance the amount of dopamine in the brain. Dual drug administration does not minimize side effects. Carbidopa does not increase the metabolism of levodopa in the brain.
`While teaching a patient about carbidopa-levodopa (Sinemet), what will the nurse include? 1 Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. 2 Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. 3 Giving both drugs together enhances adverse effects. 4 Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.
Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal adverse effects caused by dopamine in the periphery. Carbidopa does not increase levodopa's conversion in the periphery. Usually carbidopa helps minimize the adverse effects of levadopa. Carbidopa does not cross the blood-brain barrier.
A patient is on antiparkinsonian therapy. On a follow up visit, the nurse observes urinary retention and palpitations. The laboratory test reports of the patient reveal increased blood urea nitrogen (BUN) and aspartate aminotransferase (AST). Which medication does the nurse suspect to be responsible for this condition? 1 Donepezil (Aricept) 2 Ropinirole HCl (Requip) 3 Carbidopa-levodopa (Sinemet) 4 Pramipexole dihydrochloride (Mirapex)
Carbidopa-levodopa (Sinemet) is a dopamine antagonist used in the treatment of parkinsonism to relieve tremors and rigidity. Administering carbidopa-levodopa (Sinemet) increases the levels of blood urea nitrogen (BUN) and aspartate aminotransferase (AST) and causes urinary retention and palpitations. Donepezil (Aricept) is used in the treatment of Alzheimer's disease. Ropinirole HCl (Requip) is a dopamine agonist used in the treatment of parkinsonism. It causes fatigue, somnolence, and nausea. Pramipexole dihydrochloride (Mirapex) is a dopamine agonist used in the treatment of parkinsonism; it causes postural hypotension hallucinations, and dizziness.
Which side effect is caused by high doses of levodopa (Loradopa) in a patient with parkinsonism? 1 Dyskinesia 2 Urinary retention 3 Cardiac dysrhythmias 4 Orthostatic hypotension
Dyskinesia Dyskinesia is impaired voluntary movement. High doses of levodopa (Loradopa) will result in dyskinesia. Amantidine (Symmetrel) may result in urinary retention. Cardiac dysrhythmias may occur when carbidopa-levodopa dosages are increased. Early use of levodopa (Loradopa) causes orthostatic hypotension.
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 yogurt and cheese in the diet. Which food-drug interaction is the nurse trying to prevent? 1 Hypertrophy 2 Hyperthyroidism 3 Hyperglycemia 4 Hypertension
Hypertension Selegiline is a selective monoamine oxidase inhibitor that, when taken with foods such as cheese, yogurt, or beer, can cause the "cheese effect." This effect is characterized by high blood pressure. Therefore, the patient taking selegiline (Emsam) should avoid eating yogurt and 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.
A patient is prescribed 15 mg selegiline (Eldepryl) per day along with carbidopa-levodopa (Sinemet). Which sign is the nurse most likely to observe in the patient after the administration of the prescribed medications? 1 High fever 2 Severe confusion 3 Reduced sleep duration 4 Increased blood pressure
Increased blood pressure Selegiline (Eldepryl), which is an monoamine oxidase inhibitor type B, is prescribed as an additional therapy for Parkinson's disease. This medication causes the "cheese effect," which is characterized by hypertension, if the prescribed dose exceeds 10 mg/day. Therefore, the patient is likely to have increased blood pressure. High fever (hyperpyrexia), severe confusion (delirium), and reduced sleep patterns (insomnia) are not adverse effects of the cheese effect. Hyperpyrexia and delirium are adverse effects of the interaction of selegiline (Eldepryl) and meperidine (Demerol). Insomnia is an adverse effect associated with amantadine (Symmetrel), which is a dopamine modulator.
A primary health care provider has prescribed a monoamine oxidase inhibitor (MAOI) to a patient, along with carbidopa-levodopa (Sinemet). What does the nurse anticipate as the reason for suggesting this combination therapy with an MAOI? 1 It increases the efficacy of carbidopa-levodopa (Sinemet). 2 It decreases the gastrointestinal upset associated with carbidopa-levodopa (Sinemet). 3 It increases the safety of carbidopa-levodopa (Sinemet). 4 It decreases the urinary retention associated with carbidopa-levodopa (Sinemet).
It increases the efficacy of carbidopa-levodopa (Sinemet). arbidopa-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, 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 has been taking benztropine (Cogentin). Which outcome assessment helps the nurse verify therapeutic effects of this medication? Patient is unable to talk. Patient has had a decrease in tremors. Patient can sit up unassisted. Patient has an increased heart rate.
Patient has had a decrease in tremors. Anticholinergic drugs help to reduce the rigidity and tremors characteristic of parkinsonism. They should not result in the patient being unable to talk or increasing the heart rate. They will be unlikely to allow the patient to sit up unassisted when the patient has been previously unable to do so.
Which patient may develop complications while taking anticholinergics? 1 Patient with glaucoma 2 Patient with bradycardia 3 Patient with liver disease 4 Patient with urinary tract obstruction
Patient with glaucoma Anticholinergics are contraindicated in patients with glaucoma, because they further increase intraocular pressure. Patients with bradycardia, liver disease, and urinary tract obstruction should not be treated with rivastigmine (Exelon).
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 instruction? 1 Red wine and beer decrease dopamine levels. 2 Red wine and beer decrease the efficiency of levodopa. 3 Red wine and beer interact with selegiline (Emsam). 4 Red wine and beer decrease blood pressure.
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 because they do not affect levels of monoamine oxidase. Red wine and beer may cause hypertensive crisis and increase blood pressure.
Which medication helps improve memory in a patient with mild to moderate Alzheimer's disease? 1 Rivastigmine (Exelon) 2 Amantidine (Symmetrel) 3 Bromocriptine (Parlodel) 4 Carbidopa-levodopa (Sinemet)
Rivastigmine (Exelon)
The health care provider is considering placing the patient on memantine (Namenda). The patient's family member tells the nurse that the patient has a history of kidney disease. Based on this information, the nurse anticipates which adjustment in drug therapy? The dosage of the drug will be reduced. A different drug will be ordered instead. The dosage of the drug will be increased. All drug therapy will be stopped.Anticholinergic drugs help to reduce the rigidity and tremors characteristic of parkinsonism.
The dosage of the drug will be reduced. A different drug will be ordered instead. The reduction in kidney function may lead the health care provider to choose to reduce the dosage of the medication to prevent toxicity from developing.
While teaching health promotion tips to a patient with parkinsonism, the nurse instructs the patient to avoid aspirin. Which outcome in the client indicates a desired outcome? 1 The patient will not have dry mouth. 2 The patient will not have constipation. 3 The patient will have reduced gastric acidity. 4 The patient will have reduced urinary retention.
The patient will have reduced gastric acidity. Aspirin is a nonsteroidal antiinflammatory drug (NSAID), which interferes with the protective lining of the stomach, causing gastric acidity. Therefore, avoiding aspirin will reduce gastric acidity in the patient. Intake of hard candy, ice chips, or sugarless chewing gums will help relieve dry mouth. Intake of high-fiber foods will prevent constipation. Voiding before taking the medication will minimize urinary retention.
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 will the nurse anticipate to be contraindicated in the patient? 1 Ropinirole (Requip) 2 Tolcapone (Tasmar) 3 Pramipexole (Mirapex) 4 Amantadine (Symmetrel)
Tolcapone (Tasmar)
Which antiparkinsonian medication may cause severe liver damage? 1 Ropinirole (Requip) 2 Tolcapone (Tasmar) 3 Entacapone (Comtan) 4 Pramipexole (Mirapex)
Tolcapone (Tasmar) is an antiparkinsonian medication that causes severe liver damage by causing an increase in the enzyme serum aminotransferase. Ropinirole (Requip) is an antiparkinsonian medication that causes nausea, fatigue, and somnolence. Entacapone (Comtan) is an antiparkinsonian medication that results in dark yellow or orange urine. Pramipexole (Mirapex) is an antiparkinsonian medication that causes dizziness, postural hypotension, and hallucinations.
After assessing a patient with Alzheimer's disease, the nurse suspects stage 6 cognitive decline in the patient. Which symptoms support the nurse's suspicion? Select all that apply. 1 Unable to bathe 2 Unable to smile 3 Unable to move 4 Unaware of surroundings 5 Unable to recall names of family members
Unable to bathe Unaware of surroundings Unable to recall names of family members Stage 6 cognitive decline due to Alzheimer's disease is characterized by severe dementia, which includes being unaware of surroundings, being unable to bathe oneself, and being unable to recall the names of family members, spouses, or caregivers. Stage 7 or late dementia refers to a cognitive decline caused by Alzheimer's disease, which involves the inability to smile and being unable to move.