Pharmacology Chapter 15 Antiparkinson Drugs
1 Red wine and beer contain tyramine. MAOI medications interact 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 may also cause hypertensive crisis and increase blood pressure.
The nurse is assessing a patient who is receiving a nonselective monoamine oxidase inhibitor (MAOI). The nurse advises the patient to avoid drinking red wine and beer. What is the reason for this instruction? 1 Red wine and beer interact with selegiline. 2 Red wine and beer decrease blood pressure. 3 Red wine and beer decrease dopamine levels. 4 Red wine and beer decrease the efficiency of levodopa.
3 Amantadine is generally indicated during the initial stage of Parkinson disease. It is usually effective for only 6 to 12 months, after which it becomes ineffective in relieving hypokinesia and muscle rigidity. Bromocriptine, an ergot alkaloid, should be prescribed to the patient to provide relief from the symptoms. Meperidine is an analgesic drug used to reduce severe pain. Benztropine and pilocarpine hydrochloride are anticholinergic drugs that interact with amantadine and result in anticholinergic poisoning. These medications do not help reduce muscle stiffness.
The nurse is caring for a patient who has Parkinson disease who has been taking amantadine for more than a year. The nurse observes that despite taking the medication, the patient has muscle stiffness and slowed movements. Which drug may help this patient? 1 Meperidine 2 Benztropine 3 Bromocriptine 4 Pilocarpine hydrochloride
4 Bromocriptine is the antiparkinson drug that also inhibits the production of the hormone prolactin. Hence it is useful for treating prolactin-secreting tumors. Selegiline, ropinirole, and entacapone are antiparkinson drugs that have no action on the prolactin hormone. Therefore they are not useful in the treatment of prolactin-secreting tumors.
Which antiparkinson drug is useful in the treatment of prolactin-secreting tumors? 1 Selegiline 2 Ropinirole 3 Entacapone 4 Bromocriptine
1, 3, 5 Parkinson disease is a slowly progressive, degenerative, neurologic disorder. It is characterized by resting tremors, pill rolling of the fingers, masklike face, shuffling gait and forward flexion of the trunk, muscle rigidity, loss of postural reflexes, and weakness. Chorea is irregular, spasmodic, involuntary movements of the limbs and facial muscles. Chorea and dystonia are symptoms of antiparkinson therapy, but not Parkinson disease.
Which are the most common symptoms of Parkinson disease? Select all that apply. 1 Tremor 2 Chorea 3 Rigidity 4 Dystonia 5 Postural instability
3 The combined use of COMT inhibitors with MAOIs results in decreased metabolism of catecholamines, which leads to increased cardiovascular risk. Concomitant use of COMT inhibitors and MAOIs does not result in renal toxicity. COMT inhibitors and MAOIs do not cause any increase in muscular rigidity because they do not overstimulate cholinergic excitatory pathways. Intake of COMT inhibitors on an empty stomach results in gastrointestinal (GI) upset. However, GI upset is not related to the concomitant use of COMT inhibitors and MAOIs.
Which complication is observed because of the concomitant use of catechol-O-methyl transferase (COMT) inhibitors and monoamine oxidase inhibitors (MAOIs)? 1 Increased renal toxicity 2 Increased muscular rigidity 3 Increased cardiovascular risk 4 Increased gastrointestinal upset
1, 2, 4 Bradykinesia, or slowing down of movements, is a prominent symptom of Parkinson disease. Tremors occur because of involuntary contractions of the muscles. Rigidity occurs as a result of resistance to passive movement. Seizures and tachycardia 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.
Which symptoms are associated with Parkinson disease? Select all that apply. 1 Rigidity 2 Tremors 3 Seizures 4 Bradykinesia 5 Tachycardia
1 Carbidopa-levodopa is an antiparkinson drug that should decrease symptoms such as tremors. Increased urination and appetite and a decrease in dry mouth are not therapeutic effects of this medication therapy.
A patient has started on carbidopa-levodopa. What assessment indicates the patient is having a therapeutic effect of the medication? 1 Decreased tremors 2 Increased urination 3 Increased appetite 4 Decrease in "dry mouth"
4 The nurse should call the health care provider because some medications for Parkinson disease interact with vitamin B6 supplements. The patient should be prescribed an antiparkinson drug, such as ropinirole, because this drug does not interact with vitamin B6 supplements. If the patient is prescribed other drugs, the medication dose may need to be increased to overcome possible side effects.
A patient is diagnosed with Parkinson disease. The nurse finds that the patient is taking vitamin B6 supplements. What is the nurse's best action? 1 Tell the patient to stop the vitamin supplement. 2 Continue to monitor the patient; there is no risk with this supplement. 3 Call the patient's family to find out the type of vitamin supplement taken. 4 Call the health care provider because this may interfere with some medication therapy.
3 The priority is safety. The nurse should keep the patient in bed and then call the health care provider. Medications can be given to decrease the side effects of levodopa, but the primary nursing priority is safe patient care. Reassuring the family and assisting with daily activities are interventions that can be completed once the patient is safe.
A patient is experiencing constant impairment of voluntary actions after taking levodopa. What is the nurse's priority action? 1 Call the health care provider. 2 Reassure the family members. 3 Instruct the patient to stay in bed. 4 Assist the patient in daily activities.
3 Benztropine is an anticholinergic drug used for Parkinson disease and also for extrapyramidal symptoms from antipsychotic drugs. Benztropine is to be used with caution in hot weather or during exercise because it may cause hyperthermia. Other adverse effects include tachycardia, confusion, disorientation, toxic psychosis, urinary retention, dry mouth, constipation, nausea, and vomiting. Anticholinergic syndrome can occur when it is given with other drugs that are associated with a high incidence of anticholinergic effects. Alcohol is to be avoided. Benztropine is available as tablets and in injectable form. It is not necessary for the patient to assess his weight daily. Benztropine may be taken with or without food. It is not correct to say that this drug cannot be taken with any other medications; patients should consult their physicians.
A patient is receiving benztropine. What is essential for the nurse to teach the patient about therapy? 1 "Assess your weight daily." 2 "Take the medication with food." 3 "Tell your health care provider if you exercise." 4 "Do not use this drug if you are on other medications."
4 When Parkinson's disease is diagnosed, the nurse teaches the patient and family about the disease, including its pathophysiology and treatment options, to help them learn to manage this chronic, progressive neurodegenerative disorder. After patient education, both the patient and family are better equipped to understand the disease's progression, the related pharmacotherapy, the need for physical activity, and the role of assistive devices.
A patient receives a diagnosis of Parkinson's disease. Which intervention does the nurse implement first? 1 Instituting pharmacotherapy 2 Encouraging physical activity 3 Teaching about assistive devices 4 Explaining the disease's characteristics
2 Erythromycin should not be given with bromocriptine because both of them used the cytochrome P450 pathway. This competition leads to toxicity.
A patient receiving which medication cannot receive bromocriptine? 1 Tramadol 2 Erythromycin 3 Carbamazepine 4 Calcium carbonate
4 The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The symptoms return and continue on a constant basis despite treatment and medications. Chorea is a condition characterized by involuntary, purposeless, rapid motions such as flexing and extending the fingers, raising and lowering the shoulders, or grimacing. Dystonia is impaired or distorted voluntary movement, involving the head, neck, or feet. On-off phenomenon is a common experience of patients taking medication for Parkinson's disease in which they experience periods of greater symptomatic control ("on" time) alternating with periods of lesser symptomatic control ("off" time).
A patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use? 1 Chorea 2 Dystonia 3 On-off phenomenon 4 Wearing-off phenomenon
4 Benztropine is an anticholinergic drug used for Parkinson disease. The side effects of the drug include tachycardia, confusion, and disorientation. A patient who has been prescribed benztropine should be advised to avoid alcohol while taking the medication because it may worsen the side effects. Patients need not avoid yogurt because tyramine in the yogurt does not diminish the effect of the drug. The dose of benztropine is 0.5 to 6 mg per day in either a single or two divided doses. Taking 8 mg in single dose may cause serious toxicity. Patients are not advised to do regular exercise because the drug may increase body temperature and cause hyperthermia.
A patient with Parkinson disease has been prescribed benztropine. What information is essential to teach the patient? 1 Avoid yogurt in your diet. 2 Take 8 mg/day of the medication. 3 Exercise regularly to be physically fit. 4 Do not drink alcohol while on the medication.
4 Antibiotics such as ciprofloxacin reduce the clearance of ropinirole. This may lead to toxic effects caused by the accumulation of ropinirole. The nurse should assess the patient for toxicity and notify the health care provider so that an adjustment in the medication can be made. The patient's antiparkinson drug or the antibiotic will need to be changed. It would be a good idea to obtain a urine specimen to culture for susceptible medications to treat the organism, but it is not the priority intervention. There is no reason to assess coagulation. The nurse should not stop the ropinirole without discussion with the primary health care provider.
A patient with Parkinson disease is prescribed ropinirole. Upon reviewing the patient's prescriptions, the nurse notes that the patient has been prescribed ciprofloxacin for a urinary tract infection. What is the nurse's best action? 1 Stop the ropinirole. 2 Assess coagulation. 3 Obtain a urine specimen. 4 Assess the patient for toxicity and notify the health care provider
2 Many patients tend to have on-off phenomena when they are taking a dopamine medication such as levodopa. On-off phenomenon is characterized by the increase and decrease of dopamine levels. This fluctuation causes dyskinesia, in which the patient has impaired voluntary movements. Levodopa 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. Levodopa does cause suicidal intentions and aggressive behavior.
A patient with Parkinson disease is treated with levodopa. During the follow-up visit, the nurse finds that the patient is having an on-off phenomenon caused by the medication. Which findings caused the nurse to reach this conclusion? 1 Sudden increase in respiratory rate 2 Uncontrollable voluntary movements 3 Frequent delusions and hallucinations 4 Suicidal intentions and aggressive behavior
4, 6 To help diminish the patient's tremors, the nurse plans to administer an anticholinergic agent to oppose the effects of acetylcholine; these agents include trihexyphenidyl and benztropine. This is necessary because the tremors and other abnormal movements associated with Parkinson disease are the result of an imbalance between acetylcholine and dopamine wherein the dopamine is deficient. Selegiline is a monoamine oxidase-B inhibitor used in combination with carbidopa-levodopa to inhibit the breakdown of dopamine and reduce the dosage of levodopa needed. Amantadine is the only presynaptic dopamine release enhancer used to increase the release of dopamine from terminal vesicles. Ropinirole is a nonergot dopaminergic agent used to activate production of more dopamine. Pramipexole is also a nonergot dopaminergic agent used to activate production of more dopamine.
A patient with Parkinson disease takes carbidopa-levodopa but experiences disabling tremors. Which adjunct medications can be administered for alleviation of the patient's tremors? Select all that apply. 1 Selegiline 2 Amantadine 3 Ropinirole 4 Benztropine 5 Pramipexole 6 Trihexyphenidyl
4 Patients who have been on levodopa for a time may experience periods of symptom return. Adding other medications to the drug regimen can help minimize this phenomenon. Patients taking levodopa do not develop resistance; rather their condition worsens due to a reduced number of dopaminergic terminals. This condition can occur frequently, is not that rare, and is treatable. A change of medication helps to reduce the on-off phenomenon.
A patient with Parkinson disease who has been responding well to drug treatment with levodopa suddenly develops a relapse of the symptoms. Which explanation by the nurse is appropriate? 1 "You have developed resistance to your current medication and will have to change to another drug." 2 "You should continue taking your medication at the current dose. These effects will go away with time." 3 "This is an atypical response. Unfortunately, there are no other options of drug therapy to treat your disease." 4 "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
2 When administered along with selegiline, entacapone exposes the patient to cardiovascular risks due to reduced catecholamine metabolism. The patient may develop cardiac side effects such as cardiomyopathy. These medications should not be administered together. The nurse should hold the medication and notify the health care provider.
The nurse is caring for a patient who has Parkinson disease. The primary health care provider has prescribed selegiline to the patient. While doing a medication review, the nurse finds the patient has been receiving entacapone. What is the nurse's best action? 1 Monitor the patient for additive effects. 2 Hold the selegiline and notify the health care provider. 3 Make certain the selegiline is given before the entacapone. 4 Make certain both medications are on the same schedule for the best action.
4 Entacapone 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. Milk products do not interfere with entacapone, so it is safe to administer them. A patient with Parkinson disease needs to exercise because his motor abilities are diminished. Grains contain a high amount of fiber, which helps to prevent constipation. Therefore cereals should be included in the patient's diet.
The nurse is teaching the patient's caregiver about the administration of entacapone. Which statement made by the caregiver indicates the need for additional education? 1 "I may give milk and yogurt to the patient daily." 2 "I will encourage the patient to exercise regularly." 3 "I will include a high amount of cereals in the patient's diet." 4 "I will administer the drug when the patient has an empty stomach."
1 Carbidopa-levodopa with selegiline is prescribed to patients with Parkinson's disease. Selegiline and meperidine together are contraindicated because they may cause delirium and disorientation. Therefore the nurse would hold the meperidine and call the health care provider to possibly prescribe another intervention for pain control or adjust the patient's medications temporarily in the postoperative period.
The nurse reviews the medication history of a postoperative patient, which shows carbidopa-levodopa with selegiline, along with meperidine for pain, with instructions to begin taking entacapone with each dose of carbidopa-levodopa after 10 days. What is the appropriate nursing action? 1 Hold the meperidine and call the health care provider. 2 Administer all medications and monitor blood pressure hourly. 3 Administer the meperidine as ordered and hold the entacapone. 4 Administer the meperidine as ordered and hold the carbidopa-levodopa through the postoperative period.
1 Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson disease.
What does the nurse teach the patient about the use of benzodiazepines when taking levodopa? 1 Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson disease. 2 Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson disease. 3 Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson disease. 4 Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson disease.
2 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 antiparkinson effects, with fewer adverse effects associated with generalized dopaminergic stimulation.
What is the difference between carbidopa-levodopa and ropinirole? 1 Both drugs have the same pharmacodynamic and side effect profiles. 2 Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa. 3 Carbidopa-levodopa acts as a dopamine agonist, whereas ropinirole directly replaces dopamine. 4 Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson disease.
4 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 disease. The thalamus is the relay station for brain impulses. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with Parkinson disease.
What is the main anatomic area of the brain that is affected in a patient with Parkinson disease? 1 Thalamus 2 Cerebellum 3 Globus pallidus 4 Substantia nigra
2 Selegiline is a monoamine oxidase-B inhibitor used for the treatment of Parkinson disease. Meperidine is an opioid analgesic. Severe hypertension is caused by a drug-drug interaction between selegiline and buspirone. Concomitant administration of selegiline and meperidine may result in serotonin syndrome. Potential selegiline toxicity is the result of an interaction between selegiline and carbamazepine or oral contraceptives. Increased anticholinergic effects are the result of an interaction between dopamine modulators and anticholinergics.
What is the potential complication of a drug-drug interaction between selegiline and meperidine? 1 Severe hypertension 2 Serotonin syndrome 3 Potential selegiline toxicity 4 Increased anticholinergic effects
3 Catechol-ortho-methyltransferase drugs are useful for treating the on-off phenomenon in Parkinson 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. Anticholinergic drugs enhance the dopaminergic effects of the central nervous system, thus reducing the symptoms of Parkinson disease. They do not affect dopamine concentrations. Indirect-acting dopamine receptor agonists bind to the dopaminergic receptors, irrespective of the concentrations of dopamine.
Which class of drugs is administered to treat on-off phenomenon in a patient with Parkinson disease? 1 Anticholinergic drugs 2 Dopamine modulators 3 Catechol-ortho-methyltransferase 4 Indirect-acting dopamine receptor agonists
4 Carbidopa-levodopa is the drug combination contraindicated in patients with angle-closure glaucoma. The medication tends to cause an increase in intraocular pressure, and it may worsen glaucoma, resulting in blindness. Galactorrhea is a condition in which excessive milk production occurs in nursing mothers. These patients can safely take carbidopa-levodopa because the drug does not alter prolactin levels. Carbidopa-levodopa is used to replace dopamine and is beneficial in the treatment of low blood pressure. Myasthenia gravis is a muscular disorder for which the drug combination can be used if recommended.
Which condition is a contraindication for administration of carbidopa-levodopa? 1 Galactorrhea 2 Myasthenia gravis 3 Low blood pressure 4 Angle-closure glaucoma
3 Amantadine is a dopamine modulator that acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers. It is indicated in the early stages of Parkinson's disease. Selegiline is a selective monoamine oxidase-B inhibitor, which is indicated for Parkinson's disease. Entacapone is a catechol-O-methyl transferase (COMT) inhibitor indicated for the adjunctive treatment of Parkinson's disease. It acts by blocking the COMT receptors. Bromocriptine is a direct-acting dopamine receptor agonist that is used to treat Parkinson's disease. These directly stimulate the release of dopamine from the pre- and postsynaptic dopamine receptors in the brain.
Which drug indicated for Parkinson's disease acts by releasing dopamine and blocking the reuptake of dopamine into nerve fibers? 1 Selegiline 2 Entacapone 3 Amantadine 4 Bromocriptine
2 Tolcapone is an antiparkinson drug that is contraindicated in patients with liver failure. It is rarely used. Tolcapone is a catechol-ortho-methyltransferase inhibitor and gets metabolized in the liver and may cause liver toxicity. Ropinirole is a nondopamine receptor agonist and is not contraindicated in liver failure. Pramipexole is a direct-acting dopamine receptor agonist. It does not affect liver function and is not contraindicated in liver failure. Amantadine is an antiviral drug that is used in the treatment of moderate Parkinson's disease but is not contraindicated in liver failure.
Which drug is contraindicated in the patient with liver failure who needs an antiparkinson drug? 1 Ropinirole 2 Tolcapone 3 Pramipexole 4 Amantadine
1, 3, 5 Levodopa and a combination of levodopa and carbidopa are the available dopamine replacement drugs. Large doses of dopamine replacement drugs may result in undesired effects that include dyskinesia (difficulty performing voluntary movements), palpitations caused by cardiac involvement, and urinary retention as a result of decreased elimination of the drug by the kidneys. Somnolence is an adverse effect associated with the use of ropinirole, which is a nonergot alkaloid. Hypotension is the most common adverse effect caused by dopamine replacement drugs.
Which possible adverse effects are associated with the use of dopamine replacement drugs? Select all that apply. 1 Dyskinesia 2 Somnolence 3 Palpitations 4 Hypertension 5 Urinary retention