Chapter 24 Antiparkinsonism Agents

A client asks the nurse to explain parkinsonism to him. Which of the following possible causes of parkinsonism might be included in the explanation? A. Adverse effect of drug therapy B. Brain injury C. Viral infection D. Dementia E. Bacterial infection F. Birth defect

A. Adverse effect of drug therapy B. Brain injury C. Viral infection

Anticholinergic drugs are effective in early Parkinson disease. They act to A. Block stimulating effects of acetylcholine in the brain to bring activity back into balance B. Block the signs and symptoms of the disease,, making it more acceptable. C. Inhibit dopamine effects in the brain and increase neuron activity. D. Increase the effectiveness of the inhibitory neurotransmitter gamma-aminobutyric acid.

A. Block stimulating effects of acetylcholine in the brain to bring activity back into balance

When describing the possible adverse effects associated with trihexyphenidyl therapy, what would the nurse include? Select all that apply. A. Delirium B. Blurred vision C. Agitation D. Diaphoresis E. Diarrhea

A. Delirium B. Blurred vision C. Agitation Rationale:Possible adverse effects associated with trihexyphenidyl therapy, an anticholinergic agent, include delirium, agitation, reduced sweating, constipation, and blurred. Anticholinergics do not typically cause diarrhea or diaphoresis.

The nurse should monitor a client receiving a dopaminergic agent for which adverse effects. Select all that apply. A. Dysphagia B. Urinary frequency C. Hypertension D. Flushing E. Nervousness

A. Dysphagia D. Flushing E. Nervousness Rationale:Possible adverse effects of dopaminergic therapy include nervousness, dysphagia, flushing, hypotension, and urinary retention.

A client is prescribed benztropine. The nurse would anticipate administering this drug by which route? A. Oral B. Intravenous C. Subcutaneous D. Intramuscular

A. Oral Rationale:Benztropine is administered orally.

The nurse provides drug teaching to a client who has Parkinson disease and has been prescribed amantadine. How should the nurse describe the action of this drug? A. It acts on effector cells in the same manner as dopamine. B. It stimulates the natural release of dopamine. C. It acts as a direct precursor of dopamine synthesis. D. It binds directly with postsynaptic dopamine receptors.

B. It stimulates the natural release of dopamine. Rationale:Amantadine increases the release of dopamine. Levodopa is a precursor of dopamine that crosses the blood-brain barrier where it is converted to dopamine, acting like a replacement therapy. Apomorphine directly binds with postsynaptic dopamine receptors.

A patient who has been diagnosed with Parkinson's disease for many years and whose symptoms were controlled using Sinemet has started to exhibit increasing signs of the disease. Possible treatment might include A. An increased exercise program. B. Adding iron to the person's diet. C. Combination therapy with an anticholinergic drug. D. Changes in diet to eliminate Vitamin B6.

C. Combination therapy with an anticholinergic drug.

The main underlying problem with Parkinson's disease seems to be a decrease in the neurotransmitter A. Acetylcholine B. Norepinephrine C. Dopamine D. Serotonin

C. Dopamine

The nurse is providing care for a client with Parkinson disease. Which of the client's medications will most directly affect catecholamine-O-methyl transferase (COMT) function? A. Selegiline B. Benztropine C. Entacapone D. Diphenhydramine

C. Entacapone Rationale:Entacapone inhibits COMT. Selegiline mechanism of action is unknown, but it does irreversibly inhibit monoamine oxidase, not COMT. Benztropine opposes the effects of acetylcholine at receptor sites in the substantia nigra and corpus striatum. Diphenhydramine opposes the effects of acetylcholine at receptor sites in the substantia nigra and corpus striatum.

When reviewing the medical record of a client receiving levodopa, what client factors should alert the nurse to the need for closer monitoring after administering the drug? A. The client has taken calcium and vitamin D supplements for many years to prevent osteoporosis B. The client is obese and has usually led a sedentary lifestyle C. The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma D. The client had cataract surgery last year and has hypertension

C. The client has peptic ulcer disease and takes bronchodilators for the treatment of asthma Rationale:Levodopa should be used cautiously in clients with peptic ulcer disease or asthma, both of which could be exacerbated by dopamine receptor stimulation. None of the other listed client factors contraindicates the use of levodopa or necessitates close monitoring.

A client has been diagnosed with Parkinson disease, and the primary healthcare provider has prescribed levodopa (100 mg)-carbidopa (10 mg) PO q8h. What is the nurse's best action? A. Contact the provider to question the route. B. Contact the provider to question the frequency. C. Contact the provider to question the dose. D. Administer the medication as prescribed and monitor for therapeutic and adverse effects.

D. Administer the medication as prescribed and monitor for therapeutic and adverse effects. Rationale:This prescription is within recommended parameters. The nurse should administer the medication and monitor the client.

True or false With Parkinson disease, nerve cell bodies in the medulla begin to degenerate.

False Rationale:Parkinson disease affects the nerve cell bodies in the substantia nigra.

True or false Clients with Parkinson's disease experience deterioration in intellectual functioning along with lack of coordination of unconscious muscle movement.

False Rationale:Parkinson's disease does not affect a person's intellectual functioning. Parkinson disease does not affect the higher levels of the cerebral cortex, so a very alert and intelligent person may be trapped in a progressively degenerating body.

True or false: The combination of benztropine and an antipsychotic would lead to an increase in the level of benztropine.

False Rationale:The combination of benztropine with an antipsychotic would lead to a decrease in the effectiveness of the antipsychotic agent.

The nurse is planning the care of an older adult client who has been diagnosed with Parkinson disease and begun on levodopa. What should the nurse include in the care plan? Select all that apply. A. Monitor the client's vital signs each shift. B. Auscultate the client's lung sounds each shift. C. Monitor the client's urine output each shift. D. Auscultate the client's bowel sounds once per shift. E. Monitor the client's creatinine clearance whenever available.

A. Monitor the client's vital signs each shift. C. Monitor the client's urine output each shift. D. Auscultate the client's bowel sounds once per shift. E. Monitor the client's creatinine clearance whenever available. Rationale:The potential adverse effects of levodopa are varied and necessitate a number of assessments. These should include assessments of vital signs, kidney function, urine output, and bowel motility. Respiratory effects, however, are less common, and there is no direct indication for lung auscultation.

The nurse is teaching the client about the combination drug carbidopa-levodopa. What teaching points will the nurse include in the teaching plan? Select all that apply. A. Suspicious skin lesions should be reported to the provider immediately B. Take a daily multivitamin to compensate for common side effects of drug therapy C. Do not drive until effects of the drug are known D. Follow-up with the provider regularly for disease monitoring as well as dosage adjustments E. Cleanse the injection site with alcohol prior to administration in order to prevent infection

A. Suspicious skin lesions should be reported to the provider immediately C. Do not drive until effects of the drug are known D. Follow-up with the provider regularly for disease monitoring as well as dosage adjustments Rationale:Levodopa has been associated with the development of melanoma so the client should be taught what a suspicious skin lesion will look like and know to call the doctor immediately if one is found. CNS effects are multiple, so clients should be taught to avoid driving or operating dangerous equipment until they have an opportunity to see what effects they will experience. Clients will need to understand the importance of following up with their physician both so their disease progression can be monitored as well as for drug and dosage adjustments that will be needed to minimize symptoms. Carbidopa-levodopa is taken only PO. Clients who take dopaminergics should be cautioned to avoid over-the-counter vitamins; if such medications are used, the client should be monitored closely because a decrease in dopaminergic effectiveness can result.

What is the correct dosage of the combination drug carbidopa-levodopa the nurse will administer to the client with Parkinson disease? A. 100 mg levodopa with 10 to 25 mg carbidopa two times a day B. 100 mg levodopa with 10 to 25 mg carbidopa three times a day C. 10 to 25 mg levodopa with 100 mg carbidopa two times a day D. 10 to 25 mg levodopa with 100 mg carbidopa three times a day

B. 100 mg levodopa with 10 to 25 mg carbidopa three times a day Rationale:The correct dosage of the combination drug carbidopa-levodopa is 100 mg levodopa with 10 to 25 mg carbidopa three times a day.

What client factor should the nurse identify as a contraindication to the use of benztropine? A. Hypertension B. Benign prostatic hypertrophy C. Obstructive sleep apnea D. Depression

B. Benign prostatic hypertrophy Rationale:Benztropine is contraindicated for clients with prostatic hypertrophy because it could be exacerbated by the peripheral anticholinergic effects of the drug. Benztropine can be safely used in clients with hypertension, OSA, and depression.

The nurse learns that the client who has been taking an anticholinergic drug to treat Parkinson disease was recently started on amitriptyline to treat the depression resulting from their worsening condition. What is the nurse's best action? A. Assess the client bowel function frequently B. Contact the care provider to question the prescription C. Initiate cardiac monitoring for the first 24 hours D. Monitor the client for urinary hesitancy

B. Contact the care provider to question the prescription Rationale: When anticholinergic drugs are used with tricyclic antidepressants, there is a risk of potentially fatal paralytic ileus and an increased risk of toxic psychoses. Consequently, questioning the order would be a priority.

For the past year, the client has been taking carbidopa-levodopa to treat Parkinson disease. When the client's response to this drug declines, the provider adds tolcapone. Prior to administering the first dose of tolcapone, the nurse should contact the provider to question administration of this drug based on what test result? A. Slight elevation of red blood cell count B. Elevated AST, ALT, and bilirubin C. Prolonged QT interval on the ECG D. Elevated blood urea nitrogen and creatinine

B. Elevated AST, ALT, and bilirubin Rationale:Tolcapone has been associated with fulminant and potentially fatal liver damage, so it is contraindicated in the presence of liver disease. Reduced renal function may indicate a need for dosage reduction but would not contraindicate the drug. Prolonged QT interval and elevated red blood cell count would have no direct impact on administration of tolcapone.

A patient receiving an anticholinergic drug for Parkinson's disease is planning a winter trip to Tahiti. The temperature in Tahiti is 70 degrees warmer than at home. What precautions should the patient be urged to take? A. Take the drug with plenty of water to stay hydrated. B. Reduce the dose, and take precautions to reduce the risk of heat stroke. C. Wear sunglasses and use sunscreen because of photophobia and will develop. D. Avoid drinking the water to prevent gastric distress.

B. Reduce the dose, and take precautions to reduce the risk of heat stroke.

No therapy is available that will stop the loss of neurons and the eventual decline of function in clients with Parkinson's disease. As a result, nursing care should involve which of the following interventions? A. Regular exercises to slow loss of function. B. Supportive education as drugs fail and new therapy is needed C. Community and family support networking. D. Discontinuation of drug therapy to test for a cure. E. Special vitamin therapy to slow the loss of the neurons. F. Explanations of the adjunctive drug therapy that may be used.

B. Supportive education as drugs fail and new therapy is needed C. Community and family support networking. F. Explanations of the adjunctive drug therapy that may be used.

An older adult client with Parkinson disease currently takes carbidopa-levodopa 100-25 mg PO t.i.d. and benztropine 3 mg PO daily. What change in this client's health status would necessitate a change in the medication regimen? A. The client's mood and affect have deteriorated and the provider believes the client needs an antidepressant. B. The client's latest digital-rectal exam suggests prostatic hypertrophy. C. The client's blood urea nitrogen levels have been gradually rising over the past month. D. The client's most recent hemoglobin value is 11.5 g/dL.

B. The client's latest digital-rectal exam suggests prostatic hypertrophy. Rationale:Prostatic hypertrophy often contraindicates the use of an anticholinergic. Most antidepressants can be safely used with these two drugs, and a modest decline in hemoglobin is not problematic. A gradual increase in BUN must be monitored but would not likely require a change in medications.

A client is taking levodopa. What should the nurse caution the client to avoid? A. Aged cheese B. Vitamin B6 C. St. John's wort D. Analgesics

B. Vitamin B6 Rationale:Vitamin B6 interacts with levodopa decreasing its effectiveness. St. John's wort is not known to interact with levodopa but does interact with rasagiline. Aged cheese contains tyramine and should be avoided if the client is taking rasagiline, but there is no caution associated with levodopa. Analgesics are not known to interact with levodopa.

Parkinson's disease reflects an imbalance between inhibitory and stimulating activity of nerves in the A. Reticular activating systems B. Cerebellum C. Basal ganglia D. Limbic system

C. Basal ganglia

Replacing dopamine in the brain would seem to be the best treatment for Parkinson's disease. This is difficult because dopamine A. Is broken down in gastric acid. B, Is not available in drug form. C. Cannot cross the BBB. D. Is used peripherally before reaching the brain.

C. Cannot cross the BBB.

A nurse is assessing a client with Parkinson disease. The nurse determines that the client's drug therapy is effective when the client exhibits what? A. Decreased aggression B. Improved short-term memory C. Improved level of intellectual functioning D. Decreased tremors

D. Decreased tremors Rationale:Decreased tremors would indicate effective antiparkinsonism therapy. Intellectual dysfunction is not a manifestation associated with Parkinson disease. Parkinson disease is not associated with aggression.

A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client? A. Impaired dentition B. Impaired skin integrity C. Risk for injury D. Imbalanced nutrition: less than body requirements

D. Imbalanced nutrition: less than body requirements Rationale:The client's complaints suggest that their intake of food and fluids may be altered leading to problems with inadequate nutritional intake. Risk for injury would be more appropriate if the client was experiencing CNS effects. These symptoms are unlikely to affect the client's dentition or skin integrity.

Parkinson's disease is a progressive, chronic neurological disorder that is usually A. Associated with severe head injury B. Associated with chronic diseases. C. Associated with old age. D. Known to affect people of all ages with no known cause.

D. Known to affect people of all ages with no known cause.

A client taking carbidopa-levodopa for the treatment of Parkinson disease reports blurred vision, and the nurse observes that the client has worsening ataxia. Which nursing diagnosis should the nurse prioritize? A. Disturbed body image B. Ineffective role performance C. Impaired verbal communication D. Risk for injury

D. Risk for injury Rationale:The client has blurred vision and ataxia (muscular incoordination) placing the client at risk for falls and injury. Impaired verbal communication would be appropriate if the client was experiencing difficulty with speech. Disturbed body image would be appropriate if the client was voicing complaints related to appearance or effect of the disease or drug therapy on their appearance or body. Ineffective role performance would be appropriate if the client verbalized problems in fulfilling their role due to the changes in vision and the motor problems.

A client has just been diagnosed with Parkinson disease and prescribed rasagiline. What education should the nurse provide? Select all that apply. A. Apply a new transdermal patch once per day B. Blood levels will need to be evaluated weekly for 6 weeks C. Expect pink-tinged urine for the first few days of treatment D. Take the drug once daily, by mouth E. Avoid sausage and aged cheeses

D. Take the drug once daily, by mouth E. Avoid sausage and aged cheeses Rationale:Foods containing tyramine by clients taking rasagiline because of the increased risk for potentially serious adverse reactions. It is generally taken daily, exclusively by the oral route. Laboratory work is not required, and pink-tinged urine is not expected.

True or false: Dopaminergic agents can exacerbate cardiovascular disease due to dopamine receptor stimulation.

True Rationale:Administer dopaminergic agents cautiously with clients who have any condition that could be exacerbated by dopamine receptor stimulation, such as cardiovascular disease, including myocardial infarction, arrhythmias, and hypertension; bronchial asthma; history of peptic ulcers; urinary tract obstruction; and psychiatric disorders.

True or false Levodopa is used as treatment for Parkinson disease, primarily acting as a replacement neurotransmitter.

True Rationale:Levodopa is the mainstay of treatment for Parkinson disease. This precursor of dopamine crosses the blood-brain barrier and is converted into dopamine. In this way, it acts like a replacement therapy.

A client has been diagnosed with Parkinson disease, and the nurse is providing health education. The client asks the nurse, "Why can't I take a dopamine pill if that's what is lacking?" When responding, the nurse should address what topic? A. The role of acetylcholinesterase B. The structure and function of the blood-brain barrier C. The differences in anatomy and physiology between the central nervous system and the peripheral nervous system D. The functioning of the sodium-potassium pump

B. The structure and function of the blood-brain barrier Rationale:Dopamine cannot cross the blood-brain barrier, so exogenous supplements would have no therapeutic benefit. This is unrelated to the functions of acetylcholinesterase, sodium-potassium pumps, or the CNS and PNS.

A patient taking levodopa and over-the-counter megavitamins might experience A. a cure from Parkinson disease. B. the return of Parkinson symptoms. C. Improved health and well-being. D. A resistance to viral infections.

B. the return of Parkinson symptoms.

A client's dose of the combination drug carbidopa-levodopa has recently been increased due to an exacerbation of the client's parkinsonian symptoms. What assessment finding would suggest that the client is experiencing adverse effects? A. The client's blood pressure is 152/93 mm Hg and the client has no history of hypertension B. The client is diaphoretic despite being afebrile C. The client has had diarrhea twice in the past 2 days D. The client is retaining urine and has required a urinary catheter

D. The client is retaining urine and has required a urinary catheter Rationale:Adverse effects of levodopa include urinary retention. Diarrhea, increased blood pressure, and diaphoresis would likely be attributable to other factors.

The client is taking carbidopa-levodopa and is having a deteriorating response to the drug. The provider has consequently prescribed selegiline to begin today. What subsequent change in the client's treatment regimen should the nurse anticipate? A. Benztropine will be added to the client's drug regimen in 1 to 2 weeks B. The client will be admitted to critical care for monitoring during the transition C. The client's carbidopa-levodopa will be discontinued D. The client's carbidopa-levodopa dose will be decreased in 2 or 3 days

D. The client's carbidopa-levodopa dose will be decreased in 2 or 3 days Rationale:After starting selegiline, the client's carbidopa-levodopa should be trialed at a lower dose after 2 or 3 days. It should not be wholly discontinued, and there is no indication for benztropine. There is no obvious need for critical care admission.

Entacapone has been recently added to the medication regimen of a client with Parkinson disease. The nurse should recognize what likely rationale for this change in medication regimen? A. The client likely developed a comorbidity that contraindicated the use of levodopa B. The client was likely unable to adhere to the strict dosing schedule of other medications C. The client likely developed worsening adverse effects of carbidopa-levodopa D. The client's carbidopa-levodopa was likely less effective than in the past

D. The client's carbidopa-levodopa was likely less effective than in the past Rationale:Entacapone is an adjunctive agent used to treat Parkinson disease. It is used with levodopa-carbidopa for clients who are experiencing "wearing off" of drug effects.

The nurse is preparing to administer a client's scheduled dose of the combination drug carbidopa-levodopa. What is the nurse's rationale for administering the combination? A. Carbidopa potentiates the action of levodopa to prevent nerve cell degeneration. B. Carbidopa makes the blood-brain barrier temporarily permeable. C. Carbidopa prevents excessive amounts of levodopa from being excreted by the kidneys and in feces. D. The combination allows a lower dose of levodopa than if levodopa were administered alone.

D. The combination allows a lower dose of levodopa than if levodopa were administered alone. Rationale:Carbidopa decreases the amount of levodopa needed to reach a therapeutic level in the brain so that the dosage of levodopa can be decreased, which reduces the incidence of adverse side effects. When levodopa is used in combination with carbidopa, the enzyme dopa is inhibited in the periphery, diminishing the metabolism of levodopa in the GI tract and in peripheral tissues, thereby leading to higher levels crossing the blood-brain barrier.