Ch.15 Antiparkinson Drugs
During a patient teaching session about antiparkinson drugs, the nurse will include which statement?
take care to change positions slowly to prevent falling due to a drop in blood pressure
Parkinson's disease is a chronic, progressive, neurodegenerative disorder causing
the degeneration of dopamine-producing neurons in the brain. Patients with this disease also have elevated acetylcholine levels and lowered dopamine levels.
A patient with Parkinson's disease will start taking entacaphone (Comtan) along with eh carbidopa-levodopa (Sinemet) he had been taking for a few years. the nurse recognizes that the advantage of taking entacapone is that
the entacapone can reduce on-off effects
the nurse is assessing a patine who had begun therapy with amantadine (Symmetrel) for Parkinson;s disease. The nurse will look for which possible adverse effects?
Nausea Dizziness Insomnia
The classic symptoms of Parkinson's disease include
bradykinesia, postural instability, rigidity, and tremors (TRAP [tremor, rigidity, akinesia, postural instability] with akinesia really manifesting as bradykinesia).
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond?
"Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa."
Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system and therefore allows a decreased dose of other medications?
selegiline
The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
"This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
TRAP
(Tremor, Rigidity, Akinesia, Postural instability); an acronym for symptoms of Parkinson's disease.
The order reads: bromocriptine (Parlodel) 10 mg per day PO. the medication is available in 2.5 mg tablets. how many tablets will the nurse give per dose?
4 tablets
When teaching a patient about carbidopa-levodopa (Sinemet), what information will the nurse include in the teaching?
Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.
On-off phenomenon
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).
Chorea
A condition characterized by involuntary, purposeless, rapid motions such as flexing and extending the fingers, raising and lowering the shoulders, or grimacing.
Postural instability
A decrease or change in motor and muscle movements that leads to unsteadiness and hesitation in movement and gait when the individual starts or stops walking, or causes leaning to the left or right when sitting; occurs in Parkinson's disease.
Wearing-off phenomenon
A gradual worsening of parkinsonian symptoms as a patient's medications begin to lose their effectiveness, despite maximal dosing with a variety of medications.
Notify the patient that this drug causes discoloration of the urine.
A patient is taking entacapone (Comtan) as part of the therapy for Parkinson's disease. Which intervention by the nurse is appropriate at this time? a. Notify the patient that this drug causes discoloration of the urine. b. Limit the patient's intake of tyramine-containing foods. c. Monitor the results of renal studies because this drug can seriously affect renal function. d. Force fluids to prevent dehydration.
The high-protein diet can slow or prevent absorption of this medication.
A patient who has been taking carbidopa-levodopa for Parkinson's disease for over 1 year wants to start a low-carbohydrate/high-protein weight-loss diet. The nurse tells the patient that this type of diet may have what effect on his drug therapy? a. There will be no problems with this diet while on this medication. b. The high-protein diet can slow or prevent absorption of this medication. c. The high-protein diet may cause increased blood levels of this medication. d. The high-protein diet will cause no problems as long as the patient also takes pyridoxine (vitamin B6).
Monitor for dizziness.
A patient will be taking selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. The nurse will implement which precautions regarding selegiline? a. Teach the patient to avoid foods containing tyramine. b. Monitor for dizziness. c. Inform the patient that this drug may cause urine discoloration. d. Monitor for weight gain.
the entacapone can reduce on-off effects.
A patient with Parkinson's disease will start taking entacapone (Comtan) along with the carbidopa-levodopa (Sinemet) he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is that a. the entacapone can reduce on-off effects. b. the levodopa may be stopped in a few days. c. there is less GI upset with entacapone. d. it does not cause the cheese effect.
Parkinson's disease
A slowly progressive, degenerative neurologic disorder characterized by resting tremor, pill-rolling of the fingers, masklike facies, shuffling gait, forward flexion of the trunk, loss of postural reflexes, and muscle rigidity and weakness.
Exogenous
A term describing any substance produced outside of the body that may be taken into the body (e.g., a medication, food, or environmental toxin).
Dyskinesia
Abnormal involuntary movements; inability to control movements.
Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease
Angle-closure glaucoma
Akinesia
Classically defined as "without movement." Absence or poverty of movement that results in a masklike facial expression and impaired postural reflexes.
The nurse is providing care for a patient who has been diagnosed with Parkinson's disease. The patient is also in early stage liver failure. What class of medications, if prescribed, would the nurse question?
COMT inhibitors
Adjunctive drugs
Drugs that are added as a second drug for combined therapy with a primary drug and may have additive or independent properties.
Presynaptic
Drugs that exert their antiparkinson effects before the nerve synapse.
"Take care to change positions slowly to prevent falling due to a drop in blood pressure."
During a patient teaching session about antiparkinson drugs, the nurse will include which statement? a. "The drug will be stopped when tremors and weakness are relieved." b. "If a dose is missed, take two doses to avoid significant decreases in blood levels." c. "Be sure to notify your physician if your urine turns brownish-orange in color." d. "Take care to change positions slowly to prevent falling due to a drop in blood pressure."
A patient is prescribed selegiline, an MAO-B inhibitor, as adjunctive therapy in treatment of Parkinson's disease. What potential adverse effects would the nurse include in education for this patient? (Select all that apply.)
Headache Insomnia Depression Blood pressure changes
Dystonia
Impaired or distorted voluntary movement, involving the head, neck, or feet.
Tremor
In Parkinson's disease, shakiness of the extremities seen mostly at rest.
A patient will be taken selegiline (Eldepryl), 10 mg daily, in addition to dopamine replacement therapy for Parkinson's disease. the nurse will implement which precaution regarding selegiline?
Monitor for dizziness
A patient is taking entacapone (Comtan) as part of the therapy for Parkinson;s disease. Which intervention by the nurse is appropriate at this time?
Notify the patient that this drug causes discoloration of the urine
These motor complications make Parkinson's disease a prominent cause of disability. Dementia may also result and is referred to as
Parkinson's disease-associated dementia.
Bradykinesia
Slowness of movement; a classic symptom of Parkinson's disease.
Rigidity
Resistance of the muscles to passive movement; leads to the "cogwheel" rigidity seen in Parkinson's disease.
The patient asks the nurse to explain the difference between carbidopa-levodopa (Sinemet) and ropinirole (Requip). How will the nurse respond?
Ropinirole is a dopamine agonist that has fewer side effects than carbidopa-levodopa
Nausea Dizziness Insomnia
The nurse is assessing a patient who has begun therapy with amantadine (Symmetrel) for Parkinson's disease. The nurse will look for which possible adverse effects? (Select all that apply.) a. Nausea b. Palpitations c. Dizziness d. Insomnia e. Fatigue
4 tablets
The order reads: bromocriptine (Parlodel) 10 mg per day PO. The medication is available in 2.5-mg tablets. How many tablets will the nurse give per dose?
The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide?
This is a normal occurrence related to entacapone
The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide?
This is a normal occurrence related to entacapone (Comtan).
The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate?
This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help diminish this effect."
What is the goal of pharmacologic therapy in treating Parkinson's disease?
To balance cholinergic and dopaminergic activity in the brain
A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa?
Use of benzodiazepines decrease the therapeutic effect of the levadopa and may result in an increase in the symptoms of Parkinson's disease.
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?
Wearing-off phenomenon
Angle-closure glaucoma
Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild Parkinson's disease? a. Diarrhea b. Tremors c. Angle-closure glaucoma d. Unstable gait
Dyskinesia is the difficulty in performing voluntary movements and is commonly seen in the disease. Most frequent are
chorea (irregular, spasmodic, involuntary movements of the limbs or facial muscles) and dystonia (abnormal muscle tone leading to impaired or abnormal movements). Dystonia commonly involves the head, neck, or feet and is a symptom common to patients with Parkinson's disease.
Rapid swings in the response to levodopa, called the
on-off phenomenon, results in worsening of the disease with too little dopamine or dyskinesias with too much.
Treatment of the disease centers around drug therapy, but many experts believe that
physical activity is as important as any drug therapy, and together these greatly improve mobility. For severe cases, the surgical technique of deep brain stimulation may be used.
