Pharm 3 Final Exam- Ch. 14: Drugs Used to Treat Parkinsons

Which statement made by a student nurse indicates a need for further instruction concerning the usage of carbidopa-levodopa? 1. "Carbidopa-levodopa is the most effective drug, and it becomes more active with the passage of time." 2. "The dosage should be reduced if the levodopa dose is higher than 600 mg/day." 3. "Carbidopa-levodopa improves memory and motor speed when combined with monoamine oxidase inhibitor type B (MAOI-B)." 4. "Dopamine receptor agonists or a catechol-O-methyltransferase (COMT) inhibitor (entacapone) should be added to the carbidopa-levodopa treatment."

1. "Carbidopa-levodopa is the most effective drug, and it becomes more active with the passage of time."

Which instruction should the nurse provide to a patient with Parkinson's disease about assisting with activities of daily living (ADLs)? Select all that apply. 1. "Provide clothes that have easy closures or fasteners, such as hook-and-loop fasteners (Velcro)." 2. "Pay close attention to mood alterations; they ideally should not happen." 3. "Assist the patient with ADLs from an early stage onward." 4. "Encourage the patient to participate in hobbies and remain socially involved." 5. "Provide the patient with a bath chair and a handheld shower nozzle.

1. "Provide clothes that have easy closures or fasteners, such as hook-and-loop fasteners (Velcro)." 4. "Encourage the patient to participate in hobbies and remain socially involved." 5. "Provide the patient with a bath chair and a handheld shower nozzle.

Which serious adverse effect can amantadine have on the cardiovascular system? 1. Dyspnea 2. Palpitations 3. Tachycardia 4. Livedo reticularis

1. Dyspnea

Which clinical manifestations will the nurse expect to see in the patient with Parkinson's disease whose symptoms have progressed to bradykinesia? 1. Slowed body movements 2. Minor change in speech 3. Minor tremors when resting 4. Jerking and spastic movements

1. Slowed body movements

For which serious adverse cardiovascular effect would a nurse monitor in a patient taking ropinirole? 1. Tachycardia 2. Dysrhythmias 3. Livedo reticularis 4. Dyspnea/edema

1. Tachycardia

Which characteristics are the main similarities between selegiline and rasagiline? Select all that apply. 1. They may help increase life expectancy. 2. They are used to delay the initiation of levodopa therapy. 3. They interact with ciprofloxacin; therefore the dosage is reduced. 4. They improve memory and motor speed when used with carbidopa-levodopa. 5. They are amphetamines that cause adverse cardiovascular and psychiatric effects.

1. They may help increase life expectancy. 2. They are used to delay the initiation of levodopa therapy. 4. They improve memory and motor speed when used with carbidopa-levodopa.

Which common adverse effect should the nurse expect levodopa to have on the patient's gastrointestinal system? 1. Diarrhea 2. Anorexia 3. Constipation 4. Abdominal discomfort

2. Anorexia

Which rationale for the use of selegiline as part of a medication regimen for Parkinson's disease is best? 1. It decreases the production of acetylcholine. 2. It slows the deterioration of dopamine-producing cells. 3. It speeds up the metabolism of dopamine. 4. It enhances the dopaminergic activity of nerve cells.

2. It slows the deterioration of dopamine-producing cells.

Which clinical manifestation is a serious adverse effect of carbidopa-levodopa therapy in patients with Parkinson's disease? Select all that apply. 1. Orthostatic hypotension 2. Tachycardia and palpitations 3. Nausea, vomiting, and anorexia 4. Nightmares, depression, and hallucinations 5. Bobbing, facial grimacing, and rocking movements

2. Tachycardia and palpitations 4. Nightmares, depression, and hallucinations 5. Bobbing, facial grimacing, and rocking movements

Which instruction would the nurse provide to the caregivers of a patient with Parkinson's disease to prevent the enhancement of tremors? 1. "Include bulk in the patient's diet plan." 2. "Cut the patient's food into bite-size pieces." 3. "Keep the patient in a stress-free environment." 4. "Encourage the patient's self-maintenance activities."

3. "Keep the patient in a stress-free environment."

Which response by the nurse is best when a patient asks how long it will take for levodopa to relieve symptoms? 1. "Because a loading dose is given, the maximum effects of the drug are seen in 24 to 48 hours." 2. "Symptom relief is immediate but will vary with stress and fatigue level." 3. "The full therapeutic effect of the drug will not be apparent for up to 6 months." 4. "Maximum symptom control occurs when top dosage is reached in 14 to 21 days."

3. "The full therapeutic effect of the drug will not be apparent for up to 6 months."

The nurse teaches a patient taking selegiline to avoid which food? 1. Popcorn 2. Oranges 3. Cheese 4. Bananas

3. Cheese

Which is the most serious neurologic adverse effect the nurse should monitor for in a patient taking amantadine hydrochloride? 1. Confusion 2. Disorientation 3. Seizure disorder 4. Mental depression

3. Seizure disorder

Which medication given for Parkinson's disease may also have "neuroprotective" properties? 1. Entacapone 2. Apomorphine 3. Selegiline 4. Diphenhydramine hydrochloride

3. Selegiline

At which time would the nurse teach a patient to take selegiline? 1. Every 6 hours to ensure maintenance of therapeutic blood levels 2. One hour before or 2 hours after meals to increase absorption 3. At bedtime to increase therapeutic effects 4. At breakfast and lunch to decrease the potential for insomnia

4. At breakfast and lunch to decrease the potential for insomnia

Which adverse effect can diphenhydramine hydrochloride have on the patient's gastrointestinal system? 1. Nausea 2. Diarrhea 3. Anorexia 4. Constipation

4. Constipation

Which information does the nurse provide to a patient taking entacapone? Constipation is a common adverse effect with entacapone and should be treated with an over-the-counter stool softener. 1. Many patients experience hyperactivity, which will decrease over time. 2. Some patients may experience unusually high blood pressure, requiring 3. alteration of their medication if taking antihypertensives. 4. Entacapone may change the color of urine to brownish orange.

4. Entacapone may change the color of urine to brownish orange.

Which adverse effect might the nurse expect anticholinergic medications to have on the patient's genitourinary system? 1. The urine may turn red or black in color. 2. Penile erection and priapism may occur. 3. The urine may turn brownish-orange. 4. Urinary retention may develop.

4. Urinary retention may develop.

How should a patient be taught to take ropinirole? 1. One hour before meals 2. Between meals 3. On an empty stomach 4. With food

4. With food

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease? a. Dopamine does not cross the blood-brain barrier when administered orally. b. Levodopa is much less expensive. c. The half-life of dopamine is too short. d. Dopamine has too many reactions with other medications

a. Dopamine does not cross the blood-brain barrier when administered orally.

Parkinson's disease has which characteristic symptom(s)? (Select all that apply.) a. Muscle tremors b. Posture alterations c. Muscle flaccidity d. Tachycardia e. Slow body movement

a. Muscle tremors b. Posture alterations e. Slow body movement

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the: a. cheese. b. eggs. c. bread. d. coffee

a. cheese.

The nurse is preparing to begin administration of apomorphine to a patient. Before administering, the nurse will perform a baselineassessment of the patient's: (Select all that apply.) a. mobility. b. orientation. c. intellectual ability. d. alertness. e. vital signs

a. mobility. b. orientation. d. alertness. e. vital signs

The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patientindicates a need for further teaching? a. "This medication will help slow the development of symptoms." b. "I will place the tablet on my tongue before breakfast." c. "I may need to use a stool softener for constipation." d. "I should not push the tablet through the foil.

b. "I will place the tablet on my tongue before breakfast."

Which vitamin will reduce the therapeutic effects of levodopa? a. A b. B6 c. C d. D

b. B6

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct? a. This medication is not to be taken with carbidopa levodopa. b. Dosage is adjusted according to the patient's response. c. There will be fewer incidences of dopaminergic effects, such as confusion. d. This medication increases the production of dopamine in the brain

b. Dosage is adjusted according to the patient's response.

Which adverse effects associated with levodopa therapy would support the nursing diagnosis risk for injury? a. Nausea and vomiting b. Orthostatic hypotension c. Anorexia and depression d. Tachycardia and palpitation

b. Orthostatic hypotension

What point(s) should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease?(Select all that apply.) a. The restoration of function resulting from stimulation of dopamine receptors ispermanent. b. Apomorphine may be administered intravenously for rapid relief. c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness

c. Apomorphine does not have any opioid activity. d. A multidose injector pen is commonly used to administer apomorphine. e. You may experience nausea and vomiting, which can be treated with trimethobenzamide (Tigan). f. You may experience sleep attacks or episodes of daytime sleepiness

What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor? a. Slows the deterioration of dopaminergic nerve cells. b. Inhibits the relative excess of dopaminergic activity. c. Reduces the destruction of dopamine in peripheral tissues. d. Enhances the cholinergic symptoms of Parkinson's disease

c. Reduces the destruction of dopamine in peripheral tissues.

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease? a. Oculogyric crisis b. Tardive dyskinesia c. Sudden sleep events d. Akathisia

c. Sudden sleep events

Which cholinergic symptoms of Parkinson's disease are reduced with anticholinergic drugs? a. Cognitive impairments b. Rigidity c. Tremors and drooling d. Postural abnormalities

c. Tremors and drooling

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood pressure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of: a. dextromethorphan. b. levodopa. c. ciprofloxacin. d. Valium

c. ciprofloxacin.

The nurse is teaching a patient with Parkinson's disease about levodopa. Which statement by the nurse is accurate regarding drugadministration? a. "Take this medication in between meals." b. "Take this medication at bedtime to prevent dizziness." c. "Take this medication when your tremors get worse." d. "Take this medication with food or antacids to reduce GI upset."

d. "Take this medication with food or antacids to reduce GI upset."

The nurse is assessing an older patient with Parkinson's disease who was started on entacapone 1 week ago. The patient has a history of coronary artery disease and takes an antihypertensive and aspirin. Which information would support the need for are duction in medication dosage by the healthcare provider? a. Constipation b. Brownish orange urine c. Drowsiness d. Dizziness

d. Dizziness