Pharmacology Olympics #2

A patient newly diagnosed with Parkinson disease is prescribed an oral dopamine agonist. Which precaution is most important to teach the patient and family about the timing for taking this drug?

"Take the drug 30-60 minutes before meals on an empty stomach"

The nurse is teaching a patient with Parkinson disease about levodopa. Which statement by the nurse is accurate regarding drug administration?

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

A patient who is newly diagnosed with Parkinson disease is perscribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?

"While some drugs show promise, there are no studies that have proven a neuroprotective effect"

Which adverse effects associated with levodpa therapy would support the nursing diagnosis risk for injury?

Orthostatic hypotension

Dopamine agonists have been linked with which adverse effects in patients with Parkinson's disease?

Sudden sleep events

How does the drug tolcapone relieve the symptoms of Parkinson disease?

Suppresses the activity of an enzyme that normally breaks down natrually occurring dopamine

A patient newly diagnosed with Parkinson disease has been taking levodopa/carbidopa for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?

Taking a lower dose with a low-protein snack

Which vitamin will reduce the therapeutic effects of levodopa?

Vitamin B6

When a patient taking a monoamine oxidase B inhibitor receives his dietary tray, the nurse knows to remove the:

cheese

A patient taking rasagiline is assessed by the nurse to have a lasting significant increase in blood presure. When reviewing the patient's current list of medications, the nurse decides to hold the next dose of:

ciprofloxacin

A nurse provides teaching for a patient who is newly diagnosed with Parkinson disease. Which statement by the patient indicates understanding of the drug therapy for this disease?

"A levodopa/carbidopa combination is used to improve motor function"

A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?

"Combination products cause fewer dyskinesias and decreased psychosis"

A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa/cabridopa [Sinemet] for 9 months and who is now having regular tics. Which statment by the patient indicates understanding of this symprom?

"I may need to try a lower dose of Sinemet to reduce my tics"

The nurse is providing education to a patient recently placed on selegiline disintegrating tablets. Which statement by the patient indicates a need for further teaching?

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

The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson disease. What will the nurse include in teaching?

"If you need to stop this drug, your provider will order a gradual withdrawl"

A patient has taken levodopa [Dopar] for Parkinson disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

"It may take several months for a response to occur"

What points should be included when teaching a patient about the use of apomorphine for treatment of Parkinson's disease?

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

Which symptoms in a patient taking levodopa for Parkinson disease indicate the drug is "wearing off?"

- Difficulty swallowing - Increased tremors - Slower gait

The nurse is preparing to begin administration of apomorphine to a patient. Before administer, the nurse will perform a baseline assessment of the patient's:

- Mobility - Orientation - Alertness - Vital signs

Parkinson's disease has which characteristic symptoms?

- Muscle tremors - Posture alterations - Slow body movement

A patient with Parkinson disease is taking levodopa/carbidopa and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. THe nurse will contact the provider to discuss:

Administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone

Why are carbidopa and levodopa usually given together?

Carbidopa enhances the action of levodopa, and less drug is needed

The nurse is assessing and 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 asprin. Which information would support the need for a reduction in medication dosage by the health care provider?

Dizziness

A nursing student wants to know how carbidopa can be effective for treating Parkinson disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:

Does not cross the blood-brain barrier.

What is the rationale for administering levodopa instead of dopamine for treatment of Parkinson's disease?

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

The nurse is providing information to a patient recently prescribed entacapone. Which statement is correct?

Dosage is adjusted to the patient's response

Which neurotransmitter has an inhibitory action within the central nervous system?

Gamma-aminobutyric acid (GABA)

When assessing a patient with Parkinson disease who takes a carbidopa/levodopa combination drug, you find that he now has almost constant muscle movements that look like uncoordinated dancing. What is your best action?

Hold the next drug dose and report the finding to the healthcare provider

A patient who has begun taking levodopa/carbidopa [Sinemet] reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend?

Increasing salt and water intake

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?

Interrupting treatment with amantadine for several weeks

A patient has been diagnosed with Parkinson disease and begins treatment with levodopa/carbidopa. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:

Re-evaluate the diagnosis

What is the pharmacologic action of entacapone, a potent catechol O methyl transferase (COMT) inhibitor?

Reduces the destruction in peripheral tissues

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:

Reducing the dose of bromocriptine

A nurse is teaching a group of nurses about Parkinson medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:

Sleep attacks

Which cholinergic symptoms of Parkinson's Disease are reduced with anticholinergic drugs?

Tremors and drooling

A hospitalized patient with Parkinson diseas who is recieving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?

Trimethobenzamide [Tigan]