Pharmacology Prep U Chapter 24 Antiparkinsonism Agents
A nursing instructor is describing Parkinsonism to a group of nursing students. When discussing the underlying cause of the symptoms, the instructor explains the depletion of dopamine in which of the following?
Central nervous system
A client is prescribed a catechol-O-methyltransferase (COMT) inhibitor. Which drug would the nurse expect to administer?
Entacapone
A client who has been receiving long-term levodopa therapy tells the nurse, "I was making good progress and then it was like the drug stopped working." The nurse interprets this as which of the following?
On-off phenomenon
A client taking carbidopa-levodopa for the treatment of Parkinson's disease reports blurred vision and the nurse observes that the client has worsening ataxia. Which nursing diagnosis should the nurse prioritize?
Risk for injury
A client with Parkinson's disease began treatment with dopaminergics two weeks ago and has now presented for a follow-up assessment. What finding best suggests to the nurse that the treatment is having a therapeutic effect?
The client is able to walk more briskly and stably than two weeks ago
A 74-year-old client with Parkinson's disease currently takes Sinement 100/25 mg PO t.i.d. and Cogentin 3 mg PO daily. What change in this client's health status would necessitate a change in the medication regimen?
The client's latest digital-rectal exam suggests prostatic hypertrophy
A female client is diagnosed with Parkinson's disease and is having difficulty performing her activities of daily living. Her health care provider orders pramipexole. Pramipexole may be used alone for which purpose?
To improve motor performance and improve ability to participate in usual activities of daily living
A male client is diagnosed with chronic renal failure. He routinely takes amantadine for his Parkinson's disease with success. Why would his health care provider consider discontinuing the amantadine?
With amantadine, excretion is primarily via the kidneys.
Common side effects of anticholinergics include:
dry mouth, urinary retention, constipation, and increased pulse rate.
The home care nurse is caring for an 80-year-old patient who is receiving carbidopa-levodopa, a dopaminergic drug used to treat Parkinson's disease. The nurse knows that this drug may place the patient at increased risk for:
falls
A client has developed symptoms of rigidity and bradykinesia. Which medication has been linked to the development of such symptomology?
haloperidol
A nurse is educating a client who has Parkinson's disease and family regarding possible adverse effects of carbidopa-levodopa. The nurse emphasizes which should be a closely monitored effect?
involuntary movements
For a client diagnosed with both Parkinson's and narrow-angle glaucoma, what medication should cause the nurse concern?
levodopa
A nurse monitoring a client taking carbidopa/levodopa (Sinemet) may notice which common adverse reactions? (Select all that apply.)
• Choreiform movements • Dry mouth • Anorexia
When describing the possible adverse effects associated with trihexyphenidyl therapy, what would the nurse include? (Select all that apply.)
• Delirium • Agitation • Blurred vision
A nurse is educating a patient newly diagnosed with Parkinson's disease. Which description would the nurse offer to describe the disease?
"It is characterized abnormalities in posture."
A pediatric client with a complex health history has developed early signs of drug-induced parkinsonism. The client's provider has prescribed diphenhydramine 25 mg PO tid. The medication is available as an oral solution with a concentration of 12.5 mg/ 5mL. How many mL should the nurse administer for each dose?
10 mL
A client is taking tolcapone for Parkinson's disease. What blood test will the nurse perform often on this client?
ALT
When describing the action of levodopa, which would the nurse include?
Acts like replacement therapy
A client with Parkinson's disease is being treated with carbidopa-levodopa and benztropine. The client has a comorbid diagnosis of depression and takes amitriptyline 125 mg PO daily. What assessment should the nurse prioritize?
Auscultation of bowel sounds and monitoring bowel movements
A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient?
Administer the next drug dose with meals.
A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient?
Confusion and disorientation
Dopaminergic agents can exacerbate cardiovascular disease due to dopamine receptor stimulation.
True
Levodopa is used as treatment for Parkinson's disease primarily acting as a replacement neurotransmitter.
True
A client who diagnosed with Parkinson's disease is being treated with levodopa/carbidopa. Which disorder will result in the discontinuation of this drug based on a disease-related contraindication?
narrow-angle glaucoma
In which clients should the nurse review medical conditions prior to administering a carbidopa/levodopa (Sinemet), as its use is contraindicated in these clients? (Select all that apply.)
• Narrow angle glaucoma • Renal disease • Hepatic disease • Use of MAOI antidepressants
A client has been diagnosed with Parkinson's disease and the primary health care provider has prescribed levodopa(100 mg)-carbidopa(10 mg) PO q8h. What is the nurse's best action?
Administer the medication as prescribed and monitor for therapeutic and adverse effects
A client receiving a dopaminergic agent has recently experienced nausea, vomiting, and dysphagia. Which nursing diagnosis would be most appropriate for this client?
Imbalanced nutrition: less than body requirements
A male client's physician orders levodopa for the treatment of the client's Parkinson's disease. The client asks the nurse whether the levodopa will cure his condition. Which is a correct statement about the effects of levodopa?
It does not alter the underlying disease process, but it may improve a client's quality of life.
Which action would be a priority for a client receiving apomorphine?
Monitoring cardiac status
A client has been diagnosed with Parkinson's 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?
The structure and function of the blood-brain barrier
A client has been prescribed an anticholinergic agent for treatment of Parkinson-related symptoms. What client education should be provided?
Void before taking the medication.
After teaching an in-service program about nervous system conditions, the nurse determines that the teaching was successful when the group identifies which condition or disease as a group of symptoms involving motor movement characterized by tremors, rigidity, and bradykinesia?
Parkinsonism
A nurse is caring for a client who has been diagnosed with Parkinson's disease. The client does not understand how the medication, carbidopa-levodopa, is going to help the condition. What is the correct response by the nurse?
"Carbidopa-levodopa increases the activity of dopamine in your body, which will decrease your symptoms."
A nurse has been invited to speak to a support group for Parkinson's disease clients and families. Which statement addresses the chronic nature of the disease and the relevant drug therapies?
"Drugs do not cure these disorders; they instead enhance quality of life."
After seeking care for tremors that have become increasingly severe in recent months, a 71-year-old man has been diagnosed with Parkinson's disease and will soon begin treatment with carbidopa-levodopa. Which statement indicates that the patient has an accurate understanding of the new medication?
"I've read that carbidopa-levodopa is quite short-acting so I'll have to take it several times a day."
A nurse is caring for a 59-year-old client with Parkinson's disease. What would indicate to the nurse that the client is experiencing an adverse reaction related to the drug carbidopa-levodopa?
Blurred vision
What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy?
Blurred vision
A nurse is assessing a client with Parkinson's disease. The nurse determines that the client's drug therapy is effective when the client exhibits what?
Decreased tremors
A female client is prescribed centrally acting anticholinergics for her Parkinson's disease. Six weeks later, her daughter asks the health care provider to hospitalize the client for a psychiatric evaluation. The nurse anticipates that the provider will respond in what way to the daughter's request?
Evaluate the client for adverse reactions from the centrally acting anticholinergics
For a client diagnosed with Parkinson's and narrow angle glaucoma, what medication would be contraindicated?
Levodopa
A client with Parkinson's disease is experiencing fewer therapeutic benefits of carbidopa-levodopa in recent weeks so the provider has prescribed selegiline 5 mg PO b.i.d. In addition to assessing for therapeutic effects on the client's Parkinson's symptoms, the nurse should prioritize what assessment?
Monitoring blood pressure
A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson's disease. The nurse would expect to administer this drug by which route?
Oral
The nurse is preparing to administer a client's scheduled dose of Sinemet. What is the nurse's rationale for administering levodopa with carbidopa?
The combination allows a lower dose of levodopa than if levodopa were administered alone.
A 52-year-old male client is being treated for Parkinson's disease. The nurse is aware that Parkinson's disease results in several physical manifestations. What occurs in the neurons that causes these symptoms?
There is an imbalance between dopamine and acetylcholine.
A client with diagnoses of Parkinson's disease and hepatic disease is to begin tolcapone therapy. What monitoring intervention should be included in the client's plan of care?
a baseline liver function test
An older adult client diagnosed with Parkinson's disease will soon begin treatment with levodopa, carbidopa, and entacapone. Prior to starting this course of treatment, the nurse must ensure the implementation of which intervention to ensure adequate function of which organ system?
assess renal function
A client whose Parkinson's disease is being treated with tolcapone should concurrently take what drug?
levodopa/carbidopa
What may parkinsonism result from? (Select all that apply.)
• Drugs • Encephalitis
A client asks the nurse why the client must take levodopa in combination with carbidopa. Which response by the nurse would be most appropriate?
"The carbidopa allows a lower dose of levodopa to be used."
A group of nursing students are preparing for a class presentation to discuss drugs used to treat Parkinson disease. Which drug would the group include when discussing dopaminergic agents?
Carbidopa
A client with Parkinson's disease has been prescribed diphenhydramine 25 mg IV. The nurse knows that the drug must be added to a 50 mL minibag of 0.9% NaCl and that diphenhydramine is available in single-use vials of 50 mg/1 mL. How many mL of diphenhydramine should the nurse add to the minibag?
0.5 mL
After reviewing the drugs used to treat Parkinson's disease, the students demonstrate understanding when they identify what as a dopaminergic agent?
Bromocriptine
A nurse is caring for a client who is prescribed an antiparkinsonism drug. Before administering the drug, which nursing action would the nurse include in the preadministration assessment?
Evaluating the client's current mental condition
A client is receiving levodopa as treatment for Parkinson disease. The nurse would instruct the client to avoid foods high in which vitamin to prevent a reduction in the effect of levodopa?
Pyridoxine (vitamin B6)
A client is taking levodopa. What should the nurse caution the client to avoid?
Vitamin B6
Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
decrease salivation, spasticity, and tremors.
A nurse is caring for a client who is prescribed biperiden as treatment of drug-induced extrapyramidal symptoms. After administering the drug, the nurse would assess the client for which of the following? Select all that apply.
• Skin rash • Dry mouth
What are the classic symptoms associated with Parkinson's disease? Select all that apply.
• bradykinesia • muscle rigidity • resting tremors
