Ch.15 Antiparkinsons Drugs (Exam 1)

How can the nurse best explain the "off-on phenomenon" that some patients with PD experience?

A. The need to take a drug holiday to improve response to medications

B. The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms

C. The alternating schedule of medications needed to control PD

D. The fluctuation of emotions that often occurs with PD

B. The variable response to levodopa, resulting in periods of good control and periods of poor control of PD symptoms

Which drug used for the management of the patient with PD is most likely to cause postural hypotension?

A. Amantadine (Symmetrel)

B. Selegiline (Eldepryl)

C. Tolcapone (Tasmar)

D. Entacapone (Comtan)

A. Amantadine (Symmetrel)

When providing teaching to a patient receiving an anticholinergic for the treatment of PD, the nurse will include which information?

A. Take the medication first thing in the morning.

B. Limit fluid intake when taking this drug.

C. The tremors you experience will be reduced within 24 hours of taking this drug.

D. Do not take this medication at the same time as other medications.

D. Do not take this medication at the same time as other medications.

A patient has been diagnosed with PD. Medication therapy is started for this patient. What teaching should the nurse include to the patient and caregiver regarding pharmacologic therapy of PD? Select all that apply

A. The medication should be stopped when the patient's symptoms improve.

B. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber.

C. A common side effect of anticholinergics is drooling.

D. Improvements in symptoms are expected within 5 days of medication therapy.

B. Alcohol, over-the-counter drugs, and herbals are to be avoided unless approved by the prescriber.

D. Improvements in symptoms are expected within 5 days of medication therapy.

Which statement explains the action of carbidopa-levodopa?

A. Carbidopa decreases symptoms of parkinsonism.

B. Carbidopa inhibits the breakdown of dopamine at the synapses in the brain.

C. Carbidopa inhibits the catechol-o-methyltransferase (COMT) enzyme, increasing the concentration of levodopa.

D. Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain.

D. Carbidopa prevents levodopa decarboxylation in the periphery, resulting in more levodopa being transported to the brain.

Through which route is carbidopa-levodopa excreted?

A. Liver

B. Urine

C. Bile

D. Saliva

B. Urine

Match the class of drugs used to treat Parkinson's disease with its mechanism of action.

A. Affect dopamine content of the brain

B. Stimulate dopamine receptors of nerve cells in the brain

C. Inhibit activity of acetylcholine

D. Inhibit activity of monoamine oxidase (MAO)

a. MAO-B inhibitors

b. Dopamine agonists

c. Dopaminergics

d. Anticholinergics

A. Affect dopamine content of the brain - c. Dopaminergics

B. Stimulate dopamine receptors of nerve cells in the brain - b. Dopamine agonists

C. Inhibit activity of acetylcholine - d. Anticholinergics

D. Inhibit activity of monoamine oxidase (MAO) - a. MAO-B inhibitors

Which statement correctly explains the action of rivastigmine?

A. Interferes with the breakdown of dopamine

B. Breaks down acetylcholine in the neuron receptors

C. Increases availability of acetylcholine in the neuron receptors

D. Reverses clinical manifestations of Alzheimer’s disease

C. Increases availability of acetylcholine in the neuron receptors

Which route of administration for rivastigmine results in a peak concentration between 8 and 16 hours?

A. Oral

B. Intravenous

C. Transdermal

D. Subcutaneous

C. Transdermal

Which side effects would the nurse teach Mrs. Hill to expect while taking rivastigmine?

Select all that apply.

A. Nausea

B. Diarrhea

C. Anorexia

D. Headache

E. Tachycardia

F. Hypertension

A. Nausea

B. Diarrhea

C. Anorexia

D. Headache

Which information related to rivastigmine would the nurse provide Mrs. Hill?

A. “Weight gain can occur.”

B. “Avoid grapefruit products.”

C. “Take ibuprofen 30 minutes before a meal to prevent GI upset.”

D. “Rise slowly from sitting or lying positions, because orthostatic hypotension can occur.”

D. “Rise slowly from sitting or lying positions, because orthostatic hypotension can occur.”

Which baseline laboratory tests would be obtained for a female patient who has been prescribed carbidopa-levodopa?

Select all that apply.

A. Complete blood count (CBC)

B. Liver function tests (LFTs)

C. Serum electrolytes

D. Kidney profile

E. Prolactin level

F. Pregnancy test

A. Complete blood count (CBC)

B. Liver function tests (LFTs)

E. Prolactin level

F. Pregnancy test

Which adverse effect of carbidopa-levodopa would the nurse teach the patient and family to report to the health care provider?

A. Gastrointestinal (GI) upset

B. Seizures

C. Dyskinesia

D. Elevated temperature

C. Dyskinesia

Which instructions would the nurse include in patient teaching for a patient taking extended-release carbidopa-levodopa?

Select all that apply.

A. “Report tremors to your health care provider.”

B. “Do not abruptly stop taking this medication.”

C. “You may continue to have symptoms for several weeks or months “

D. “If this medication causes gastrointestinal upset, you can crush the tablets and mix them with food.”

E. “You may experience discolored urine or dark perspiration while taking this medication.”

B. "Do not abruptly stop taking this medication."

C. "You may continue to have symptoms for several weeks or months "

E. "You may experience discolored urine or dark perspiration while taking this medication."

Which phrase describes a correct therapeutic goal for treatment of Parkinson’s disease?

A. Cure Parkinson’s disease

B. Delay the progression of Parkinson’s disease

C. Improve the patient’s ability to carry out activities of daily living

D. Return the patient’s ability to carry out activities of daily living to baseline

C. Improve the patient’s ability to carry out activities of daily living

Which statement about carbidopa-levodopa is accurate?

A. Carbidopa-levodopa should not be taken with food.

B. Carbidopa-levodopa should not be stopped abruptly.

C. High-protein foods should be consumed with every meal.

D. A decrease in the symptoms of Parkinson’s disease occurs within a week of starting medication treatment.

B. Carbidopa-levodopa should not be stopped abruptly.

Which statement about the mechanism of action of carbidopa is accurate?

A. Carbidopa has no therapeutic effect on its own.

B. Carbidopa works by crossing the blood-brain barrier.

C. Carbidopa aids in the breakdown of levodopa in the peripheral tissues.

D. Because of periphery loss of the medication, only 2% of carbidopa taken is available to the brain.

A. Carbidopa has no therapeutic effect on its own.

A nurse administers oral carbidopa-levodopa to a patient who has tremors caused by Parkinson’s disease. The nurse would expect to see the medication effect in which time frame?

A. 1 hour

B. 3 hours

C. 5 hours

D. 8 hours

C. 5 hours

Which statement is accurate about the pharmacodynamics of topical rivastigmine?

A. The patch should be applied three times daily.

B. Peak action is 24 hours.

C. Onset of action is 2 to 4 hours.

D. Onset of action is 0.5 to 1 hour.

D. Onset of action is 0.5 to 1 hour.

Which description of the therapeutic effect of rivastigmine is accurate?

A. Improves memory

B. Restores damaged neurons

C. Improves oxygenation in the brain

D. Increases antioxidants in the brain

A. Improves memory

Rivastigmine must be used with caution in patients with which condition?

A. Diabetes mellitus

B. Peripheral vascular disease

C. Asthma

D. Hypothyroidism

C. Asthma

A nurse is evaluating the effectiveness of a patient’s drug regimen for Alzheimer’s disease. Which assessment finding by the nurse would indicate that the drug is effective?

A. Absence of dizziness

B. Decrease in blood pressure from baseline

C. Levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at baseline

D. Improvement in mental status

D. Improvement in mental status

A patient has been taking carbidopa-levodopa for many years. During assessment, the nurse finds that the patient presents with hand tremors, drooling, and a mask-like facial expression. Which action would the nurse anticipate incorporating into the plan of care?

A. Increase in medication dosage

B. Decrease in medication dosage

C. Discontinuation of the medication

D. Discussion of medication adherence

A. Increase in medication dosage

Which foods would the nurse instruct a patient who is taking selegiline to avoid?

Select all that apply.

A. Honey, beer, and apples

B. Boiled peanuts and hot dogs

C. Grapefruit juice and tomatoes

D. Aged cheeses

E. Red wine

F. Bananas

D. Aged cheeses

E. Red wine

F. Bananas

The nurse is providing education to a patient taking carbidopa-levodopa. Which statement by the nurse correctly explains why the patient should take this medication with low-protein foods?

A. "A high-protein diet will increase renal excretion of carbidopa-levodopa."

B. "Low-protein foods accelerate the transportation of this medication to the central nervous system."

C. "A low-protein diet will help prevent gastrointestinal distress from the medication."

D. "High-protein foods interfere with transportation of this medication to the central nervous system."

D. "High-protein foods interfere with transportation of this medication to the central nervous system."

A patient taking an antihypertensive drug and carbidopa-levodopa tells the nurse that he or she is applying for a job that involves operating heavy machinery. Which information would the nurse share with the patient?

A. "Perform exercises for lumbar support while sitting."

B. "Your tremors will stop, so you will be able to operate machinery.”

C. "These medications stimulate your central nervous system, so you will be able to operate heavy machinery."

D. "These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery."

D. "These medications together may increase your risk for hypotension, so you will need to use caution when operating heavy machinery."

Which instruction is most important for the nurse to include when teaching a patient who has been prescribed sustained-released carbidopa-levodopa?

A. "Take this medication with food."

B. "Take this medication with low-protein foods."

C. "Watch for adverse effects like dizziness and drowsiness."

D. "Inform the health care provider if your symptoms do not improve."

C. "Watch for adverse effects like dizziness and drowsiness."

Which statement related to carbidopa-levodopa and symptoms of dyskinesia would the nurse include in patient teaching?

A. "Your dyskinesia will be cured by this medication."

B. "Your dyskinesia will worsen with this medication."

C. "It will take 3 to 5 days for your symptoms to be controlled."

D. "It may take weeks or months before your symptoms are controlled."

D. "It may take weeks or months before your symptoms are controlled."

The nurse is preparing to administer rivastigmine to a patient. The prescription states to administer 8 mg b.i.d. The pharmacy sends four 2-mg tablets for the morning dose. Which action would the nurse take?

A. Administer the medication.

B. Call the pharmacy to ask for one 8-mg tablet.

C. Call the health care provider for a prescription change.

D. Ask a family member what dosage the patient takes at home.

C. Call the health care provider for a prescription change.

Which effect may occur when theophylline and rivastigmine are administered together?

A. Increased potassium levels

B. Decreased blood glucose levels

C. Increased risk for theophylline toxicity

D. Increased risk for rivastigmine toxicity

C. Increased risk for theophylline toxicity

Which factor in a patient’s health history is most important for the nurse to consider with regard to treatment for Alzheimer’s disease using rivastigmine?

A. Acid reflux

B. Liver disease

C. Prostate cancer

D. Basal cell carcinoma

B. Liver disease

A family member states, “My father complains of an upset stomach after taking rivastigmine.” Which response by the nurse is appropriate?

A. “We may need to decrease his dose.”

B. “Make sure he takes the medication with food.”

C. “Make sure he takes the medication without food.”

D. “We may need to reduce the frequency of his dosing to once daily.”

B. “Make sure he takes the medication with food.”

To evaluate the effectiveness of dopaminergic agents, the nurse would assess for which condition?

A. Weight loss

B. Correction of shuffling gait

C. Improved memory and thinking

D. Improvement in balance

D. Improvement in balance

A patient diagnosed with Parkinson’s disease who has been positively responding to medication therapy asks the nurse, “Why have I suddenly developed a relapse of my symptoms.” Which explanation by the nurse is appropriate?

A. “You have developed drug tolerance to your current medication, and a higher dose will need to be prescribed.”

B. “This is very common and it is temporary. Continue to take the medicine, and you will feel better in a few weeks.”

C. “You have developed medication toxicity. Thus, the drug dose will be reduced to avoid potentially toxic drug blood levels.”

D. “This is called the “on–off phenomenon.” Discuss this with your health care provider and a possible change in the medication regimen to help manage this effect.”

D. "This is called the "on-off phenomenon." Discuss this with your health care provider and a possible change in the medication regimen to help manage this effect."

When teaching a patient about carbidopa-levodopa, what information would the nurse include about this medication?

A. Giving both drugs together minimizes adverse effects and decreases the risk of kidney or liver disease.

B. Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.

C. Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain.

D. Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.

D. Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier.

Which antiparkinson drug causes an increase in the levels of dopaminergic stimulation in the central nervous system (CNS) and therefore allows a decreased dose of other medications?

A. Tolcapone

B. Selegiline

C. Diphenhydramine

D. Carbidopa- levodopa

B. Selegiline

What is the goal of pharmacologic therapy in treating Parkinson's disease?

A. To balance cholinergic and dopaminergic activity in the brain

B. To increase the amount of acetylcholine at the presynaptic neurons

C. To decrease the amount of dopamine available in the substantia nigra

D. To block dopamine receptors in both presynaptic and postsynaptic neurons

A. To balance cholinergic and dopaminergic activity in the brain

The patient asks the nurse to explain the difference between carbidopa-levodopa and ropinirole . How will the nurse respond?

A. "Both drugs have the same pharmacodynamic and adverse effect profiles."

B. "Ropinirole is a dopamine agonist that has fewer adverse effects than carbidopa-levodopa."

C. "Whereas carbidopa-levodopa acts as a dopamine agonist, ropinirole directly replaces dopamine."

D. "Carbidopa-levodopa is less effective than ropinirole in treating the symptoms of Parkinson's disease."

B. "Ropinirole is a dopamine agonist that has fewer adverse effects than carbidopa-levodopa."

The nurse is caring for a patient diagnosed with Parkinson's disease who has been taking entacapone for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide to the patient?

A. Laboratory tests are needed to determine kidney function.

B. Brown discoloration of urine may indicate a urinary tract problem.

C. This is a normal adverse effect of entacapone and is not harmful.

D. Abdominal ultrasonography will be performed to evaluate for liver damage or failure.

C. This is a normal adverse effect of entacapone and is not harmful.

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?

A. Chorea

B. Dystonia

C. On-off phenomenon

D. Wearing-off phenomenon

D. Wearing-off phenomenon

The nurse is providing care for a patient with a diagnosis of Parkinson's disease who has pre-existing liver failure. What class of medications, if prescribed, would the nurse question?

A. Anticholinergics

B. Ergot derivative

C. Dopamine modulator

D. Catechol-O-methyltransferase (COMT) inhibitors

D. Catechol-O-methyltransferase (COMT) inhibitors

A patient diagnosed with Parkinson's disease discusses experiencing insomnia recently with the nurse. The patient asks the nurse, "Can I take my old prescription of benzodiazepine that is prescribed to treat my insomnia?" What does the nurse know about the use of benzodiazepines in patients taking levodopa?

A. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease.

B. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease.

C. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease.

D. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease.

D. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease.

A patient is prescribed selegiline, , 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.)

A. Headache

B. Insomnia

C. Weight gain

D. Back pain

E. Blood pressure changes

A. Headache

B. Insomnia

D. Back pain

E. Blood pressure changes

The patient diagnosed with PD has been started on dopaminergic replacement drug therapy with carbidopa-levodopa.

What is a priority action for the nurse?

A.Assess the patient for dizziness and syncope when the patient is walking.

B.Administer the medication first thing in the morning.

C.Administer the medication on an empty stomach.

D.Omit protein from the patient's diet.

A.Assess the patient for dizziness and syncope when the patient is walking.

The patient has now been ordered an oral disintegrating form of the MAO-B inhibitor drug selegiline. What should the nurse consider when administering this drug?

A.Tell the patient to take the medication with liquids.

B.Tell the patient to take the medication with a meal.

C.Assess the patient for hypertension, a common side effect of this medication.

D.Tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted.

D.Tell the patient to place oral disintegrating dosage forms on the tongue, and do not swallow dosage form until it is completely melted.

What drug class does Carbidopa-Levodopa belong to?

A. Dopamine agonist

B. Dopamine precursor

C. MAO-B inhibitor

D. Anticholinergic

B. Dopamine precursor

What is the primary use of Carbidopa-Levodopa?

A. Treatment of essential tremor

B. Management of Parkinson’s disease motor symptoms

C. Prevention of migraine headaches

D. Anxiety treatment

B. Management of Parkinson's disease motor symptoms

What is the most important safety concern when administering Carbidopa-Levodopa?

A. Risk of liver toxicity

B. Risk of orthostatic hypotension and dyskinesias

C. Risk of respiratory depression

D. Risk of hypoglycemia

B. Risk of orthostatic hypotension and dyskinesias

Which assessment finding requires immediate intervention in a patient taking Carbidopa-Levodopa?

A. Mild nausea

B. Severe involuntary movements (dyskinesia) or sudden worsening of motor symptoms

C. Drowsiness

D. Constipation

B. Severe involuntary movements (dyskinesia) or sudden worsening of motor symptoms

What drug class does Opicapone belong to?

A. COMT inhibitor

B. MAO-B inhibitor

C. Dopamine agonist

D. Anticholinergic

A. COMT inhibitor

Catechol Ortho-Methyltransferase Inhibitors

What is the primary use of Opicapone?

A. Monotherapy for Parkinson’s disease

B. Adjunct therapy with Levodopa to prolong its effect and reduce “off” episodes

C. Treatment of essential tremor

D. Migraine prevention

B. Adjunct therapy with Levodopa to prolong its effect and reduce "off" episodes

What is the most important safety concern when administering Opicapone?

A. Risk of liver toxicity

B. Risk of hypotension and worsening dyskinesia

C. Risk of respiratory depression

D. Risk of bradycardia

B. Risk of hypotension and worsening dyskinesia

Which assessment finding requires immediate intervention in a patient taking Opicapone?

A. Mild dizziness

B. Severe uncontrolled involuntary movements

C. Mild nausea

D. Headache

B. Severe uncontrolled involuntary movements

What drug class does Benztropine belong to?

A. Dopamine agonist

B. Anticholinergic

C. COMT inhibitor

D. MAO-B inhibitor

B. Anticholinergic

What is the primary use of Benztropine?

A. Management of Parkinson’s disease tremor and rigidity

B. Migraine treatment

C. Seizure control

D. Treatment of depression

A. Management of Parkinson's disease tremor and rigidity

What is the most important safety concern when administering Benztropine?

A. Risk of respiratory depression

B. Risk of anticholinergic toxicity (e.g., confusion, hyperthermia, dry mouth, urinary retention)

C. Risk of bradycardia

D. Risk of hypotension

B. Risk of anticholinergic toxicity (e.g., confusion, hyperthermia, dry mouth, urinary retention)

Which assessment finding requires immediate intervention in a patient taking Benztropine?

A. Mild dry mouth

B. Severe confusion, hallucinations, or urinary retention

C. Constipation

D. Mild blurred vision

B. Severe confusion, hallucinations, or urinary retention