Chapter 15: Antiparkinson Drugs

Multiple Choice

1. A patient has been taking selegiline (Eldepryl), 20 mg/day for 1 month. Today, during his office visit, he tells the nurse that he forgot and had a beer with dinner last evening, and “felt awful.” What did the patient most likely experience?

a. Hypotension b. Hypertension c. Urinary discomfort d. Gastrointestinal upset

ANS: B

At doses that exceed 10 mg/day, selegiline becomes a nonselective monoamine oxidase inhibitor (MAOI), contributing to the development of the cheese effect, so-called because it interacts with tyramine-containing foods (cheese, red wine, beer, and yogurt) and can cause severe hypertension.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Carbidopa allows for larger doses of levodopa to be given. b. Carbidopa prevents the breakdown of levodopa in the periphery. c. There are concerns about drug-food interactions with levodopa therapy that do not exist with the combination therapy. d. Carbidopa is the biologic precursor of dopamine and can penetrate into the central nervous system.

2. A patient has been given a prescription for levodopa-carbidopa (Sinemet) for her newly diagnosed Parkinson’s disease. She asks the nurse, “Why are there two drugs in this pill?” The nurse’s best response reflects which fact?

ANS: B

When given in combination with levodopa, carbidopa inhibits the breakdown of levodopa in the periphery and thus allows smaller doses of levodopa to be used. Lesser amounts of levodopa result in fewer unwanted adverse effects. Levodopa, not carbidopa, is the biologic precursor of dopamine and can penetrate into the CNS.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Minimize the amount of fluid taken while on this drug. b. Discontinue the medication if adverse effects occur. c. Take the medication on an empty stomach to enhance absorption. d. Use artificial saliva, sugarless gum, or hard candy to counteract dry mouth.

3. When a patient is taking an anticholinergic such as benztropine (Cogentin) as part of the treatment for Parkinson’s disease, the nurse should include which information in the teaching plan?

ANS: D

Dry mouth can be managed with artificial saliva through drops or gum, frequent mouth care, forced fluids, and sucking on sugar-free hard candy. Anticholinergics should be taken with or after meals to minimize GI upset and must not be discontinued suddenly. The patient must drink at least 3000 mL/day unless contraindicated. Drinking water is important, even if the patient is not thirsty or in need of hydration, to prevent and manage the adverse effect of constipation.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Decreased appetite b. Gradual development of cogwheel rigidity c. Newly developed dyskinesias d. Improved ability to perform activities of daily living

4. A patient has been treated with antiparkinson medications for 3 months. What therapeutic responses should the nurse look for when assessing this patient?

ANS: D

Therapeutic responses to antiparkinson agents include an improved sense of well-being, improved mental status, increased appetite, increased ability to perform activities of daily living and to concentrate and think clearly, and less intense parkinsonian manifestations.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. Drowsiness, headache, weight loss b. Dizziness, insomnia, nausea c. Peripheral edema, fatigue, syncope d. Heart palpitations, hypotension, urinary retention

5. Carbidopa-levodopa (Sinemet) is prescribed for a patient with Parkinson’s disease. The nurse informs the patient that which common adverse effects can occur with this medication?

ANS: D

Common adverse reactions associated with carbidopa-levodopa include palpitations, hypotension, urinary retention, dyskinesia, and depression. The other effects may occur with other antiparkinson drugs.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Glaucoma b. Seizure disorder c. Liver failure d. Benign prostatic hyperplasia

6. The nurse is assessing the medication history of a patient with a new diagnosis of Parkinson’s disease. Which condition is a contraindication for the patient, who will be taking tolcapone (Tasmar)?

ANS: C

Tolcapone is contraindicated in patients who have shown a hypersensitivity reaction to it, and it should be used with caution in patients with pre-existing liver disease. The other conditions listed are not contraindications.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential a. Diarrhea b. Urinary retention c. Risk for infection d. Disturbed sleep pattern

7. The nurse is developing a care plan for a patient who is taking an anticholinergic drug. Which nursing diagnosis would be appropriate for this patient?

ANS: B

Patients receiving anticholinergic drugs are at risk for urinary retention and constipation, not diarrhea. The other nursing diagnoses are not applicable to anticholinergic drugs.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Nursing Diagnosis

MSC: NCLEX: Physiological Integrity: Physiological Adaptation a. It has a shorter duration of action. b. It causes less gastrointestinal distress. c. It has a slower onset than traditional Parkinson’s disease drugs. d. It is associated with fewer wearing-off effects.

8. A patient has a new order for a catechol ortho-methyltransferase (COMT) inhibitor as part of treatment for Parkinson’s disease. The nurse recognizes that which of these is an advantage of this drug class?

ANS: D

COMT inhibitors are associated with fewer wearing-off effects and have prolonged therapeutic benefits. They have a quicker onset, and they prolong the duration of action of levodopa.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. This is a harmless effect of the drug. b. The patient has taken this drug along with red wine or cheese. c. The patient is having an allergic reaction to the drug. d. The ordered dose is too high for this patient.

9. A patient taking entacapone (Comtan) for the first time calls the clinic to report a dark discoloration of his urine. After listening to the patient, the nurse realizes that what is happening in this situation?

ANS: A

COMT inhibitors, including entacapone, may darken a patient’s urine and sweat.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Rigid, tense muscles b. Difficulty in performing voluntary movements c. Limp extremities with weak muscle tone d. Confusion and altered mental status

10. While a patient is receiving drug therapy for Parkinson’s disease, the nurse monitors for dyskinesia, which is manifested by which finding?

ANS: B

Dyskinesia is the difficulty in performing voluntary movements that is experienced by some patients with Parkinson’s disease. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. There are rapid swings in the patient’s response to levodopa. b. The patient cannot tolerate the medications at times. c. The medications begin to lose effectiveness against Parkinson’s disease. d. The patient’s liver is no longer able to metabolize the drug.

11. When treating patients with medications for Parkinson’s disease, the nurse knows that the wearing-off phenomenon occurs for which reason?

ANS: C

The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The other options are incorrect.

DIF: COGNITIVE LEVEL: Understanding (Comprehension)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. When assessing the medication history of a patient with a new diagnosis of Parkinson’s disease, which conditions are contraindications for the patient who will be taking carbidopa-levodopa?

(Select all that apply.)

a. Angle-closure glaucoma b. History of malignant melanoma c. Hypertension d. Benign prostatic hyperplasia e. Concurrent use of monoamine oxidase inhibitors (MAOIs)

ANS: A, B, E

Angle-closure glaucoma, a history of melanoma or other undiagnosed skin conditions, and concurrent use of MAOIs are contraindications to the use of carbidopa-levodopa. The other options are incorrect.

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk Potential

Completion

1. The prescriber writes this order, “Give amantadine (Symmetrel) 100 mg per PEG tube twice a day.” The medication is available in a liquid form with a concentration 50 mg/5 mL. Identify how many milliliters will the nurse give with each dose.

ANS: 10 mL

DIF: COGNITIVE LEVEL: Applying (Application)

TOP: NURSING PROCESS: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies