Antiparkinsonian Drugs

Question 1

Levodopa-Carbidopa. What does each component do?

Answer 1

Levodopa is a precursor to dopamine. Blood brain barrier doesnt allow exogenously supplied dopamine to enter but allows levodopa.
-Levodopa is taken up by the dopaminergic terminal, converted to dopamine, then released as needed. Neurotransmitter release controlled in early PD in patients that still have functioning nerve terminals.
Carbidopa does not cross the blood brain barrier and prevents breakdown of Levodopa in the periphery. As a result, more Levodopa crosses the blood brain barrier where it is converted to dopamine.

Question 2

Therapeutic response of antiparkinsonian meds

Answer 2

To little dopamine parkinson’s worsens
To much dopamine dyskinesia occurs

Question 3

Dopamine modulator, antiviral drug. Indirect acting. Causes release of dopamine and other catecholamines from their storage sites in the presynaptic fibers of nerve cells within the basal ganglia that have not yet been destroyed by the disease in the process. Blocks the reuptake of dopamine into the nerve fibers which results in higher levels of dopamine in the synapses between nerves and improve dopamine neurotransmission between neurons.

Answer 3

Amantadine MOA

Question 4

During patient teaching for antiparkinsonian drugs, the nurse will include which statement?
a) the drug will be stopped when tremors and weakness are relieved
b) if a dose is missed, take to doses to avoid significant decreases in blood levels
c) be sure to notify your physician if your urine turns brownish orange
d) take care to change positions slowly to prevent falling due to a drop in blood pressure

Answer 4

d) take care to change positions slowly to prevent falling due to a drop in blood pressure

Question 4

Which condition will alert the nurse to a potential caution or contraindication regarding the use of a dopaminergic drug for treatment of mild PD?
a) diarrhea
b) tremors
c) angle closure glaucoma
d) unstable gait

Answer 4

c) angle closure glaucoma

Question 5

An advantage of using COMT inhibitors?

Answer 5

entacapone (Comtan) prolongs the duration of action of levodopa; reduces the wearing off phenomenon

Question 5

A patient is taking entacapone as part of the therapy for PD. Which intervention by the nurse is appropriate at this time?
a) notify the patient that this drug causes discoloration of the urine
b) limit the patients intake of tyramine foods
c) monitor results of kidney studies because this drug can seriously affect the kidney function
d) increase fluid intake to prevent dehydration

Answer 5

a) notify the patient that this drug causes discoloration of the urine

Question 5

Difficulty in performing voluntary movement commonly seen in PD. Occurs when to much dopamine

Answer 5

Dyskinesia

Question 6

A patient will be taking selegiline, 10 mg daily, in addition to dopamine replacement therapy for PD. The nurse will implement which precautions regarding selegiline?
a) teach the patient to avoid foods containing tyramine
b) monitor for dizziness
c) inform the patient that this drug may cause urine discoloration
d) monitor for tachycardia and palpitations

Answer 6

b) monitor for dizziness

Question 7

A patient with PD will start taking entacapone along with the levodopa-carbidopa he has been taking for a few years. The nurse recognizes that the advantage of taking entacapone is which of the following?
a) the entacapone can reduce on off effects
b) the levodopa may be stopped within a few days
c) there is less GI upset with entacapone
d) it does not cause the cheese effect

Answer 7

a) the entacapone can reduce on off effects

Question 8

The nurse is assessing a patient who has begun therapy with amantadine for PD. The nurse will look for which possible adverse effects? select all
a) nausea
b) palpitations
c) dizziness
d) insomnia
e) edema

Answer 8

a) nausea

Question 9

A patient who has been taking levodopa-carbidopa for PD for over 1 year wants to start a low carb/high protein diet for weight loss. The nurse tells the patient that this type of diet may have what effect on his drug therapy?
a) there will be no problems with this diet while on this medication
b) the high protein diet can slow or prevent absorption of this medication
c) the high protein diet may cause increased blood levels of this medication
d) the high protein diet will cause no problems as long as the patient also takes pyridoxine (b6)

Answer 9

b) the high protein diet can slow or prevent absorption of this medication

Question 10

A patient with PD exhibits difficulty in performing voluntary movements. When documenting the patients symptoms, what term should the nurse use to accurately describe this symptom?
a) akinesia
b) dyskinesia
c) chorea
d) dystonia

Answer 10

b) diskinesia

Question 11

Which drug may be used early in the treatment of PD but eventually loses effectiveness and must be replaced by another drug?
a) amantadine hydrochloride
b) carbidopa-levodopa
c) selegiline hydrochloride
d) entacapone (Comtan)

Answer 11

a) amantadine hydrochloride

Question 12

Carbidopa-levodopa therapy was initiated for a patient with PD. What priority instructions should the nurse give the patient concerning vitamin supplement?
a) vitamin supplements should not be taken at this time, since the patient has increased intercellular reserves
b) vitamin supplements should be taken twice a day to ensure the patient receives enough nutrients
c) the patient should avoid supplements that contain vitamin b6 (pyridoxine)
d) the patient should not take more than the recommended amount of calcium

Answer 12

c) the patient should avoid supplements that contain b6 (pyridoxine)

Question 13

A patient who is newly diagnosed with PD and beginning medication therapy with entacapone (Comtan), a catecholortho-methyltransferase (COMT) inhibitor, asks the nurse. “How soon will improvement occur?” What is the nurses best response?
a) that varies from patient to patient concerning the therapeutic response
b) you should discuss that with your health care provider
c) you should notice a difference right away
d) this may take several weeks before you notice any degree of improvement.

Answer 13

c) you should notice a difference right away

Question 14

A patient with PD is prescribed an anticholinergic drug in addition to the antiparkinsonian drug. What clinical condition does the anticholinergic drug aim to control or minimize? select all.
a) drooling
b) constipation
c) muscle rigidity
d) bradykinesia
e) dry mouth

Answer 14

b) a, c

Question 15

The nurse is providing information to a patient undergoing COMT inhibitor therapy. What symptom should the nurse teach the patient to monitor as a common adverse effect of this therapy?
a) dizziness
b) urine discoloration
c) leg edema
d) visual changes

Answer 15

b) urine discoloration

Question 16

Carbidopa-levodopa (Sinemet) is prescribed for a patient with PD. What priority adverse effects should the nurse tell the patient to monitor closely? select all.
a) palpitations
b) insomnia
c) hypotension
d) urinary frequency
e) GI distress

Answer 16

a, c, e