Unit 5: Chapter 24 (Karch 7th Ed) - Antiparkinsonism Agents Flashcards
1. Degeneration in neurons that release a neurotransmitter leads to Parkinson’s disease. What neurotransmitter is involved? A) Gamma-aminobutyric acid (GABA) B) Acetylcholine C) Dopamine D) Serotonin
Ans: C
Feedback:
Degeneration of dopamine-releasing neurons in the substantia nigra leads to Parkinson’s disease. When
dopamine is decreased in the area of the corpus striatum, a chemical imbalance allows the cholinergic
or excitatory cells to dominate. This affects the functioning of the basal ganglia and cortical and
cerebellar components of the extrapyramidal motor system. This system provides coordination for
unconscious muscle movements, including those that control position, posture, and movement. The
result of the imbalance produces the signs and symptoms of Parkinson’s disease. The corpus striatum in
the brain is connected to the substantia nigra by a series of neurons that use the inhibitory
neurotransmitter GABA. Higher neurons from the cerebral cortex secrete acetylcholine in the area of
the corpus striatum as an excitatory neurotransmitter to coordinate movements of the body. Serotonin is
not involved in these functions.
2. A 10-year-old boy has been prescribed an antiparkinsonian drug. Which drug would the nurse expect as the first choice for this child? A) Benztropine (Cogentin) B) Diphenhydramine (Benadryl) C) Trihexyphenidyl (Artane) D) Procyclidine (Kemadrin)
Ans: B
Feedback:
Parkinson’s disease is rare in children. However, if a child needs an antiparkinsonian drug, diphenhydramine is the drug of choice. Benztropine, trihexyphenidyl, and procyclidine are not
recommended for use in children.
- A patient is newly diagnosed with Parkinson’s disease. An anticholinergic drug is ordered for the
patient. When reviewing the patient’s medical history, the nurse realizes an anticholinergic drug is
contraindicated for this patient because of what secondary diagnosis? (Select all that apply.)
A) Benign prostatic hypertrophy
B) Narrow-angle glaucoma
C) Myasthenia gravis
D) Dysrhythmias
E) Hepatic dysfunction
Ans: A, B, C
Feedback:
Anticholinergics are contraindicated in the presence of narrow-angle glaucoma, GI obstruction,
genitourinary (GU) obstruction, and prostatic hypertrophy, all of which could be exacerbated by the
peripheral anticholinergic effects of these drugs, and in myasthenia gravis, which could be exacerbated
by the blocking of acetylcholine-receptor sites at the neuromuscular synapses. These agents should be
administered cautiously, but they are not contraindicated in therapy for the following conditions:
tachycardia and other dysrhythmias and hypertension or hypotension because the blocking of the
parasympathetic system may cause a dominance of sympathetic stimulatory activity, and in hepatic
dysfunction, which could interfere with the metabolism of the drugs and lead to toxic levels.
- A patient is newly diagnosed with Parkinson’s disease and levodopa (Dopar) has been prescribed. What
patient teaching information should be considered a high priority for this patient?
A) Avoid vitamin B6 intake.
B) Avoid hot environments.
C) Many adverse effects will subside when the body adjusts to the drug.
D) Allow rest periods.
Ans: A
Feedback:
The priority information would be to avoid vitamin B6 intake, which would include grains and bran. Vitamin B6 speeds the conversion of levodopa to dopamine before it can cross the blood brain barrier.
This leads to Parkinson’s symptoms. The other options are all important and should be discussed with
the patient. However, sweating, headaches, difficulty sleeping, fatigue, weakness, and dizziness are
expected adverse effects, which will eventually subside or decrease.
- A patient with Parkinsonism has been told that the levodopa prescribed is no longer controlling the
disease. What drug would the nurse question if ordered as adjunctive therapy?
A) Diphenhydramine (Benadryl)
B) Pramipexole (Mirapex)
C) Trihexyphenidyl (Artane)
D)
Vitamin B6
Ans: D
Feedback:
Vitamin B6 would further decrease the therapeutic effects of levodopa and is contraindicated with
levodopa, so the nurse would question this order. Pramipexole, diphenhydramine, and trihexyphenidyl
are all useful adjunctive drugs when Parkinson’s disease is no longer controlled with levodopa therapy
alone.
- The nurse provides patient teaching about use of levodopa for treatment of Parkinson’s disease. What
statement by the patient would indicate a good understanding of levodopa?
A) I will take the medication for about a year and then stop.
B) I should avoid exercising while taking this drug.
C) I should take this drug with meals to avoid GI upset.
D) I will take megavitamins to ensure that I have good nutrition.
Ans: C
Feedback:
The patient should be instructed to take levodopa with meals if GI upset occurs. Patients being treated
for Parkinson’s disease should be taught that drug treatment will be needed for life and cannot be
stopped in a year. The patient should continue to be as active as possible. Multivitamins will contain
vitamin B6, which should be avoided when taking levodopa.
7. What drug does the nurse administer to treat Parkinson’s disease that is also classified as an antiviral? A) Amantadine (Symmetrel) B) Entacapone (Comtan) C) Diphenhydramine (Benadryl) D) Ropinirole (Requip)
Ans: A
Feedback:
Amantadine is an antiviral drug that increases the release of dopamine and is effective in Parkinson’s
disease so long as there is a possibility of more dopamine release. Ropinirole is a dopaminergic
antiparkinsonism drugs. Entacapone is used as adjunctive treatment of idiopathic Parkinson’s disease
with levodopa carbidopa for patients who are experiencing wearing off of drug effects.
Diphenhydramine is used, particularly in children, to treat parkinsonism and is also classified as an
antihistamine.
- A patient has Parkinson’s disease. Apomorphine (Apokyn), a dopamine agonist, has been prescribed
for periods of hypomobility. What will the nurse teach the patient regarding administration of the drug?
A) The drug will be injected intramuscularly three times a day in a range of 1.0 to 1.5 mL.
B) The drug will be given intravenously, 50 mg every third day.
C) The drug will be administered subcutaneously three times a day with a dosage range of 2 to 6 mg.
D) The drug is taken orally, 20 mg three times a day.
Ans: C
Feedback:
The drug is administered subcutaneously three times a day in a range of 2 to 6 mg per dose. A dosing
pen is available for patient use. The other options are inappropriate for this drug.
- An order is written for a drug that is an adjunctive therapy for Parkinson’s disease. The nurse reviews
the order before administering the drug. What medication orders should the nurse question?
A) Levodopa 0.5 to 1 g/d orally in 2 divided doses
B) Amantadine (Symmetrel) 200 mg orally b.i.d.
C) Tolcapone (Tasmar) 400 mg orally t.i.d.
D) Selegiline (Carbex) 10 mg/d orally
Ans: C
Feedback:
The order for tolcapone should be questioned. The maximum dose is 600 mg daily. The order is a total
of 1,200 mg a day (400 times 3 equals 1,200 mg). The other options are correct dosages.
10. The expected outcome for a patient taking benztropine as drug therapy for Parkinson’s disease would be what? A) Decrease in rigidity B) Decrease in light-headedness C) Decrease in disorientation D) Decrease in flushing
Ans: A
Feedback:
Benztropine should cause a decrease in rigidity. Light-headedness, disorientation, and flushing are all
adverse effects of benztropine and can be expected with a patient taking this drug
- A patient is newly diagnosed with parkinsonism. Parkinsonism, which may occur in association with
long-term use of antipsychotics, can be treated with what drug type?
A) Anticholinergic agents
B) Monoamine oxidase inhibitors (MAOIs)
C) Synthetic antiviral agents
D) Dopaminergic drugs
Ans: A
Feedback: Anticholinergic drugs that are centrally active are useful in treating parkinsonism. MAOIs, synthetic
antiviral agents, and dopaminergic agents are incorrect.
- The nurse is presenting an educational event to a local community group on Parkinson’s disease. What
will the nurse tell the attendees causes the classic Parkinson’s disease symptoms?
A) Decreased enzyme aromatic l-amino acid decarboxylase (AADC)
B) Increased gamma-aminobutyric acid (GABA)
C) Brain lesions
D) Degeneration of dopamine-producing nerve cells
Ans: D
Feedback:
Classic Parkinson’s disease results from destruction or degenerative changes in dopamine-producing
nerve cells in an area of the brain that controls movement.
13. The nurse has a patient who is receiving selegiline (Carbex, Eldepryl). What is the nurse’s priority assessment? A) Irregular heart rate B) Elevated blood pressure C) Decreased urinary output D) Gingival hyperplasia
Ans: B
Feedback:
The excessive stimulation of the sympathetic nervous system can cause severe hypertension and stroke
so it is important for the nurse to assess blood pressure. Gingival hyperplasia is an adverse effect of
phenytoin (Dilantin). Irregular heart rate and decreased urinary output are not adverse effects of
selegiline
- The nurse is speaking to a group at the senior citizen’s center about Parkinson’s disease and explains
the importance of avoiding what when taking an anticholinergic medication?
A) Strenuous exercise in high environmental temperatures
B) Fluids high in potassium
C) Foods high in vitamin K
D) Anything containing red dye
Ans: A
Feedback:
Anticholinergic drugs decrease sweating. As a result, the body is not as effective at reducing internal
temperature as this could result in fever and heatstroke. Elderly people taking anticholinergic drugs do
not need to avoid fluids high in potassium, foods high in vitamin K, or anything containing red dye.
15. When providing patient teaching for older adults, the nurse employs what priority strategy to improve patient understanding? A) Repetition B) Meticulous detail C) Extensive written teaching D) Family involvement
Ans: C
Feedback:
The drugs that are used to manage Parkinson’s disease are associated with many adverse effects in
older people with long-term problems. In many cases, other pharmacotherapeutic agents are given to
counteract the adverse effects of these drugs. So patients then have complicated drug regimens with
many associated adverse effects and problems. Consequently, it is essential for these patients to have
extensive written drug-teaching protocols. Repetition, attention to detail, and family involvement can
further improve effectiveness of teaching, but providing written instructions is the highest priority
strategy.
- A patient, newly diagnosed with Parkinson’s disease, has been prescribed an anticholinergic drug.
What common adverse effect of anticholinergic agents used for the treatment of Parkinson’s disease
will the nurse share with the patient?
A) Blood dyscrasias
B) Diaphoresis
C) Memory loss
D) Diarrhea
Ans: C
Feedback:
Most people diagnosed with Parkinson’s disease are older adult men so it is important for the nurse to
warn the patient that memory loss may occur to reduce anxiety the patient may experience with this
adverse effect. Blood dyscrasias are not associated with these drugs. Constipation is more likely than
diarrhea and lack of sweating rather than diaphoresis is associated with anticholinergics.
- The nurse often gives another drug with levodopa (L-dopa) to decrease the amount of levodopa needed
to reach a therapeutic level in the brain, thereby reducing adverse effects? What is the name of this
drug?
A) Bromocriptine
B) Carbidopa
C) Amantadine
D) Trihexyphenidyl
Ans: B
Feedback:
Carbidopa is frequently given with levodopa in a fixed-dose combination product called Sinemet or
Sinemet CR. When used with carbidopa, the enzyme dopa decarboxylase is inhibited in the periphery,
diminishing the metabolism of levodopa in the gastrointestinal (GI) tract and in peripheral tissues,
thereby leading to higher levels crossing the blood brain barrier. Because carbidopa decreases the
amount of levodopa needed to reach a therapeutic level in the brain, the dosage of levodopa can be
decreased, which reduces the incidence of adverse effects. Bromocriptine, amantadine, and
trihexyphenidyl may be effective longer than levodopa but are not usually prescribed together.
- When the nurse develops a plan of care for a patient newly diagnosed with Parkinson’s disease, the
nurse includes what appropriate goal for this patient?
A) Deficient knowledge related to the disease process
B) Increase compliance with drug regimen as evidenced by no missed dosages within 1 week of
discharge
C) Risk for injuries related to the disease process
D) Symptom improvement as demonstrated by ability to ambulate the length of the hall within 24
hours of starting medication
Ans: D
Feedback:
One goal of drug therapy is to reduce symptoms to allow for more normal movement involving
muscles. Goals should be specific and measurable, so the ability to ambulate the length of the hall is a
valid assessment. The patient cannot increase compliance when he or she has not been lacking in
compliance because this is a new diagnosis. Deficient knowledge and risk for injury are nursing
diagnoses and not goals.
19. The nurse is teaching a new patient about levodopa (L-dopa). What is important to instruct the patient to avoid using concurrently with L-dopa? A) Aspirin compounds B) Multivitamin-mineral preparations C) Alcohol D) Antianginal agents
Ans: B
Feedback:
Iron preparations and multivitamin mineral preparations containing iron should not be given with Ldopa.
Aspirin compounds, alcohol, and antianginal agents are not contraindicated in concurrent therapy
with L-dopa.
- When carbidopa is given with levodopa (L-dopa), the dosage of L-dopa must be reduced. What would
the reduction of L-dopa cause?
A) Heightened levels of sedation
B) Prolonged effect of medications
C) Decreased adverse effects
D) Decreased effectiveness of symptom control
Ans: C
Feedback:
Because carbidopa decreases the amount of L-dopa needed to reach a therapeutic level in the brain, the
dosage of L-dopa can be decreased, which reduces the incidence of adverse effects. Other options are
incorrect.
- What is the main purpose of the drugs used to treat Parkinson’s disease?
A) Adjust the balance of neurotransmitters.
B) Make the catechol-O-methyltransferase (COMT) inhibitors work better.
C) Substitute monoamine oxidase inhibitors (MAOIs) for dopamine agonists.
D) Increase the actions of acetylcholine in the brain.
Ans: A
Feedback:
Drugs used in Parkinson’s disease increase levels of dopamine (levodopa, dopamine agonists,
monoamine oxidase [MAO] inhibitors, COMT inhibitors) or inhibit the actions of acetylcholine (i.e.,
anticholinergic agents) in the brain. Thus, the drugs help adjust the balance of neurotransmitters
- The nurse is teaching a group of student nurses about Parkinson’s disease. The nurse would determine
teaching was successful if the students identified what neurotransmitters as imbalanced in Parkinson’s
disease?
A) Cholinergic and anticholinergic neurotransmitters
B) Gamma-aminobutyric acid (GABA) and dopamine
C) GABA and anticholinergic neurotransmitters
D) Dopamine and acetylcholine
Ans: D
Feedback:
The correct balance of dopamine and acetylcholine is important in regulating posture, muscle tone, and
voluntary movement. People with Parkinson’s disease have an imbalance in these neurotransmitters,
resulting in a decrease in inhibitory brain dopamine and a relative increase in excitatory acetylcholine.
- The nurse is caring for a patient diagnosed with Parkinson’s disease who has been prescribed an
anticholinergic drug. When are anticholinergic drugs usually added to the therapeutic regimen?
A) When symptoms increase
B) Sporadically to reduce development of toleration to levodopa
C) When levodopa does not elicit a therapeutic response
D) During the end stage of the disease process
Ans: C
Feedback:
Although anticholinergics are not as effective as levodopa in the treatment of advancing cases of the
disease, they may be useful as adjunctive therapies and for patients who no longer respond to levodopa.
They are not withheld until symptoms advance or end-stage symptoms occur and they are not given
sporadically.
- 2 Drugs in Focus Anticholinergic Agents
A) Combines with anticholinergic receptors to increase the action of levodopa
B) Stimulates postsynaptic dopamine receptors directly
C) Combines with anticholinergic receptors to increase dopamine action
D) Inhibits postsynaptic dopamine receptors directly
Ans: B
Feedback:
Ropinirole is a newer drug that directly stimulates dopamine receptors. It is also used to treat restless
legs syndrome. The other options are incorrect because ropinirole only works as a dopamine receptor
stimulant.
