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Drugs for Parkinson's Disease
Drugs for Parkinson's Disease (continued)
Drugs for Alzheimer's Disease
Drugs for Multiple Sclerosis
100
The physiologic goal of drug therapy is to restore the functional balance between which two neurotransmitters?
Dopamine and acetylcholine Symptoms of PD result from an imbalance of these neurotransmitters due to degeneration of neurons supplying dopamine to the brain. This leads to unopposed acetylcholine (and too much GABA) which results in movement disorders.
100
Pramipexole (Mirapex) 1.5 mg by mouth is prescribed. The hospital pharmacy stocks pramipexole 0.25 mg. How many tablets should the nurse administer?
6 tablets of this dopamine agonist (1.5 / 0.25 = 6)
100
True or false: High levels of the neurotransmitter acetylcholine are found in patients with AD.
False. Rationale: There is degeneration of cholinergic neurons in patients with AD resulting in the breakdown of acetylcholine.
100
True or false: Current drug therapy repairs the myelin sheath on peripheral nerves.
False Rationale: No drugs can cure MS or reverse the disease process. Current goals for drug therapy include modifying the disease process, treating an acute relapse, and managing symptoms.
200
What is a realistic outcome for a patient receiving drug therapy for Parkinson's Disease? a. Absence of tremor b. A normal gait c. Improved ability to perform ADLs d. Reversal of neurodegeneration
c. Improved ability to perform ADLs Rationale: The primary goal of medication therapy is to improve the patient's ability to carry out ADLs, and improve motor symptoms. Drugs can only provide some symptomatic relief; they do not cure or stop disease progression.
200
Parkinson's disease is a neurodegenerative disorder of the extrapyramidal system in the brain.A disruption of neurotransmission within this system results in which symptoms?
Motor symptoms (dyskinesias/movement disorders - tremor, rigidity, bradykinesia, akinesia/absense of movement) Non-motor symptoms (psychological disturbances - sleep disturbances, dementia, psychoses, depression)
200
A patient is worried about the risk of developing Alzheimer’s disease because both parents had the disease. The nurse will tell this patient that known risk factors include all of the following EXCEPT a. Family history b. Gender c. Alcoholism d. Advanced age
c. Alcoholism Rationale: Significant risk factors include advancing age (>65) and family history. Females may be at a higher risk due to longer life expectancy. Alcoholism is not a risk factor.
200
The nurse is administering high-dose intravenous methylprednisolone to a patient who is experiencing an acute relapse of MS. Which chronic condition, if also present, could be affected by this treatment? a. Asthma b. Diabetes mellitus (DM) c. Hypertension d. Rheumatoid arthritis
b. Diabetes mellitus (DM) Rationale: Methylprednisolone is a glucocorticoid to help suppress reduce the duration and severity of the attack. An adverse effect of glucocorticoid therapy is increased blood glucose levels which would be concerning in a patient with concurrent DM.
300
Dietary teaching that may help the abrupt "on-off" phenomenon of PD includes avoiding which foods? a. Foods with a high glycemic index b. High fat meals c. Processed foods d. High protein foods
d. High protein foods Rationale: High protein diets will reduce therapeutic effects because the amino acids compete with levodopa for absorption in the intestine and for transport across the blood-brain barrier.
300
The nurse is educating the patient about the gradual loss of effect of levodopa that could occur near the end of the dosing interval. She explains that all of the following are ways to help reduce the likelihood EXCEPT: a. Add a drug that prolongs levodopa's plasma half life (ie Comtan) b. Change (lengthen) dosing intervals c. Use a controlled release (CR) form of levodopa d. Add a direct acting dopamine agonist (Mirapex)
b. Change (lengthen) dosing intervals Rationale: To reduce the gradual "wearing off" effect, it would be more beneficial to shorten the dosing interval.
300
A patient will begin taking a cholinesterase inhibitor (Aricept) for early Alzheimer’s disease. The nurse is teaching the patient’s spouse about the medication. Which statement by the spouse indicates a need for further teaching? a. “Gastrointestinal symptoms are common with this medication.” b. “People taking this drug should not take antihistamines.” c. “This drug helps neurons that aren’t already damaged to function better.” d. “This drug significantly slows the progression of the disease.”
d. “This drug significantly slows the progression of the disease.” Rationale: Cholinesterase inhibitors produce modest improvements in cognition, behavior, and function and may slightly delay disease progression; they do not have a major impact on delaying progression of the disease. Gastrointestinal symptoms are common side effects. Drugs that block cholinergic receptors, including antihistamines, can reduce therapeutic effects and should be avoided. Cholinesterase inhibitors do not affect neurons already damaged, but they do improve function in those not yet affected.
300
A patient has been newly diagnosed with multiple sclerosis (MS), and the nurse provides teaching about the medications for the disease. Which statement by the patient indicates a need for further teaching? a. “I may need to take additional drugs at times of acute relapse.” b. “I will need to take medication indefinitely.” c. “If medication is begun early, permanent remission can be achieved.” d. “Some symptoms may need to be managed with symptom-specific drugs.”
c. “If medication is begun early, permanent remission can be achieved.” Rationale: Drug therapy can reduce the frequency and severity of relapses, maintain quality of life, and prevent permanent damage to axons, but it does not produce permanent remission. Patients may need to take additional drugs during times of relapse and will need to take medications indefinitely. Some symptoms may be managed with symptom-specific drugs.
400
Sinemet is a levodopa/carbidopa combination now prescribed instead of levodopa alone. What is the effect of the addition of carbidopa to the regimen? a. It adds to the therapeutic effect because carbidopa more readily crosses the blood-brain barrier than levodopa. b. It allows for an increase in levodopa dosage. c. It inhibits the conversion of levodopa to dopamine in the intestines and in tissue outside the CNS. d. There may be increased cardiovascular adverse effects.
c. It inhibits the conversion of levodopa to dopamine in the intestines and in tissue outside the CNS. Rationale: This increases the amount of levodopa available to cross the blood brain barrier. Carbidopa does not have any effect on its own. The levodopa dosage could be decreased thus decreasing the risk for cardiovascular adverse effects.
400
The nurse is discussing selegiline (an MAO-B inhibitor which suppresses the breakdown of dopamine) with a student. The student correctly acknowledges which of the following as a potential adverse effect of the drug? a. Hypertensive crisis b. Drowsiness c. Depression d. Orthostatic hypotension
a. Hypertensive crisis Rationale: When taking an MAOI, hypertensive crisis can be triggered by ingesting foods that contain tyramine.
400
A nurse is caring for an older adult patient who has Alzheimer’s disease. The patient is taking a cholinesterase inhibitor drug (Aricept). Which side effects would concern the nurse? a. Confusion and memory impairment b. Slowed heart rate and lightheadedness c. Nausea, vomiting, and diarrhea d. Dizziness and headache
b. Slowed heart rate and lightheadedness Rationale: Cardiovascular effects of cholinesterase inhibitor drugs are uncommon but cause the most concern. Bradycardia and fainting can occur when cholinergic receptors in the heart are activated. Confusion and memory impairment are signs of the disease and are not side effects of the drug. Dizziness, headache, nausea, vomiting, and diarrhea are all expected adverse effects, and although uncomfortable, they do not present an increased risk to the patient.
400
A patient with MS who is hospitalized with pneumonia is receiving the immunomodulator interferon beta-1a (Avonex). It would be of greatest priority for the nurse to report which laboratory test to the prescriber? a. ALT: 45 b. Hemoglobin A1c: 5.2% c. RBC: 4.9 d. WBC: 2
d. WBC: 2 Rationale: Interferon beta can cause myelosuppression. A normal WBC count is between 4-10 so this patient may be immunosuppressed which would be especially concerning with their diagnosis of pneumonia.
500
The nurse notes an orange color to the urine of a PD patient who is scheduled to receive a dose of entacapone (Comtan). What should the nurse do in this situation? a. Continue nursing care, including administration of the medication. b. Consult with the prescriber. c. Assess for symptoms of liver failure. d. Hold the medication, and contact the prescriber immediately.
a. Continue nursing care, including administration of the medication. Rationale: Entacapone (Comtan) can cause a harmless yellow-orange tint to the urine.
500
A patient who has begun taking levodopa/carbidopa (Sinemet) reports feeling lightheaded and dizzy, especially when standing up from a sitting position. What will the nurse recommend? a. An alpha-adrenergic antagonist medication b. Discussing an MRI with the prescriber c. Increasing the salt and water intake d. Taking a drug holiday
c. Increasing the salt and water intake Rationale: Postural hypotension is common early in treatment and can be reduced by increasing the intake of salt and water.
500
The nurse should be particularly cautious when administering a cholinesterase inhibitor drug to any patient with a history of which condition? (Select all that apply.) a. Asthma b. COPD c. Heart failure d. Hypertension e. Constipation
A, B, C Rationale: Adverse effects come from parasympathetic stimulation and include GI effects (N/V/D), bronchoconstriction, hypotension, and bradycardia.
500
A patient is scheduled to receive mitoxantrone (Novantrone), an immunosuppressant drug. What would be a reason to withhold the medication and contact the prescriber? (Select all that apply.) a. Elevated AST & ALT b. Blue-green colored urine c. Elevated hCG level d. Low neutrophil count
A, C, D Rationale: Mitoxantrone is eliminated by the liver and should not be used by patients with any type of hepatic dysfunction. It causes a harmless blue-green tint to urine. It can cause myelosuppression and fetal harm.