Antiparkinsonism Agents

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.

3.

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.

4.

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.

5.

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.

6.

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.

8.

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.

9.

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.

11.

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.

12.

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.

14.

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.

16.

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.

17.

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.

18.

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 L-dopa. Aspirin compounds, alcohol, and antianginal agents are not contraindicated in concurrent therapy with L-dopa.

20.

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.

21.

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.

22.

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.

23.

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.

24.

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.

25.

A home health nurse is visiting an elderly patient with Parkinson’s disease. What would the nurse assess this man for related to common adverse effects?
A)
Blood dyscrasias
B)
Increased dopamine activity
C)
Pliability
D)
Urinary retention
Ans:
D

Feedback:

The nurse would assess the patient for urinary retention because this reaction is caused by loss of muscle tone in the bladder and is most likely to occur in elderly men who have enlarged prostate glands. Parkinson’s does not generally cause blood dyscrasias. The nurse cannot assess for increased dopamine activity except to assess for reduced symptoms caused by medication therapy. Pliability is a distracter for this question.

26.

What patient is most likely to be diagnosed with Parkinson’s disease?
A)
A 45-year-old woman
B)
A 35-year-old man
C)
A 55-year-old person of either gender
D)
A 60-year-old man
Ans:
D

Feedback:

Although Parkinson’s disease may affect people of any age, gender, or nationality, the frequency of the disease increases with age. This debilitating condition, which affects men more often than women, may be one of many chronic problems associated with aging.

27.

The nurse is teaching a patient about antiparkinson drugs. What drug would the nurse expect to be prescribed for the patient experiencing “wearing off” of drug effects?
A)
Pramipexole
B)
Entacapone
C)
Ropinirole
D)
Amantadine
Ans:
B

Feedback:

Entacapone is an adjunctive drug that is prescribed when a patient with Parkinson’s disease has a “wearing off” effect of his or her other Parkinson’s medications, meaning the drugs previously prescribed are having less of an effect. Therefore, options A, C, and D are incorrect.

28.

While providing patient education for a patient newly diagnosed with Parkinson’s disease and his or her family, the nurse will explain that Parkinson’s disease is characterized by what?
A)
Reduced cognitive function
B)
Abnormalities in stature
C)
Postural instability
D)
Reduced nerve transmission
Ans:
C

Feedback:

Parkinson’s disease is a chronic, progressive, and degenerative disorder of the central nervous system (CNS) characterized by abnormalities in movement and posture (e.g., tremor, bradykinesia, joint and muscular rigidity, postural instability).

29.

The nurse is assessing a patient who was prescribed levodopa 1 week earlier. How might the nurse evaluate the effectiveness of drug therapy?
A)
Stable mood
B)
Psoriasis
C)
Drug–drug interactions with dopaminergic agents
D)
Improvement in handwriting
Ans:
D

Feedback:

The nurse would evaluate the patient for improvement in function and reduction in symptoms. With preparations containing levodopa and with dopaminergic agents, assess for improvement in mobility, balance, posture, gait, speech, handwriting, and ability to provide self-care. Drooling and seborrhea may be abolished, and mood may be elevated. Stable mood and psoriasis are not findings associated with Parkinson’s disease. Assessing for drug–drug interactions is an important nursing assessment but it is not related to evaluating effectiveness of the drug.

30.

When describing Parkinson’s disease to a patient with a new diagnosis, what statement made by the nurse would be accurate?
A)
“Parkinson’s disease can be cured if medication is taken regularly as prescribed.”
B)
“Degeneration of the neurons is arrested by medication.”
C)
“Surgical procedures involving the basal ganglia have had varying degrees of success.”
D)
“Diet-related therapy is the primary treatment for managing Parkinson’s disease.”
Ans:
C

Feedback:

Surgical procedures involving the basal ganglia have been tried with varying success at prolonging the physical degeneration caused by this disease. Drug therapy remains the primary treatment. At this time, no available treatment arrests the neuron degeneration of Parkinson’s disease and the eventual decline in patient function.

31.

What is the primary reason a nurse might administer an antiparkinsonism drug to a child?
A)
New-onset Parkinson’s disease
B)
Drug abuse
C)
Fibromyalgia
D)
Parkinsonian symptoms
Ans:
D

Feedback:

The incidence of Parkinson’s disease in children is very low. Children do, however, experience parkinsonian symptoms as a result of drug adverse effects, not of drug abuse. Fibromyalgia is not usually diagnosed in children either.

32.

The nurse is caring for a patient who is unable to swallow properly. What drug would the nurse expect to be prescribed?
A)
Apomorphine (Apokyn)
B)
Bromocriptine (Parlodel)
C)
Levodopa (Dopar)
D)
Ropinirole (Requip)
Ans:
A

Feedback:

Only apomorphine can be given parenterally so this would be an appropriate drug to give to a patient with difficulty swallowing. Bromocriptine, levodopa, and ropinirole are only given in oral formulations.

33.

How does the drug levodopa contrast with dopamine? (Select all that apply.)
A)
Levodopa is a precursor of dopamine.
B)
Levodopa crosses the blood–brain barrier.
C)
Levodopa is converted to dopamine.
D)
Levodopa is effective for 8 to 10 years.
E)
Dopamine returns to levodopa for metabolism.
Ans:
A, B, C

Feedback:

Levodopa is a precursor of dopamine, which is deficient in parkinsonism; it crosses the blood–brain barrier, where it is converted to dopamine and acts as a replacement neurotransmitter; it is effective for 2 to 5 years in relieving the symptoms of Parkinson’s disease.

34.

The nurse is preparing to administer the patient’s first dosage of trihexyphenidyl (Artane). What will the nurse tell the patient about the dosage?
A)
“Initial dose is 1 to 2 mg and then dosage is titrated up to manage symptoms of disease.”
B)
“Initial dose is 6 mg to establish serum levels and then 1 mg is taken daily.”
C)
“A 5-mg dose is taken orally twice a day starting with first dose.”
D)
“ Take 1 to 2 mg orally every day starting with first dosage.
Ans:
A

Feedback:

Trihexyphenidyl (Artane) is given 1 to 2 mg orally daily initially and then titrated up to 6 to 10 mg/d with a maximum of up to 15 mg/d to control symptoms. Trihexyphenidyl is an adjunctive therapy to levodopa in treatment of parkinsonism but it can be used alone for the control of drug-induced extrapyramidal disorders.