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Pharm: Parkinsonism and Alzheimers Ch 20/23
Terms in this set (37)
Chronic neurologic disorder characterized by an imbalance of dopamine and acetylcholine marked by degeneration of neurons of the extrapyramidal motor tract
Mental status and mood changes (insomnia, tired, confusion, depression, hallucinations)
Dyskinesia (Involuntary body movements)
Parkinsonism medication side effects
Take parkinsonism medicines ______ low protein food if nausea
Anticholinergics _____ the release of acetylcholine
Increased pulse, palpitations, dysrhythmias
Mental status and mood changes
Anticholinergic Side Effects
Dopaminergics used for parkinsonism
Orthostatic hypotension, palpitations, dysrhythmias
Dyskinesia, psychosis, severe depression
Carbidopa-levodopa side effects
When levodopa is used alone, only 1% reaches the brain because 99% converts to dopamine while in the peripheral nervous system. By combining carbidopa with levodopa, carbidopa can inhibit the enzyme decarboxylase in the periphery, thereby allowing more levodopa to reach the brain
What was the reason of adding carbidopa and levodopa together?
Dopamine Agonist used for parkinsonism
Mental status changes
Amantadine side effects
Monoamine Oxidase B Inhibitors for parkinsonism
Dizziness, headache, nausea, dry mouth
Orthostatic hypotension, hypertension
Impulse control disorder, suicidal ideation
Selegiline side effects
Foods high in tyramine can cause hypertensive crisis when taking ___________
Catechol-O-Methyltransferase Inhibitors used for Parkinsonism
Impulse control disorder
Tolcapone side effects
Chronic, progressive neurodegenerative conditions
that may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques.
Used for Alzheimer's disease and dementia
Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors
Acetylcholinesterase Inhibitors/Cholinesterase Inhibitors used for alzhemer's
GI distress, GI bleeding, dizziness, depression, peripheral edema, dry mouth, dehydration, restless legs syndrome, nystagmus, seizures, bradycardia, orthostatic hypotension, cataracts, myocardial infarction, heart failure
Rivastigmine side effects
Give rivastignmine ______ food
This patient is exhibiting signs of Parkinson's disease and should be treated with carbidopa-levodopa. The other drugs are used to treat Alzheimer's disease.
An older patient exhibits a shuffling gait, lack of facial expression, and tremors at rest. The nurse will expect the provider to order which medication for this patient?
a. Carbidopa-levodopa (Sinemet)
b. Donepezil (Aricept)
c. Rivastigmine (Exelon)
d. Tacrine (Cognex)
Parkinson's disease (PD) is characterized by an imbalance of dopamine (DA) and acetylcholine (ACh) caused by an unexplained degeneration of the dopaminergic neurons allowing the excitatory response of acetylcholine to exceed the inhibitory response of dopamine. Alzheimer's disease (AD) may result from decreased ACh, degeneration of cholinergic neurons, and neuritic plaques. Dopamine does not appear to play a role in Alzheimer's disease.
A nursing student asks the nurse to differentiate the pathology of Alzheimer's disease from that of Parkinson's disease. Which description is correct?
a. Alzheimer's disease involves a possible excess of acetylcholine and neuritic plaques.
b. Alzheimer's disease is caused by decreased amounts of dopamine and degeneration of cholinergic neurons.
c. Parkinson's disease is characterized by an imbalance of dopamine and acetylcholine.
d. Parkinson's disease involves increased dopamine production and decreased acetylcholine.
PD is a progressive disorder. Nonpharmacologic measures can lessen symptoms and help patients and families cope with the disorder. Although the aging process may contribute to the development of PD, it is not necessarily a normal part of aging. Treatment may slow the progression but does not arrest or cure the disease.
The spouse of a patient newly diagnosed with mild, unilateral symptoms of Parkinson's disease (PD) asks the nurse what, besides medication, can be done to manage the disease. The nurse will
a. counsel the spouse that parkinsonism is a normal part of the aging process in some people.
b. recommend exercise, nutritional counseling, and group support to help manage the disease.
c. tell the spouse that the disease will not progress if mild symptoms are treated early.
d. tell the spouse that medication therapy can be curative if drugs are begun in time.
Benztropine is given to reduce rigidity and some of the tremors. It does not enhance walking or reduce bradykinesia or improve mental function.
A patient who has Parkinson's disease is being treated with the anticholinergic medication benztropine (Cogentin). The nurse will tell the patient that this drug will have which effect?
a. Helping the patient to walk faster
b. Improving mental function
c. Minimizing symptoms of bradykinesia
d. Reducing some of the tremors
Patients with a history of glaucoma should not take anticholinergic medications. Anticholinergics are not contraindicated in patients who have asthma, hypertension, or irritable bowel disease.
The nurse is preparing to administer a first dose of benztropine (Cogentin) to a patient diagnosed with parkinsonism. The nurse would notify the patient's provider if the patient had a history of which condition?
d. Irritable bowel disease
Urinary retention can occur with anticholinergic medications. Dry mouth is a harmless side effect. The nurse should report the lower than expected urine output to the provider. Increasing fluid intake will not increase urine output in the patient with urinary retention. Renal function tests are not indicated since this is a neuromuscular problem of the bladder caused by the medication.
The nurse is caring for a patient who is receiving trihexyphenidyl (Artane) to treat parkinsonism. The patient reports having a dry mouth, and the nurse notes a urine output of 300 mL in the past 8 hours. Which action will the nurse perform?
a. Encourage increased oral fluids.
b. Obtain an order for intravenous fluids.
c. Report the urine output to the provider.
d. Request an order for renal function tests.
Without carbidopa, about 99% of levodopa is converted to dopamine before crossing the blood-brain barrier, causing peripheral adverse effects. When carbidopa is added, the enzyme decarboxylase is inhibited, allowing levodopa to cross into the brain before being converted to the active metabolite dopamine. The result is less levodopa required to achieve the desired effect. The drug still has many side effects, but the peripheral effects are lessened.
A nursing student asks the nurse why patients who have parkinsonism receive a combination of carbidopa and levodopa. The nurse will explain that the combination product
a. allows larger doses of levodopa to be given without causing increased adverse reactions.
b. causes more levodopa to be converted to dopamine before crossing the blood-brain barrier.
c. eliminates almost all drug side effects of both levodopa and carbidopa.
d. reduces peripheral side effects by inhibiting decarboxylase in the peripheral nervous system.
Amantadine is an antiviral drug that acts on dopamine receptors and is sometimes used to treat Parkinson's disease (PD). The other drugs listed do not work for PD patients.
Which antiviral medication improves symptoms of Parkinson's disease in some patients?
a. Acyclovir (Zovirax)
b. Amantadine HCl (Symmetrel)
c. Interferon (INF)
d. Zanamivir (Relenza)
Bromocriptine is often used for patients who do not tolerate carbidopa-levodopa. Amantadine is useful for treating Parkinson's disease but does not have sustained effects. Benztropine is given to reduce muscle rigidity and some tremors. Tacrine is used to treat Alzheimer's disease.
A patient who has parkinsonism has been taking carbidopa-levodopa and has shown improvement in symptoms but develops dystonic movements, nausea, and vomiting. Which medication will the nurse expect the provider to order for this patient to replace carbidopa-levodopa?
a. Amantadine HCl (Symmetrel)
b. Benztropine (Cogentin)
c. Bromocriptine mesylate (Parlodel)
d. Tacrine (Cognex)
Selegiline (Eldepryl) inhibits monoamine oxidase-B, and it has similar adverse reactions to other monoamine oxidase inhibitors. Patients should be cautioned against consuming foods containing tyramine because of the risk of hypertensive crisis. Red wine is high in tyramine. Use of this drug may delay, but will not prevent, the need for levodopa. Severe adverse drug interactions may occur between this drug and tricyclic antidepressants.
A patient who has parkinsonism will begin taking selegiline HCl (Eldepryl) to treat symptoms. What information will the nurse include when teaching this patient about this drug?
a. "Avoid consuming foods that are high in tyramine."
b. "This drug will prevent the need to take levodopa."
c. "You may have red wine with dinner on occasion."
d. "You will not have serious drug interactions with this drug."
Carbidopa-levodopa can cause orthostatic hypotension, so patients should be taught to take care when getting out of bed or a chair. Darkening of the urine and perspiration is a harmless side effect. Patients should take the drug with low-protein foods to improve drug transport to the CNS. Carbidopa-levodopa should not be discontinued abruptly because rebound parkinsonism may occur; insomnia is an expected adverse effect of the drug, and the patient should report this effect to his or her health care provider.
A patient who has parkinsonism will begin taking carbidopa-levodopa. What information will the nurse include when teaching this patient about this medication?
a. "Call your health care provider immediately if your urine or perspiration turn a dark color."
b. "Rise slowly from your bed or your chair to avoid dizziness and falls."
c. "Take the drug with foods high in protein to improve drug delivery."
d. "Discontinue the drug if you experience insomnia."
Taking carbidopa-levodopa with food decreases absorption of the drug, although gastrointestinal distress may decrease when the medication is taken with food. Cholinergic side effects are common. Orthostatic hypotension occurs early and will resolve over time. Nightmares and mental disturbances should be reported.
The nurse is teaching a patient who has Parkinson's disease about the side effects of carbidopa-levodopa. Which statement by the patient indicates a need for further teaching?
a. "I may experience urinary retention, dry mouth, and constipation."
b. "I may feel dizzy at first, but this side effect will go away with time."
c. "I should report nightmares and mental disturbances to my provider."
d. "I should take the drug with food to increase absorption."
Entacapone can cause the urine to be dark yellow to orange. It does not indicate drug toxicity, liver effects, or changes in renal function
A patient is taking entacapone (Comtan) along with carbidopa-levodopa to treat parkinsonism. The nurse notes that the patient's urine is orange in color. The nurse will
a. notify the provider of possible drug toxicity.
b. reassure the patent that this is a harmless side effect.
c. request an order for liver function tests.
d. request an order for a urinalysis.
Patients taking rivastigmine for Alzheimer's disease are at risk for falls and loss of balance. Caregivers should assist with standing and walking. The drug is taken twice daily, and it should be taken on an empty stomach. NSAIDs increase gastrointestinal side effects.
The nurse is caring for an 80-year-old patient who has Alzheimer's disease who will begin taking rivastigmine (Exelon). What will the nurse include in the plan of care for this patient?
a. Administer the drug once daily.
b. Assist the patient to stand and walk.
c. Give the drug with food to increase absorption.
d. Use nonsteroidal anti-inflammatory drugs (NSAIDs) instead of acetaminophen for pain.
AD is chronic and progressive, and there is no cure. It affects memory and personality. The onset is usually between 45 and 65 years. Symptoms cannot be arrested but may be slowed with treatment.
The nurse is providing teaching for the family of a patient who has been newly diagnosed with Alzheimer's disease (AD). Which statement by the family member indicates understanding of the teaching?
a. "Alzheimer's disease is a chronic, progressive condition."
b. "Alzheimer's disease affects memory but not personality."
c. "The onset of Alzheimer's disease is usually between 65 and 75 years."
d. "With proper treatment, symptoms of this disease can be arrested."
Tacrine can help to increase cognitive function for patients with mild to moderate AD. For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress
The nurse is teaching a family member about an elderly parent's new prescription for tacrine (Cognex) to treat Alzheimer's disease (AD). The family member asks what to expect from this drug. The nurse will respond that the patient will
a. demonstrate improved ambulation.
b. have reversal of all symptoms.
c. have decreased deterioration of cognition.
d. show improved communication ability.
For the most part, drugs to treat AD do not result in improvement of symptoms but help slow the progress. The most realistic care plan for a patient with advanced AD is that they will receive appropriate and safe care.
The nurse is helping to develop a plan of care for a patient who has advanced Alzheimer's disease. The patient will be taking a new medication. Which is a realistic goal for this patient?
a. Demonstrate improved cognitive function.
b. Exhibit improved ability to provide self-care.
c. Receive appropriate assistance for care needs.
d. Show improved memory for recent events.
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