Deck 21: Drugs for Parkinson Disease

Question 1

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet]. The prescriber orders bromocriptine [Parlodel] to treat dyskinesias. The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:

A) adding an antipsychotic medication.
B) changing from bromocriptine to cabergoline [Dostinex].
C) reducing the dose of bromocriptine.
D) reducing the dose of levodopa/carbidopa.

Answer 1

reducing the dose of bromocriptine.

Question 2

A nursing student wants to know why a patient who has been taking levodopa [Dopar] for years will now receive levodopa/carbidopa [Sinemet]. The nurse explains the reasons that levodopa as a single agent is no longer available. Which statement by the student indicates a need for further education?

A) "Carbidopa increases the availability of levodopa in the central nervous system."
B) "Carbidopa reduces the incidence of nausea and vomiting."
C) "Combination products reduce peripheral cardiovascular side effects."
D) "Combination products cause fewer dyskinesias and decreased psychosis."

Answer 2

"Combination products cause fewer dyskinesias and decreased psychosis."

Question 3

The nurse provides teaching for a patient who will begin taking rotigotine [Neupro] to treat Parkinson disease. What will the nurse include in teaching?

A) "If you develop nausea and vomiting, you should stop taking the medication."
B) "If you need to stop this drug, your provider will order a gradual withdrawal."
C) "You will start this drug regimen with a higher than usual loading dose."
D) "You will take this medication by mouth with food."

Answer 3

"If you need to stop this drug, your provider will order a gradual withdrawal."

Question 4

A nurse provides teaching for a patient who is newly diagnosed with Parkinson disease. Which statement by the patient indicates understanding of the drug therapy for this disease?

A) "A levodopa/carbidopa combination is used to improve motor function."
B) "There are several drugs available to treat dyskinesias."
C) "When 'off' times occur, I may need to increase my dose of levodopa."
D) "With adequate drug therapy, the disease progression may be slowed."

Question 5

A patient has been diagnosed with Parkinson disease (PD) and begins treatment with levodopa/carbidopa [Sinemet]. After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:

A) add a dopamine agonist.
B) discuss the "on-off" phenomenon.
C) increase the dose of Sinemet.
D) re-evaluate the diagnosis.

Question 6

A hospitalized patient with Parkinson disease who is receiving apomorphine to treat "off" episodes develops nausea and vomiting. The nurse will discuss the use of which medication with the patient's provider?

A) Levodopa [Dopar]
B) Ondansetron [Zofran]
C) Prochlorperazine [Compazine]
D) Trimethobenzamide [Tigan]

Question 7

A patient has taken levodopa [Dopar] for Parkinson disease for 2 weeks but reports no improvement in the symptoms. Which response by the nurse is correct?

A) "Another agent will be needed to manage your symptoms."
B) "Double the dose to see whether an effect occurs."
C) "It may take several months for a response to occur."
D) "The prescriber may need to change your drug regimen."

Question 8

A nursing student wants to know how carbidopa can be effective for treating Parkinson disease if it prevents the conversion of levodopa to dopamine. The nurse explains that carbidopa:

A) can be taken with high-protein meals.
B) does not cross the blood-brain barrier.
C) has dopamine-like effects of its own.
D) reduces abrupt loss of effect.

Question 9

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 amantadine with the prescriber
C) Increasing salt and water intake
D) Taking a drug holiday

Question 10

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet] along with amantadine [Symmetrel] 400 mg/day to treat dyskinesias. The patient reports having increased dyskinesias several months after beginning the amantadine. The nurse will contact the provider to discuss which action?

A) Increasing the dose of amantadine [Symmetrel]
B) Interrupting treatment with amantadine for several weeks
C) Ordering renal function tests
D) Ordering another anticholinergic medication

Question 11

A patient who is newly diagnosed with Parkinson disease is prescribed levodopa [Dopar]. The patient asks the nurse about drugs to prevent disease progression. What will the nurse tell this patient?

A) "Levodopa may prevent disease progression in higher doses and is safe to use for this purpose."
B) "MAO-B inhibitors and dopamine agonists have both shown neuroprotective effects in human studies."
C) "Vitamin E has been shown to delay neuron degeneration and may be used as adjunctive therapy."
D) "While some drugs show promise, there are no studies that have proven a neuroprotective effect."

Question 12

A nurse is discussing motor symptoms with a patient with Parkinson disease who has been taking levodopa/carbidopa [Sinemet] for 9 months and who is now having regular tics. Which statement by the patient indicates understanding of this symptom?

A) "I may need to try a lower dose of Sinemet to reduce my tics."
B) "My provider may order clozapine to treat these tics."
C) "These tics are an indication that my dose of Sinemet is too low."
D) "This means I will have to have surgery to stop the symptoms."

Question 13

A patient newly diagnosed with Parkinson disease has been taking levodopa/carbidopa [Sinemet] for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?

A) Taking a lower dose on an empty stomach
B) Taking an increased dose along with a high-protein snack
C) Taking a lower dose with a low-protein snack
D) Taking dopamine in addition to levodopa/carbidopa

Question 14

A nurse is teaching a group of nurses about Parkinson medications. The nurse is correct to state that one side effect associated with pramipexole [Mirapex] that is less likely to occur with other dopamine agonists is:

A) sleep attacks.
B) dizziness.
C) hallucinations.
D) dyskinesias.

Question 15

A patient with Parkinson disease is taking levodopa/carbidopa [Sinemet] and reports occasional periods of loss of drug effect lasting from minutes to several hours. The nurse questions the patient further and discovers that these episodes occur at different times related to the medication administration. The nurse will contact the provider to discuss:

A) administering a catechol-O-methyltransferase (COMT) inhibitor, such as entacapone.
B) adding the DA-releasing agent amantadine to the regimen.
C) giving a direct-acting dopamine agonist.
D) shortening the dosing interval of levodopa/carbidopa.