Chapter 10, Drugs for Central Nervous System Problems: Drugs for Parkinson’s Disease- Sherpath

Question 1 of 12

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Which finding would the nurse expect when completing an assessment on a patient diagnosed with Parkinson’s disease? Select all that apply. One, some, or all responses may be correct.

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  • Slow movementsSlow movements or bradykinesia is a symptom of Parkinson’s disease.
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  • Stooped, shuffling gaitStooped, shuffling gait is a symptom of Parkinson’s disease.
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  • Masklike facial expressionA masklike facial expression is a symptom of Parkinson’s disease.
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  • Cogwheel rigidityCogwheel rigidity, or arms and legs moving in a stop-and-go fashion, is a symptom of Parkinson’s disease.
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  • TremorsTremors are a symptom of Parkinson’s disease.

Question 2 of 12

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Which statement is true regarding dopamine agonists?

• • They are used to decrease the levels of dopamine in the brain.Dopamine agonists have the same chemical structure as natural dopamine and are used to increase the levels of dopamine in the brain, restoring balance between the actions of acetylcholine and dopamine.
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  • They help reduce muscle tremors and rigidity in Parkinson’s disease.The therapeutic effect of dopamine agonists helps reduce muscle tremors and rigidity and improve mobility, muscular coordination, and performance.
• • They should be used alone, as they interact with other medications.Dopamine agonists can be used alone, or, as symptoms progress, they can be used in combination.
• • They are available intravenously to deliver continuous therapy.Carbidopa/levodopa are dopamine agonists that are available as an intestinal infusion pump to deliver continuous therapy. There are no intravenous forms of dopamine agonists for Parkinson’s disease.

Question 3 of 12

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Which side effect is associated with the use of dopamine agonists? Select all that apply. One, some, or all responses may be correct.

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  • Postural hypotensionOne of the most common side effects of carbidopa/levodopa and all dopamine agonists includes postural hypotension.
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  • General hypotensionOne of the most common side effects of carbidopa/levodopa and all dopamine agonists includes general hypotension.
• • Daytime sleepinessOne of the most common side effects of carbidopa/levodopa and all dopamine agonists includes insomnia, not daytime sleepiness.
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  • HeadacheOne of the most common side effects of carbidopa/levodopa and all dopamine agonists includes headache.
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  • ConfusionOne of the most common side effects of carbidopa/levodopa and all dopamine agonists includes confusion.

Question 4 of 12

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Which medication reduces the effectiveness of dopamine agonists?

• • PhenelzinePhenelzine is a nonselective MAO inhibitor which can cause a hypertensive crisis.
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  • MetoclopramideMetoclopramide can reduce the effectiveness of dopamine agonists because it is a dopamine antagonist that prevents dopamine from combining with dopamine receptors.
• • LorazepamUse of dopamine agonists with sedatives worsens drowsiness and increases the risk of confusion, hallucinations, and delusions, especially in those persons already suffering from mental illnesses.
• • Vitamin B₆Vitamin B₆ increases the metabolism of levodopa if taken without carbidopa.

Question 5 of 12

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Which assessment finding is important to monitor for patients with Parkinson’s disease taking dopamine agonists? Select all that apply. One, some, or all responses may be correct.

• • Albumin levelsAlbumin levels do not have to be monitored when taking dopamine agonists.
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  • Serum glucose levelsClosely monitor serum glucose levels because dopamine agonists can cause hypoglycemia.
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  • BUN levelsMonitor BUN levels to rule out renal impairment when taking dopamine agonists, because 90% of drug is excreted by the kidneys.
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  • Motor skillsEstablish a baseline of motor skills and functional ability for walking and eating to ensure safety from falls and aspiration.
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  • Orthostatic blood pressuresDopamine agonists frequently cause postural hypotension, therefore orthostatic blood pressures should be monitored.

Question 6 of 12

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Which statement is true regarding catechol-O-methyltransferase (COMT) inhibitors?

• • They are given with levodopa to keep blood levels normalized in the brain.COMT inhibitors are given with levodopa to allow blood levels of levodopa to stay high enough to enter the brain to be converted to dopamine.
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  • They help restore acetylcholine (ACh)-dopamine balance in the brain.COMT inhibitors suppress the activity of the COMT enzyme so that naturally occurring dopamine and dopamine agonists remain active in the body and help restore the ACh-dopamine balance in the brain.
• • They suppress the activity of dopamine in the body.COMT inhibitors suppress the activity of the COMT enzyme to help dopamine and dopamine agonists remain active in the body longer.
• • They metabolize COMT enzymes to decrease the action of dopamine agonists.COMT inhibitors metabolize COMT enzymes to retain the action of dopamine and dopamine agonists.

Question 7 of 12

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Which lab would the nurse monitor for a patient who is prescribed tolcapone for the treatment of Parkinson’s disease?

• • BUNTolcapone is metabolized by the liver. BUN measures renal function and does not need to be monitored.
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  • Liver enzymesTolcapone leads to a higher risk of severe liver failure and is not used unless other measures fail. Liver functions must be closely monitored every 6 months if used.
• • Serum glucoseTolcapone does not affect serum glucose levels.
• • CreatinineCreatinine monitors renal function and tolcapone is metabolized in the liver.

Question 8 of 12

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Which occurrence would the nurse teach a patient to notify the healthcare provider about when prescribed a catechol-O-methyltransferase (COMT) inhibitor?

• • Brownish-orange urineBrownish-orange urine is an expected side effect and is not dangerous.
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  • Worsening depressionNotify the healthcare provider if worsening depression, delirium, or hallucinations are experienced.
• • DizzinessDizziness is an expected side effect from hypotension caused by using a COMT Inhibitor.
• • Levodopa useTaking a COMT inhibitor prevents the breakdown of levodopa. This helps to prolong the duration of action for a dose of levodopa for best the desired effect.

Question 9 of 12

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Which statement is true regarding monoamine oxidase type B (MAO-B) inhibitors?

• • MAO-B enzymes metabolize epinephrine and dopamine.MAO-B enzymes specifically metabolize dopamine and serotonin. MAO-A enzymes break down many neurotransmitters, including epinephrine, norepinephrine, serotonin, and dopamine.
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  • MAO-B inhibitors suppress MAO-B to allow dopamine levels to increase and reduce the symptoms of Parkinson’s disease (PD).MAO-B inhibitors suppress the action of MAO-B, which allows dopamine levels to increase and reduces the symptoms of PD.
• • MAO-B inhibitors are sometimes used to treat psychosis.MAO-B inhibitors are sometimes used to treat depression because they also reduce the breakdown of serotonin.
• • MAO-B inhibitors allow the dose of levodopa to be increased, which lessens the side effects of carbidopa.Adding MAO-B inhibitors to levodopa/carbidopa regimen allows the dose of levodopa to be decreased, which lessens the side effects of higher levodopa levels.

Question 10 of 12

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Which side effect or adverse effect is associated with the administration of MAO-B inhibitors? Select all that apply. One, some, or all responses may be correct.

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  • Dry mouthDry mouth is a common side effect of MAO-B inhibitors.
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  • LightheadednessLightheadedness is a common side effect of MAO-B inhibitors.
• • HypertensionHypertension is an adverse effect of MAO-B inhibitors.
• • InsomniaDrowsiness, not insomnia, is a common side effect of MAO-B inhibitors.
• • ConfusionConfusion can occur when older adults use MAO-B inhibitors but is not a common side effect.

Question 11 of 12

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Which compound, if combined with monoamine oxidase type B (MAO-B) inhibitors, may cause a hypertensive crisis? Select all that apply. One, some, or all responses may be correct.

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  • GinsengGinseng, ephedra, ma huang, and St. John’s Wort are over-the-counter and herbal drugs that may cause a hypertensive crisis when using MAO-B inhibitors.
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  • DextromethorphanDextromethorphan is a cough medicine that stimulates the sympathetic nervous system and can cause a hypertensive crisis when using MAO-B inhibitors.
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  • TramadolTramadol is an opiate used for pain and can interact with MAO-B inhibitors causing a hypertensive crisis.
• • AmitriptylineTaking MAO-B inhibitors with tricyclic antidepressants, such as amitriptyline can cause hyperthermia, tremors, seizures, or delirium.
• • FluoxetineTaking MAO-B inhibitors with selective serotonin reuptake inhibitors, such as fluoxetine can cause hyperthermia, tremors, seizures, or delirium.

Question 12 of 12

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Which instruction would the nurse include when teaching a patient about the administration of MAO-B inhibitors? Select all that apply. One, some, or all responses may be correct.

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  • MAO-B inhibitors take several weeks to begin working.MAO-B inhibitors can take several weeks to begin working and sometimes a sedative may be prescribed in the interim to help relieve anxiety or sleep problems.
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  • Avoid beer, smoked meat, and cheeses.Avoid foods that contain tyramine, such as beer, red wine, aged cheese, smoked meat, cheese, fish, soy products, and pickled herring.
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  • Wear sunscreen, sunglasses, and protective clothing when outside.MAO-B inhibitors may increase the risk of serious sunburn when outside, even with darker pigmented skin.
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  • Avoid driving or using dangerous machinery.MAO-B inhibitors may cause drowsiness, so avoid driving or using dangerous machinery until drug effect has been established.
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  • Do not take Ginseng or St. John’s Wort.Do not take over-the-counter drugs or herbal remedies without checking with the pharmacist or healthcare provider while using MAO-B inhibitors.