NUR 521 Module 9 Exam Study Guide(University of Alabama)
Questions and Answers
Chapter 45: Parkinson’s Disease
1. Dopamine is a neurotransmitter that can both inhibitory and
excitatory transmitters
2. Some of the first treatments for Parkinson’s focus on exercise and
GLP-1 agonists. What is the proposed theory that these therapies
work? Dopamine cells preserve longer. Some believe it’s the microbes in
the stomach and their relationship to the neurotransmitters that cause the
drug to work, and preserve the basal ganglion
**Bicycle use and extenatide (GLP-1) agonist
3. Pramipexole and MAO-B medications can be used in early
Parkinson’s. Explain MAO-B and the wearing off effect.
• Give as a co-drug with Sinemet and will have a longer
dopamine effect
• MAO-B plays a major role in the metabolism of dopamine. By
inhibiting this metabolism, concentrations of dopamine are
increased, allowing more dopamine to reach the brain and
ultimately reducing motor symptoms of PD. MAO-B can delay the
need for levodopa & reduce the wearing off effect.
• Wearing off effect: After several years of levodopa treatment,
patients can begin to experience a “wearing-off” phenomenon,
which involves the
return of motor and nonmotor symptoms prior to the next dose
of levodopa. As PD progresses, patients may find a shortening in
the length of time with a good response to the medication, also
known as “on time,” and a lengthening of time with a poor
response, also known as “off time.” As PD progresses, patients
have a diminished capacity to produce dopamine and store
converted levodopa for release when needed, resulting in a
reappearance of symptoms. Although “wearing off” can occur
with many different drugs
4. Levodopa and carbidopa work to restore which neurotransmitter?
• Dopamine
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 1 of 25
,Why can dopamine not be taken orally?
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 2 of 25
, • Peripherally administered (outside of the central nervous
system) dopamine is not effective because it cannot cross the
blood brain barrier.
In end stage Parkinson’s which type of preparation is recommended?
• Supportive care. Speech therapy, OT, social work, and home
health. These interventions will prolong independence in
ADLs and improve
quality of life while reducing complications like pain, decubiti,
and falls. (google)
• Will see hallucinations and dementia findings in end stage
• Long-acting levodopa
• Pimavanserin (Nuplazid) helps with hallucinations and paranoia
5. What are the adverse effects of L-dopa?
• dizziness, irregular heartbeat, mental/mood changes (such as
agitation)
• nausea, vomiting, constipation, dyskinesias
6. What medication is given to diminish the stiffness of PD? Who
should not use this medication?
• Pramipexole reduces stiffness & restlessness 1st treatment
• Patients with NARROW-ANGLE GLUCOMA should AVOID
this medication
7. What clinical manifestations are seen at later stages of Parkinson’s
Disease and can be treated with pimavanserin? What is the
mechanism of action of this medication?
• Pimavanserin is used during later stages of PD because some
patients
hallucinate, schizophrenia behavior, paranoid and dementia
• MOA: exact mechanism of action unknown; acts as inverse
agonist and antagonist at serotonin 5-HT2A, 5-HT2C receptors
8. Anticholinergics are often given in PD to reduce symptoms. Why
are these medications on the Beers list? What side effects do the
anticholinergic medications have?
• These medications are on the Beers List because it
can cause drowsiness, agitation, delirium & cognitive
impairment
• SE: dry mouth, blurred vision, dizziness, nausea,
nervousness, constipation, drowsiness, trouble urinating-
retention, impaired memory, confusion, hallucinations,
monitor for vision changes.
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 3 of 25
Questions and Answers
Chapter 45: Parkinson’s Disease
1. Dopamine is a neurotransmitter that can both inhibitory and
excitatory transmitters
2. Some of the first treatments for Parkinson’s focus on exercise and
GLP-1 agonists. What is the proposed theory that these therapies
work? Dopamine cells preserve longer. Some believe it’s the microbes in
the stomach and their relationship to the neurotransmitters that cause the
drug to work, and preserve the basal ganglion
**Bicycle use and extenatide (GLP-1) agonist
3. Pramipexole and MAO-B medications can be used in early
Parkinson’s. Explain MAO-B and the wearing off effect.
• Give as a co-drug with Sinemet and will have a longer
dopamine effect
• MAO-B plays a major role in the metabolism of dopamine. By
inhibiting this metabolism, concentrations of dopamine are
increased, allowing more dopamine to reach the brain and
ultimately reducing motor symptoms of PD. MAO-B can delay the
need for levodopa & reduce the wearing off effect.
• Wearing off effect: After several years of levodopa treatment,
patients can begin to experience a “wearing-off” phenomenon,
which involves the
return of motor and nonmotor symptoms prior to the next dose
of levodopa. As PD progresses, patients may find a shortening in
the length of time with a good response to the medication, also
known as “on time,” and a lengthening of time with a poor
response, also known as “off time.” As PD progresses, patients
have a diminished capacity to produce dopamine and store
converted levodopa for release when needed, resulting in a
reappearance of symptoms. Although “wearing off” can occur
with many different drugs
4. Levodopa and carbidopa work to restore which neurotransmitter?
• Dopamine
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 1 of 25
,Why can dopamine not be taken orally?
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 2 of 25
, • Peripherally administered (outside of the central nervous
system) dopamine is not effective because it cannot cross the
blood brain barrier.
In end stage Parkinson’s which type of preparation is recommended?
• Supportive care. Speech therapy, OT, social work, and home
health. These interventions will prolong independence in
ADLs and improve
quality of life while reducing complications like pain, decubiti,
and falls. (google)
• Will see hallucinations and dementia findings in end stage
• Long-acting levodopa
• Pimavanserin (Nuplazid) helps with hallucinations and paranoia
5. What are the adverse effects of L-dopa?
• dizziness, irregular heartbeat, mental/mood changes (such as
agitation)
• nausea, vomiting, constipation, dyskinesias
6. What medication is given to diminish the stiffness of PD? Who
should not use this medication?
• Pramipexole reduces stiffness & restlessness 1st treatment
• Patients with NARROW-ANGLE GLUCOMA should AVOID
this medication
7. What clinical manifestations are seen at later stages of Parkinson’s
Disease and can be treated with pimavanserin? What is the
mechanism of action of this medication?
• Pimavanserin is used during later stages of PD because some
patients
hallucinate, schizophrenia behavior, paranoid and dementia
• MOA: exact mechanism of action unknown; acts as inverse
agonist and antagonist at serotonin 5-HT2A, 5-HT2C receptors
8. Anticholinergics are often given in PD to reduce symptoms. Why
are these medications on the Beers list? What side effects do the
anticholinergic medications have?
• These medications are on the Beers List because it
can cause drowsiness, agitation, delirium & cognitive
impairment
• SE: dry mouth, blurred vision, dizziness, nausea,
nervousness, constipation, drowsiness, trouble urinating-
retention, impaired memory, confusion, hallucinations,
monitor for vision changes.
NUR 521 Module 9 Study Guide
(Chapters 38, 39, 44, and 45, and Lehne’s Chapter 40)
Page 3 of 25
