Chapter 27: Antiparkinson Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. The nurse is preparing to administer pramipexole to a client with Parkinson disease. The nurse notes the client is also prescribed verapamil. Which potential reaction should the nurse prioritize for careful monitoring? a. Cardiac symptoms b. Agonist effectiveness c. Toxicity of both drugs d. Psychotic behavior Answer: B Rationale: The nurse should assess for an increased risk of agonist effectiveness in the client. Increased risk of cardiac symptoms and increased risk of toxicity of both drugs are the effects of the interaction of COMT inhibitors with MAOI antidepressants and adrenergic drugs. Increased risk of psychotic behavior is the effect of the interaction of cholinergic blocking drugs with haloperidol. Question Format: Multiple Choice Chapter: 27 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 329, Dopamine Receptor Agonists 2. A nurse has administered entacapone to a 55-year-old client with Parkinson disease. Which adverse reaction should the nurse prioritize? a. Increased hand tremor b. Constipation c. Urinary retention d. Dyskinesia Answer: D Rationale: The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hyperkinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs. Question Format: Multiple Choice Chapter: 27 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 330, COMT Inhibitors 3. A nurse completed teaching a client with influenza A about the prescribed amantadine. The nurse determines the session was successful when the client correctly chooses which action to counter adverse reactions to the drug? a. Instruct the client to take ice chips frequently. b. Encourage the client to take small, frequent meals. c. Instruct the client to avoid protein-rich foods. d. Stop the use of the antiparkinsonism drug by the client. Answer: A Rationale: The nurse should instruct the client to suck on ice chips or hard candy (if allowed). The nurse should also instruct the client to take frequent sips of water throughout the day and between meals. The nurse encourages the client to have small, frequent meals when the client experiences a GI disturbance and not when the client reports dry mouth. The nurse does not need to instruct the client to avoid protein-rich foods because this will not reduce the client's discomfort due to dry mouth. The nurse should stop the use of the antiparkinsonism drug when the client reports severe nausea or vomiting and not when the client is experiencing dry mouth. If dry mouth is so severe that there is difficulty in swallowing or speaking, or if loss of appetite and weight loss occur, the dosage of the antiparkinsonism drug may be reduced but not stopped completely. Question Format: Multiple Choice Chapter: 27 Learning Objective: 5 Cognitive Level: Apply Client Needs: Physiological Integrity: Basic Care and Comfort Integrated Process: Teaching/Learning Reference: p. 333, Malnutrition 4. A 70-year-old client with Parkinson disease is prescribed an anticholinergic drug. Which finding on assessment should the nurse prioritize? a. Confusion and disorientation b. Choreiform movements c. Suicidal tendencies d. Psychotic episodes Answer: A Rationale: The nurse should assess for confusion and disorientation when caring for this elderly client receiving anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug. Question Format: Multiple Choice Chapter: 27 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 331, Cholinergic Blocking Drugs (Anticholinergics)