Pharmacology Anti-Epileptic and Anti-Parkinsonian Drugs Practice Questions – Flashcards
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A client is in status epilepticus. What is an appropriate nursing action? A. Hold the client's limbs steady. B. Apply restraints. C. Administer intravenous antiepileptic drug therapy D. Administer intravenous pain medications
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C During status epilepticus, the client is unable to swallow medications, and the appropriate treatment is to administer intravenous drug therapy to stop the seizure. Pain medications are not necessary. The nurse should not restrain the client or hold the limbs during this time, but the nurse should make certain the client does not get injured.
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A 25-year-old female patient is has begun taking phenobarbital therapy for seizure control. What information is essential for the nurse to include in discharge teaching? A. Discuss alternate forms of birth control with the health care provider. B. Do not take the medication when not having seizures. C. Skip the medication dosage if headaches occur. D. Make certain to keep the medication out of light.
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A The nurse should instruct the patient in the fact that this medication can interfere with oral contraceptives, and alternate forms of birth control should be used. The medication is taken daily to prevent seizures, is not stopped if the patient has headaches, and does not need to be kept out of the light.
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The patient is being started on the first-line antiepileptic medication carbamazepine. The patient asks the nurse to assist in planning meals that will not conflict with dietary restrictions related to the medication. The nurse's response is based on the knowledge that the patient who is taking this medication should avoid which fluid? A. Grape juice B. Orange juice C. Grapefruit juice D. Apple juice
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C The patient who is taking carbamazepine should avoid drinking grapefruit juice because it may lead to toxicity of the medication.
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A nurse is caring for a client who has been started on antiepileptic drug therapy for seizures. What information should be included in the teaching plan for the client? A. If this medication is not effective, another drug will be added. B. If you there are side effects of therapy, stop the drug C. Take the medication at the same time each day. D. Alter drug therapy based on normal meal times.
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C It is important that the client maintain consistent serum drug levels of antiepileptic medication to prevent seizure occurrence. If therapy with one drug fails, the drug is tapered off while a second one is introduced. Clients do not start on multiple drug therapy unless single drug therapy fails. The medication administration should not be changed based on meals. If a client has side effects, they should call their healthcare provider, but not stop the drug. Stopping the drug abruptly can cause withdrawal seizures.
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The patient was started on an antiepileptic medication 6 weeks ago. The nurse notes that the patient's blood level of the medication is very low after 6 weeks of the drug. How will the nurse interpret this result? A. The patient should be placed on a different medication. B. The patient has received a toxic amount of the drug. C. The patient is experiencing an allergic reaction to the drug. D. The patient may not be taking the medication as ordered.
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D If the patient's blood level of the drug is very low, it may be because the patient has not been taking the medication. It will not be extremely low as a result of a toxic amount of the drug, because it is not effective, or because the patient is experiencing an allergic reaction to the medication.
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The client's serum phenytoin (Dilantin) level is 31 mcg/ml. What is the nurse's best action? A. Hold the medication. B. Increase the medication dose. C. Administer the medication intravenously. D. Have the client continue their current regimen.
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A A therapeutic drug level for phenytoin is 10 to 20 mcg/ml. The nurse should hold the medication then call the healthcare provider.
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While teaching a patient newly diagnosed with a seizure disorder, what does the nurse state as the goal of pharmacologic therapy of this medication? A. Eradicating all seizure activity and then weaning off medication once the patient is seizure-free for 3 months. B. Reducing seizure occurrence to one per week. C. Maximally reducing seizure activity while minimizing side effects of medication therapy. D. Maximizing drug dosages to control seizure activity.
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C Anticonvulsant medications have many adverse side effects. The goal of therapy is to control seizure activity while maintaining quality of life with minimal side effects.
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What is the best direction for the nurse to give the patient who is taking an antiepileptic drug with a narrow therapeutic index? A. Make certain the drug is taken at the same time daily. B. Crush the drug and put it in applesauce for better absorption. C. Take the medication every other day. D. Keep the medication with you at all times.
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A A drug with a narrow therapeutic index has toxic and therapeutic levels that are very close together. Consistent dosing of the drug at the same time daily is essential for maintaining stable serum drug levels. Crushing the drug will change the absorption. The medicaTIon should not be taken every other day unless that is specifically how it is prescribed. Keeping the medication with the patient at all times is not essential, as many drugs are longer acting.
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Which client should the nurse assess first? A. The client taking carbamazepine (Tegretol) who is not oriented to place or time. B. The client taking carbamazepine (Tegretol) who has bruises on his arms. C. The client taking valproic acid (Depakene) with an increased appetite. D. The client taking valproic acid (Depakene) who has lost 2 pounds since starting therapy.
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A The client who is not oriented and taking carbamazepine could be experiencing adverse effects of therapy. This is the client the nurse should assess first. The other clients are not experiencing adverse effects.
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Which antiepileptic drug may cause gingival hyperplasia in patients? A. Phenytoin B. Gabapentin C. Phenobarbital D. Levetiracetam
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A The antiepileptic drug phenytoin may cause gingival hyperplasia. Gingival hyperplasia refers to an increase in the size of the gums. The antiepileptic drug phenobarbital may cause apnea and hypotension. Gabapentin, which is an antiepileptic drug, may cause visual and speech changes, edema, and dizziness. Levetiracetam, an antiepileptic drug, may cause hyperactivity and behavioral changes, such as anxiety, hostility, agitation, or suicidal ideation.
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When administering intravenous phenytoin (Dilantin), which action will the nurse perform? A. Always use an infusion pump. B. Flush the line with normal saline before and after administration to prevent precipitation. C. Administer through peripheral intravenous sites only. D. Monitor for hypertension.
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B Phenytoin is very irritating to veins and incompatible with all fluids except normal saline. Flushing with normal saline before and after minimizes precipitation. You do not need an infusion pump when administering via IV push, and administration via central lines is preferred.
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The nurse is administering morning medications. Which administration technique is an error? A. The nurse administers intravenous Dilantin with a filter. B. The nurse administers gabapentin without checking when the patient ate. C. The nurse administers carbamazepine with grapefruit juice. D. The nurse adminsters phenobarbital elixir with fruit juice
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C Carbamazepine is not to be given with grapefruit juice, as this can lead to increased toxicity of the drug. Dilantin is administered IV with a filter. Gabapentin can safely be given without regard to meals. Phenobarbital elixir can be administered with fruit juice, but the oral pill form of the drug should be given with water.
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The nurse is administering phenytoin (Dilantin) intravenously. What intervention is essential? A. Administer the medication no faster than 50 mg/min. B. Mix the medication in 5% dextrose with 0.9% saline. C. Administer the medication in a 22-gauge or smaller catheter D. Push the medication quickly through a central line.
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A Intravenous phenytoin should be given no faster than 50 mg/minute into a 20-gauge or larger catheter. It can only be mixed or diluted in normal saline for infusion. The medication should not be given with dextrose or given quickly through a central line.
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The nurse is teaching a patient about therapy for a newly diagnosed seizure disorder. What statement should be included in the plan of care? A. "You will be started on several drugs to control your seizures." B. "Your medication is chosen based on your type of seizure." C. "You will only need to be on therapy for a few months." D. "Medication therapy is not essential to treat seizure disorders."
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B Medication therapy for seizures is matched to the type of seizure the patient presents with. Single drug therapy must fail before multiple drug therapy is tried. Therapy, in most cases, is life long and essential for treating epilepsy.
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The patient with Parkinson's disease who has been positively responding to carbidopa-levodopa (Sinemet) suddenly develops a relapse of symptoms. Which explanation by the nurse is appropriate? A. "You have obviously developed resistance to your current medication and will have to be switched to another drug." B. "This is an atypical response. Unfortunately, there are no other options for drug therapy to give you." C. "This is called the 'on-off phenomenon.' Your health care provider can change your medication regimen slightly to help reduce this effect." D. "You just need to keep taking your medication and these effects will go away."
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C Patients who have been taking levodopa for a period of time may experience periods of symptom return. Changing to Sinemet CR or adding another medication can help reduce the on-off phenomenon.
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Which neurodegenerative disorder is caused by a decrease in dopamine levels and an increase in acetylcholine levels in the brain? A. Alzheimer's disease B. Dementia C. Parkinson's disease D. Schizophrenia
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C Parkinson's disease is the neurodegenerative disorder that occurs as a result of a reduction of dopamine and an increase in acetylcholine levels in the brain. Alzheimer's disease is a neurodegenerative disorder in which there is progressive loss of neurons and a reduction in acetylcholine levels. Dementia is not a neurodegenerative disorder; it is a disorder that affects the memory center of the brain. Schizophrenia is a psychotic disorder that involves hallucinations and delusions.
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Which inhibitory neurotransmitter is involved in Parkinson's disease? A. Acetylcholine B. Adrenaline C. Dopamine D. Oxytocin
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C Dopamine is the inhibitory neurotransmitter involved in Parkinson's disease. The disease is characterized by low concentrations of dopamine. Acetylcholine is an excitatory neurotransmitter that counteracts the effects of dopamine. The adrenergic glands on the kidney release adrenaline. Oxytocin is released by the pituitary gland; it is a not a neurotransmitter.
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A patient receives a diagnosis of Parkinson's disease. Which treatment for the disease does the nurse implement first? A. Encouraging physical activity B. Instituting pharmacotherapy C. Teaching about assistive devices D. Explaining the disease's characteristics
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D When Parkinson's disease is diagnosed, the nurse teaches the patient and family about the disease, including its pathophysiology and treatment options, to help them learn to manage this chronic, progressive neurodegenerative disorder. After patient education, both the patient and family are better equipped to understand the disease's progression, the related pharmacotherapy, the need for physical activity, and the role of assistive devices.
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The nurse is caring for a patient with Parkinson's disease. The nurse finds that the primary health care provider has prescribed selegiline (Emsam) to the patient to treat depression. Which order for selegiline (Emsam) is correct? A. Administer 4 mg of selegiline (Emsam) twice a day. B. Administer 12 mg of selegiline (Emsam) if the patient is delirious. C. Administer meperidine (Demerol) followed by selegiline (Emsam). D. Administer selegiline (Emsam) along with 1.5 oz of cheese.
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A The required dosage of selegiline (Emsam) is <10 mg daily; hence the nurse may receive the instruction to administer a daily dose of 8 mg of selegiline (Emsam) (4 mg twice a day) of. Delirium is an adverse effect associated with selegiline (Emsam). Higher doses of selegiline (Emsam) worsen the symptoms of delirium. Meperidine (Demerol) is contraindicated in patients taking selegiline (Emsam) because of well-known drug interactions such as delirium and muscle rigidity. Eating cheese along with taking the drug may result in the "cheese effect" caused by the presence of tyramine in cheese.
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Which is the drug of choice for Parkinson's disease in most older adult patients? A. Selegiline (Eldepryl) B. Amantadine (Symmetrel) C. Diphenhydramine (Benadryl) D. Carbidopa-levodopa (Sinemet)
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D Carbidopa-levodopa (Sinemet) is the drug of choice for Parkinson's disease in a majority of older adult patients because of its safety and efficacy. Selegiline (Eldepryl) is used in conjunction with carbidopa-levodopa or to relieve symptom fluctuations. Amantadine (Symmetrel) is a dopamine modulator used in the early stages of Parkinson's disease, but it is not used in older adult patients. Diphenhydramine (Benadryl) is an antihistamine used as a secondary drug for tremor or muscular rigidity. It is not a drug of choice for Parkinson's disease.
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A patient with Parkinson's disease is discussing a recent bout of insomnia with the nurse. The patient asks if he can take an old prescription he has to treat insomnia. What does the nurse know about the use of benzodiazepines in patients taking levodopa? A. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease. B. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease. C. Use of benzodiazepines decreases the therapeutic effect of the levodopa and may result in a decrease in the symptoms of Parkinson's disease. D. Use of benzodiazepines increases the therapeutic effect of the levodopa and may result in an increase in the symptoms of Parkinson's disease.
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A Benzodiazepines interact with levodopa to cause reduced levodopa effects and an increase in the symptoms of Parkinson's disease.
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The nurse is assessing a patient who has recently been diagnosed with Parkinson's disease and who was prescribed tolcapone (Tasmar). What would the nurse assess for as a precaution with this particular medication? A. Mood fluctuations B. Liver function C. Bruising D. Kidney function
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B Tolcapone (Tasmar) is a catechol ortho-methyltransferase inhibitor prescribed for the treatment of Parkinson's disease. It should be used with caution in patients with liver failure because it impairs hepatic functioning and worsens the symptoms. In these patients, drug dose should be adjusted and liver function should be monitored. Tolcapone (Tasmar) is not associated with mood fluctuations, bruising, or kidney failure so the nurse would not need to monitor for these conditions in this patient.
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The nurse is caring for a patient with Parkinson's disease. The patient has been taking entacapone (Comtan) for the past week to treat an on-off phenomenon. The patient expresses concern over brown-orange urine. What information will the nurse provide? A. "You may be developing renal failure." B. "You may be developing hepatic failure." C. "Brown-orange urine signifies a lack of fluid intake." D. "This is a normal occurrence related to entacapone (Comtan)."
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D Patients should be instructed that entacapone (Comtan) can turn urine a brown-orange color so that he or she will not be alarmed when this side effect occurs.
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Which substance, if out of balance with acetylcholine, leads to Parkinson's disease? A. Serotonin B. Dopamine C. Epinephrine D. Norepinephrine
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B The underlying cause of Parkinson's disease is loss of dopaminergic neurons in the substantia nigra, resulting in a deficiency of dopamine and an imbalance between dopamine and acetylcholine. Because dopamine is an inhibitory neurotransmitter and acetylcholine is an excitatory neurotransmitter, the imbalance results in the effects of acetylcholine that dominate the patient's motor activity. These pathologic features include akinesia, bradykinesia, postural instability, rigidity, and tremors. Serotonin triggers serotonin syndrome. Both epinephrine and norepinephrine are catecholamines present in the body.
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The nurse is caring for a patient who has been diagnosed with Parkinson's disease for a long time. Which therapies should the nurse discuss with the patient's provider? Select all that apply. A. Speech therapy B. Aromatherapy C. Chemotherapy D. Physical therapy E. Occupational therapy
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A, D, E Parkinson's disease is mainly a degenerative disorder that decreases the patient's ability to perform general motor activities. The patient likely has impaired speech and functional ability. So, to improve the patient's condition, the nurse should recommend speech therapy, physical therapy, and occupational therapy. Aromatherapy is useful in relieving stress and enhancing relaxation, but it does not help relieve Parkinson's symptoms. Chemotherapy is used for patients suffering from various cancers.
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Which disorder is characterized by abnormal and distressing involuntary movements? A. Dystonia B. Akinesia C. Dyskinesia D. Bradykinesia
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C Dyskinesia is a disorder that is characterized by abnormal and distressing movements that the patient cannot control. Dystonia is characterized by impaired or distorted voluntary movement, which often involves the head, neck, or feet. Akinesia is characterized by the absent or poor body movement that result in a masklike facial expression and impaired postural reflexes. Bradykinesia is characterized by slow body movements.
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A client receiving phenytoin (Dilantin) complains of "blurred vision." What is the priority nursing action? A. Assess serum phenytoin levels. B. Monitor for seizure activity. C. Assess the client's pupils. D. Hold the client's medication.
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A At toxic levels, phenytoin can cause nystagmus, which would cause the client to have difficulty focusing. The nurse should assess serum phenytoin levels to determine the drug level. The medication should not be held unless the client is determined to have toxic levels of the drug. The client is most likely not having a seizure at this time. Assessing pupils would not assist the nurse in determining the cause of the blurred vision.
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Which patient should receive a medication as ordered at 8 AM? A. The patient who is receiving phenobarbital and has a plasma level of 38 mcg/mL B. The patient who is scheduled to receive a barbiturate and was admitted after a night of drinking alcohol. C. The patient who has been taking asprin for a headache and is scheduled to receive valproic acid. D. The patient who is scheduled to receive carbamazepine who was started on verapamil.
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A The patient who is scheduled to receive phenobarbital and has a plasma level of 38 mcg/mL is safe to receive the medication. The therapeutic range is 10 to 40 mcg/mL Barbiturates react with acohol to cause central nervous system depression. This patient should wait until the alcohol is cleared from his system. Aspirin interacts with valproic acid, and this patient should wait to take the medication. Carbamazepine interacts with verapamil and can cause toxicity. The healthcare provider should be notified in each of these cases where the medication is held.
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A parent calls the clinic to state that a child, who has a history of a seizure disorder, has a rash all over the torso. What is the most appropriate assessment question for the nurse to ask? A. Ask the parent if the child is on any new medication. B. Ask the parent if the child has seasonal allergies. C. Ask the parent to hold all medications and come into the clinic. D. Ask the parent if the child has been outside today.
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A The most appropriate question is to ask if the child is on any new medication. Several antiseizure medications can cause a rash as an adverse effect. Seasonal allergies are unlikely to cause a rash on the torso. Holding all medications should not be recommended without first assessing what medications the child is taking. If a child received a rash as a result of coming in contact with something outside, it is most likely to occur on the hands and arms or other exposed skin, not on the torso.
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Which action is the highest priority for a patient who is receiving antiepileptic drug therapy for the first time? A. Teaching the patient about side effects of therapy. B. Observing for suicidal tendencies. C. Encouraging regular check ups at the healthcare provider. D. Weighing the patient weekly.
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B The nurse should observe the patient for changes in mental status and suicidal tendencies, and teach the patient's family to observe for these potential side effects when the patient returns home. Teaching about side effects would be an appropriate second priority. Encouraging checkups and weighing the patient would most likely be prudent, but not the highest priority for the patient.
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The patient is being treated with phenytoin (Dilantin) for seizures. The nurse is instructing the patient on follow-up appointments that will be needed to maintain the patient's level of health. The nurse instructs the patient that appointments should be made on a regular basis with which health care professional? A. Physical therapist B. Dentist C. Psychologist D. Chiropractor
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B The patient should see his or her dentist frequently to avoid the possibility of gingival hyperplasia developing as a side effect of the medication.
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The nurse is assessing a patient who is receiving antiepileptic drug therapy with phenytoin. What assessment finding requires immediate action? A. Pale skin B. Weight gain C. Nystagmus D. Heart rate 60 beats/min
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C The patient who has nystagmus may be presenting with adverse effects to phenytoin therapy and should be assessed for other signs of toxicity. Pale skin, weight gain, and heart rate of 60 are not assessment findings that require immediate action. Nystagmus is the only symptom presented that could be determined to be toxic effects of therapy.
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The patient is being started on gabapentin (Neurontin) and is being seen by the nurse in order for baseline data to be gathered. Which assessment is a priority for this patient? A. Respiratory assessment B. Cardiac assessment C. Neurological assessment D. Urological assessment
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C Gabapentin requires a thorough neurologic assessment, including baseline energy levels, vision level, sensory and motor functioning, and any changes in speech.
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What is the most common adverse effect of phenobarbital? A. Sedation B. Hirsutism C. Long half-life D. Gingival hyperplasia
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A Phenobarbital is a long-acting barbiturate and is the most widely used antiseizure medication. The most common adverse effect associated with phenobarbital use is sedation. Hirsutism is an adverse effect of phenytoin. The major advantage of phenobarbital is its long half-life. Gingival hyperplasia is an adverse effect of phenytoin.
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A patient taking valproic acid (Depakene) has elevated liver function tests. What will the nurse expect the provider to order? A. Daily liver function tests B. Immediate discontinuation of the medication C. Every other day administration of the medication D. Tapering the medication as another medication is started.
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D Hepatotoxicity is an adverse effect associated with the use of valproic acid. When the medication is changed, the first medication is withdrawn as the second one is increased. The medication should not be stopped abruptly as this can precipitate seizures. The medication should not be continued.
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A postoperative craniotomy patient is received in the intensive care unit. The nurse makes sure which prescribed drug is readily available to treat acute seizure activity? A. gabapentin (Neurontin) B. diazepam (Valium) C. ethosuximide (Zarontin) D. flumazenil (Romazicon)
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B Therapy for acute seizure activity is typically diazepam (Valium), which is considered by many to be the drug of choice. Other drugs used for acute therapy include lorazepam, fosphenytoin, phenytoin, and phenobarbital.
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A provider has ordered once-daily phenytoin (Dilantin) for an 8-year-old child who has a seizure disorder, and the parents say that is is "impossible" to have the child take pills by mouth. What intervention would the nurse recommend? A. The parents should learn to administer shots, and phenytoin could be given IM. B. The parents should open the medication and put it in food without the child's knowledge. C. The parents should ask the healthcare provider for a suspension form of the medication. D. The parents should request a chewable form of phenytoin and put it into the child's food.
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C Suspensions are an alternative to pills for young children. Phenytoin is never administered IM. Childrens medication should not be mixed with food unknowingly, as this could lead to the child avoiding certain types of food. There is also the risk the child would not eat all of the food. Children should not be bribed with treats they are not normally allowed to eat, as this can lead to manipulative behavior. Chewable forms of phenytoin should not be used for once-daily dosing.
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Status epilepticus
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Tonic clonic convulsions lasting for several minutes or occurring at close intervals were patient does not regain consciousness; hypotension, hypoxia, cardiac dysrhythmias also can occur; true medical emergency
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Mechanism of AEDs
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1. Alters neurotransmitters (increasing concentration of gabapentin, which is an inhibitory neurotransmitter) 2. Affects calcium and sodium transport in nerve, increasing the length of time it takes for the nerve to return to its active state
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What is primidone metabolized to in the liver?
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Phenobarbital
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What are the 3 classes of AEDs?
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1. Barbituates 2. Hydantoins 3. Iministilbenes
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What is the most common adverse effect of phenobarbital?
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Sedation
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What are the therapeutic serum drug levels of phenobarbital?
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10-40 mcg/mL
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Phenobarbital contraindications
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known drug allergy, porphyria, liver and kidney impairment, respiratory illness
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Adverse effects of phenytoin
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Gingival hyperplasia, hirsutism, Dilantin facies, acne, osteoporosis
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Therapeutic levels of phenytoin
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10-20 mcg/mL
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Important parameters for administering phenytoin IV
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-Use a 20 gauge or larger catheter -diluted in normal saline -filter must be used -saline flushes should be performed
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Fosphenytoin
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-Injectable prodrug of phenytoin -can be given IM, continuous IV or IV push without causing irritation
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Carbamazepine (Tegretol)
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-antiepileptic and mood stabilizer -can cause autoinduction of hepatic enzyme, requiring gradually higher doses
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What is carbamazepine used to treat?
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-seizures, neuropathic pain (trigeminal neuralgia) and bipolar disorder
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What is ethosuximide (Zarontin) used to treat?
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-Absence seizures; not effective for secondary tonic-clonic seizures
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What can ethosuximide interact with?
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-Hepatic autoinducing drugs (ex: carbamazepine)
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What is the mechanism of gabapentin (Neurontin?)
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Increases the concentration and synaptic accumulation of the inhibitory neurotransmitter, GABA
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What is gabapentin used to treat?
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-seizures -neuropathic pain (ex: herpes zoster) -hot flashes -restless leg syndrome
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What is lamotrigine (Lamictal) used to treat? What are possible adverse effects?
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-seizures -bipolar disorder -adverse effects include CNS and GI symptoms as well as Stevens-Johnson syndrome
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levetiracetam (Keppra) therapeutic uses
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-adjunct seizure therapy for primary and secondary partial seizures
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Pregabalin (Lyrica) therapeutic uses
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-adjunct therapy for partial seizures -neuropathic pain, neuralgia, fibromyalgia
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What should be kept in mind with administration of oral AEDs?
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-take medication at the same time each day -eat with food to avoid GI upset -do not crush or chew extended-release forms
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Which intervention is a priority in the administration of intravenous (IV) Dilantin therapy? A. Administering by slow IV push. B. Monitor for side effects. C. Monitor serum drug levels D. Flush the tubing after administration.
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A The priority is to administer Dilantin slowly to prevent irritation to veins. Monitoring side effects, flushing the tubing and monitoring serum drug levels are all interventions that are done after administering the drug. The priority is the first intervention, which is proper administration of the medication.
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A patient is experiencing episodes of intense facial pain. The nurse anticipates that which drug may be ordered for this patient? A. Levetiracetam (Keppra) B. Carbamazepine (Tegretol) C. Lamotrigine (Lamictal) D. Topiramate (Topamax)
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B Carbamazepine (Tegretol) is indicated in the treatment of trigeminal neuralgia (a painful facial nerve condition).
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The patient has been placed on the oral form of valproic acid for seizure management. Which is an appropriate meal choice for this patient? A. Chicken, broccoli, iced tea B. Hamburger, French fries, seltzer C. Steak, macaroni and cheese D. Chicken sandwich, apple, milk
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A The patient who is being treated with the oral form of valproic acid should avoid both milk products and carbonated beverages. These should be avoided because they may lead to the drug dissolving early and irritating the mucosa.
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The nurse is administering IV diazepam (Valium). When will the nurse expect the onset of the drug to occur? A. Immediately B. Within 5 minutes C. Within 15 minutes D. Within 1 hour
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A When diazepam is given intravenously, the nurse should expect the onset of the drug to occur immediately.
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The nurse is monitoring a patient with a phenytoin level of 8 mcg/ml. What is an appropriate nursing action? A. Call the healthcare provider for an increase in dosage. B. Hold the medication and call the healthcare provider. C. Document the value and continue to monitor the patient. D. Draw another lab value within the hour.
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A Therapeutic levels for phenytoin therapy are 10 to 20 mcg/ml. A patient with a level of 8 is likely to continue to have seizures. The healthcare provider needs to be called for an increase in dosage. Since the phenytoin level is not therapeutic, holding the medication or giving it and continuing to monitor or check labs are inappropriate actions.
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What information should the nurse provide to a patient who will self-administer an antiepileptic agent for the first time at home? A. Wait to see how you react to the medication before driving. B. Lie in bed for at least an hour after taking any antiepileptic agent. C. Take the antiepileptic agent with milk or juice to prevent stomach upset. D. Do not take the medication if you have a fever.
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Antiepileptic medications suppress the central nervous system. The patient should know how they respond to the medication before attempting tasks such as driving. The patient does not have to lie in bed for an hour after taking an antiepileptic. Several medications cannot be taken with milk or fruit juice, and the nurse should not instruct the patient to administer medication in this manner. A fever is not a contraindication to taking an antiepileptic agent.
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What adverse effects should patients report to the HCP when taking AEDs?
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-LOC changes, mental status changes, mood changes, blood dyscrasias, sore throat and fever (can occur with phenytoin)
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What neurotransmitter imbalances are responsible for the symptoms associated with Parkinson's disease?
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-An increase in acetylcholine and a decrease in dopamine
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What are the classic symptoms of Parkinson's disease?
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Tremors Rigidity Akinesia Postural instability
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What are the two common types of movements associated with Parkinson's disease?
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Chorea Dystonia
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Chorea
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irregular, spasmodic, involuntary movements of the limbs or facial muscles
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dystonia
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abnormal muscle tone leading to impaired movements
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Selegiline (Eldepryl)
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Selective MAO-B inhibitor used to treat PD; does not elicit the cheese effect if 10 mg or less is given daily
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Rasagiline (Azilect)
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Selective MAO-B inhibitor used to treat PD; does not elicit the cheese effect if 10 mg or less is given daily
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What drug should not be concurrently used with selegiline and rasagiline?
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Meperidine
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What is the mechanism of amantadine?
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Indirect acting dopamine modulator and causes release of dopamine from storage to presynpatic nerve fibers and blocks the reuptake of dopamine
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What else is amantadine used for?
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Antiviral used in the treatment of influenza Used early in the course of the disease and is only effective for 6 to 12 months Used in adjunct with levodopa
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To what class do tolcapone and and entacapone belong?
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COMT inhibitors: they block COMT, which is an enzyme that breaks down the body's catecholamines
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What are the therapeutic uses of COMT inhibitors?
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Prolong the effects of levadopa and lessen the wearing off effect
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A common side effect of tolcapone and entacapone is
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Discolored urine
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What is an adverse effect of tolcapone
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Severe liver failure
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Levodopa
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The precursor to dopamine
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What is the mechanism of bromocriptine?
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Activates presynaptic dopamine receptors to stimulate the production of more dopamine
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What are some indications of bromocriptine?
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-PD -inhibits prolactin production to treat galactorrhea -treatment of prolactin-secreting tumors
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In what patients would you use caution with bromocriptine?
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Patients with peripheral vascular disease
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What drugs does bromocriptine interact with?
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-Erythromycin -Adrenergic drugs
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Ropinirole (Requip) and Rotigotine
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-Also used to treat restless leg syndrome
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Carbidopa
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-Administered with levodopa; acts as a vehicle that delivers levodopa to the blood-brain barrier and prevents the breakdown of levodopa in the periphery -Requires lower doses of levodopa
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What are the contraindications for carbidopa-levodopa?
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-use caution in patients with open-angle glaucoma -contraindicated in patients with closed-angle glaucoma
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What does levodopa interact with?
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Pyridoxine and dietary protein
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How should carbidopa-levodopa be administered?
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-with food to minimize GI upset, but can be taken on an empty stomach
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What anticholinergics are used to treat PD?
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-benztropine -trihexyphenidyl -antihistamines: diphenhydramine (Benadryl)
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Teaching points for benztropine
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-use caution in hot weather as it can cause hyperthermia -avoid alcohol
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What are the indications for benztropines?
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-PD -extrapyramidal symptoms for antipsychotics
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What might happen if levodopa is taken with MAOIs?
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Hypertensive crisis
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The nurse is assessing a patient with Parkinson's disease who has been prescribed levodopa (Sinemet) and selegiline (Emsam). The nurse advises the patient to avoid drinking red wine and beer. What is the most probable reason for giving such instruction? A. Red wine and beer decrease dopamine levels. B. Red wine and beer decrease the efficiency of levodopa. C. Red wine and beer interact with selegiline (Emsam). D. Red wine and beer decrease blood pressure.
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C Red wine and beer contain tyramine. Selegiline (Emsam) interacts with tyramine, increasing catecholamine concentrations and inhibiting the activity of the drug. This is called the "cheese effect." Therefore, the patient must be advised to avoid drinking red wine and beer. Red wine and beer increase the concentration of serotonin and dopamine; they do not decrease dopamine concentrations. Red wine and beer do not interact with levodopa because they do not affect levels of monoamino oxidase. Red wine and beer may cause hypertensive crisis and increase blood pressure.
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What is the main anatomical area of the brain that is affected in a patient with Parkinson's disease? A. Substantia nigra B. Cerebellum C. Thalamus D. Globus pallidus
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A The substantia nigra is a part of the extrapyramidal system, which is involved in motor function, including posture, muscle tone, and smooth muscle activity. Dopamine depletion in this area causes Parkinson's disease. The cerebellum is the area of the brain involved in the regulation of muscle coordination. The thalamus is the relay station for brain impulses. The globus pallidus is a structure adjacent to the substantia nigra and is not affected in patients with Parkinson's disease.
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Which clinical symptom in a patient who is receiving anticholinergic drug therapy requires the least intervention by a nurse? A. Dark urine B. Tachycardia C. Constipation D. Blurred vision
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A Anticholinergic drugs such as entacapone (Comtan) cause dark discoloration of the urine. This is due to the presence of the drug in the urine and does not require an intervention by a nurse. Tachycardia, constipation, and changes in vision, such as blurred vision, are the possible adverse effects of anticholinergic drugs and should be reported to a nurse because they occur as a result of a pathologic change in the underlying organ of the body.
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The nurse is assessing a patient who was recently diagnosed with Parkinson's disease. The patient's medical records show the presence of liver failure. Which drug will the nurse anticipate to be contraindicated in the patient? A. Ropinirole (Requip) B. Tolcapone (Tasmar) C. Pramipexole (Mirapex) D. Amantadine (Symmetrel)
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B Tolcapone (Tasmar) is an anti-Parkinson drug that is contraindicated in patients with liver failure. Tolcapone (Tasmar) is a catechol ortho-methyltransferase inhibitor and gets metabolized in the liver and may cause liver toxicity. Ropinirole (Requip) is a nondopamine receptor agonist and is not contraindicated in liver failure. Pramipexole (Mirapex) is a direct-acting dopamine receptor agonist. It does not affect liver function and is not contraindicated in liver failure. Amantadine (Symmetrel) is an antiviral drug that is used in the treatment of moderate Parkinson's disease but is not contraindicated in liver failure.
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The nurse is caring for a patient who has Parkinson's disease. The primary health care provider has prescribed an indirect-acting dopamine receptor agonist and a dopamine replacement drug to the patient. What advice does the nurse give to the patient to increase the effectiveness of the treatment? A. "Include cheese in your diet." B. "Take vitamin B6 supplements." C. "Take medications before bed." D. "Perform regular physical activity."
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D Indirect-acting dopamine receptor agonists and dopamine replacement drugs are prescribed for the treatment of Parkinson's disease. Regular physical activity is necessary because exercising along with the drug therapy helps to greatly improve mobility and increases the effectiveness of the treatment. Indirect-acting dopamine receptor agonists interact with food containing tyramine, resulting in complications; therefore, cheese should be avoided. Pyridoxine may decrease the efficacy of dopamine replacement drugs, so vitamin B6 supplements should be avoided. Selegiline (Emsam) and carbidopa-levodopa (Sinemet) do not have any sedative effect; therefore, these drugs are not necessarily taken before bed.
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While teaching a patient about carbidopa-levodopa (Sinemet), what will the nurse include? A. Carbidopa decreases levodopa's conversion in the periphery, increasing the levodopa available to cross the blood-brain barrier. B. Carbidopa increases levodopa's conversion in the periphery, enhancing the amount of dopamine available to the brain. C. Giving both drugs together enhances adverse effects. D. Carbidopa crosses the blood-brain barrier to increase the metabolism of levodopa to dopamine in the brain.
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A Adding carbidopa to levodopa decreases the breakdown of levodopa in the periphery, increasing the amount available to cross the blood-brain barrier and decreasing the extrapyramidal adverse effects caused by dopamine in the periphery. Carbidopa does not increase levodopa's conversion in the periphery. Usually carbidopa helps minimize the adverse effects of levadopa. Carbidopa does not cross the blood-brain barrier.
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A patient with Parkinson's disease and comorbid depression is prescribed selegiline (Emsam). What will the nurse do when administering the medication to the patient? A. Ask the patient to chew the drug properly before swallowing. B. Ask the patient to keep the drug under the tongue for 5 minutes. C. Apply the transdermal patch of the drug on the patient's upper arm. D. Dissolve the drug in 250 mL of water before administration.
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C Selegiline (Emsam) is a type B monoamine oxidase inhibitor that is used to treat major depressive disorder. Selegiline (Emsam) is available as a transdermal formulation with the trade name Emsam. Therefore, the nurse should apply the transdermal form of the drug to the patient's skin using a dry, smooth area of skin. The nurse should ask the patient to chew the medication when administering the buccal form of the drug (e.g., Zelapar). Sublingual formulations of medications should be kept under the tongue. Therefore, the nurse would not ask the patient to keep the medication under the tongue. Dissolving the drug in 250 mL of water is useful for oral forms of drugs that require more time to disintegrate.
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A patient is prescribed pramipexole (Mirapex) twice a day. After assessing the patient, the nurse reports to the primary health care provider that the patient gained 8 kg weight in a week. Which probable instruction does the nurse expect to receive from the primary health care provider? A. Increase the fiber content in the patient's diet. B. Administer pramipexole (Mirapex) once a day. C. Discontinue pramipexole (Mirapex). D. Avoid giving foods containing tyramine to the patient.
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C Pramipexole (Mirapex) is a nondopamine receptor agonist that is used to treat Parkinson's disease. Its major adverse effect is edema (fluid retention), which causes weight gain. The patient's weight increased 8 kg, indicating that the patient has edema. Therefore, the nurse would expect the primary health care provider to discontinue pramipexole (Mirapex) in this patient. Increasing fiber content will not be effective because it does not reduce edema. Administering pramipexole (Mirapex), even if only once a day, would result in adverse effect of the drug due to drug metabolism. Avoiding foods containing tyramine helps to prevent the cheese effect in patients who have been prescribed monoamine oxidase inhibitors. This does not help to prevent the edema caused by pramipexole (Mirapex).
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The nurse is providing care for a patient who has been diagnosed with Parkinson's disease. The patient is also in early stage liver failure. What medication or class of medications, if prescribed, would the nurse question? A. ropinirole (Requip) B. Anticholinergic C. Tolcapone (Tasmar) D. Ergot derivative
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C Tolcapone is contraindicated in patients with liver failure or liver disease. Potential liver failure is also a known side effect. The use of this drug is restricted to those who have not responded to other drug therapies.
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A patient who has been taking antiparkinson medications for years begins to have increased symptoms on a constant basis. In documenting these symptoms, what term will the nurse use? A. On-off phenomenon B. Wearing-off phenomenon C. Chorea D. Dystonia
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B The wearing-off phenomenon occurs when antiparkinson medications begin to lose their effectiveness, despite maximal dosing, as the disease progresses. The symptoms return and continue on a constant basis despite treatment and medications.
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A patient is taking an anticholinergic medication along with an antiparkinson medication to treat Parkinson's disease. Which statement by the patient indicates further teaching is required? A. "If it makes me nauseated, I can take the medication with crackers." B. "I can take this medication at bedtime, as it makes me sleepy." C. "No matter what, I cannot take this medication with food." D. "I can use hard candy to decrease any mouth dryness."
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C With anticholinergic drugs, patients need to take the medication as prescribed, after meals or at bedtime, and not at the same time as other medications. Because of the risk of stomach upset (nausea, vomiting), it is recommended that these drugs be taken with a snack, such as ginger ale and crackers. These medications are generally taken at night because of their sedating properties. Measures to help prevent and treat dry mouth are encouraged, such as increasing fluids and sucking on sugar-free hard candies.
