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PrepU – Chapter 47: Drug Therapy for Parkinson’s Disease and Anticholinergics

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The three major features of Parkinson’s include:
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rigidity, bradykinesia, and tremors.
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A patient is newly diagnosed with Parkinson’s disease, and levodopa (Dopar) has been prescribed. What patient teaching information should be considered a high priority for this patient?
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Avoid vitamin B6 intake, since a combination with levodopa may lead to decreased efficacy.
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A nurse is speaking to a group at the Senior Citizens Center about Parkinson’s disease. What should the nurse include in the presentation about what elderly people using anticholinergic medications should avoid?
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Strenuous exercise in high environmental temperatures
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A 66-year-old woman presents at the clinic with motion sickness. The physician orders a scopolamine patch. Which statement by the client leads the nurse to believe the client knows how to use the patch? – “I will place it on my chest each morning after I shower.” – “I will use it only if I feel sick to my stomach.” -“I will change the patch every 4 hours. I can use the patches for 1 week.” -“I will change the patch every 3 days.”
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“I will change the patch every 3 days.”
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A nurse is caring for 70-year-old patient who is undergoing anticholinergic drug therapy. The nurse should assess for which condition when caring for this elderly patient?
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Confusion and disorientation
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The nurse is preparing a male client for pacemaker surgery. The physician orders atropine to be given 30 minutes before the patient leaves for the operating room. The nurse knows that the physician ordered this medication for what reason?
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To dry up respiratory secretions to prevent aspiration during surgery
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A client with symptomatic bradycardia has been receiving atropine for the past 4 days. The client reports constipation, a common adverse effect of the drug. What is the most important suggestion the nurse could give the client?
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Increase bulk in the diet.
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An elderly woman is given scopolamine while on a cruise. She becomes very agitated and confused. The nurse knows that which is a likely reason for these symptoms?
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Older clients have a greater chance of adverse reactions to cholinergic blocking drugs.
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A 57-year-old female client has a history of two myocardial infarctions in the past 3 years. She presents to the physician’s office with symptoms of an overactive bladder. She requests an anticholinergic medication that she saw advertised on television. What does the nurse expect the physician to do for this client?
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Explain to the client that the medication is contraindicated because of her medical history p.885,887
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A client is to receive trihexyphenidyl as adjunctive treatment for Parkinson’s disease. The nurse would expect to administer this drug by which route?
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Oral
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Indications for use of anticholinergic drugs in the treatment for Parkinsonism include to:
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decrease salivation, spasticity, and tremors.
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Clients with what disorder should not be given anticholinergic drugs? -Epilepsy -Attention deficit disorder -Glaucoma -Severe anxiety or hyperactivity
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Glaucoma
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Atropine is derived from the belladonna plant. True or False.
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True
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A student asks the pharmacology instructor to explain the action of anticholinergic agents. What would be the instructor’s best response?
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They act to block the effects of the parasympathetic nervous system.
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What may parkinsonism result from? (Select all that apply.) Drugs Stroke Myocardial infarction Encephalitis Epilepsy
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Drugs Encephalitis
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A nurse is caring for a patient who has received carbidopa/levodopa. After administration of the first dose of the drug, the patient has developed gastrointestinal disturbances. Which nursing intervention should the nurse perform when caring for this patient?
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Administer the next drug dose with meals.
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A patient who is going on a cruise is concerned about motion sickness and sees the physician, who prescribes scopolamine. The nurse informs the patient that using scopolamine may cause the patient to experience:
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drowsiness.
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A 52-year-old male client is being treated for Parkinson’s disease. The nurse is aware that Parkinson’s disease results in muscle rigidity, tremor at rest, and postural instability. What occurs in the neurons that causes these symptoms?
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There is an imbalance between dopamine and acetylcholine.
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A 75-year-old male client is experiencing extrapyramidal symptoms secondary to an antipsychotic drug. Which drug would the nurse expect the physician to order to relieve these symptoms?
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Anticholinergics
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A client is using a scopolamine patch for treatment of motion sickness. The nurse would instruct the client to change the patch at which frequency?
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Every 3 days
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A patient is taking levodopa. What would the nurse caution the patient to avoid?
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Vitamin B6
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After teaching a patient who is prescribed a scopolamine patch, the nurse determines that the teaching was successful when the patient states that she will change the patch in which time frame?
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Every 3 days
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Anticholinergics do not block the effects of acetylcholine in the central nervous system. True or False.
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False
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Which drug is classified as a dopaminergic agent that treats Parkinsonism by supplementing the amount of dopamine in the brain?
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Carbidopa (Lodosyn)
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A nurse has been invited to speak to a support group for persons with movement disorders and their families. Which statement by the nurse addresses the chronic nature of these diseases and the relevant drug therapies? -“Drug therapy can consist of one or more drugs to eliminate the symptoms of these diseases.” -“Drugs do not cure these disorders; they instead enhance quality of life.” -“Persons of all cultures are treated similarly and respond in similar ways to treatment.” -“Drugs used to treat these disorders always pose a risk of severe liver and kidney dysfunction.”
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“Drugs do not cure these disorders; they instead enhance quality of life.”
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The pharmacology instructor is discussing the adverse effects of anticholinergic drugs. What drug would the instructor indicate is administered to counteract the effects of atropine poisoning?
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Physostigmine
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Administration of which classes of medications can decrease secretions of the upper respiratory tract?
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Cholinergic blocking drug
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Which agent would a nurse expect to administer transdermally?
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Scopolamine
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A male client is diagnosed with Parkinson’s disease. The nurse visits him 1 week after hospitalization to assess his progress and medication regimen compliance. He states that there is no significant improvement in his symptoms. What is the best response by the nurse? -“Noticeable improvement may not occur for several weeks after the initial drug dose.” – “Noticeable improvement usually occurs 7 to 10 days after the initial drug dose.” -“You should have noticed improvement by now; I will notify your physician.” -“Are you sure that you are taking the medication as ordered?”
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“Noticeable improvement may not occur for several weeks after the initial drug dose.”
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Unwanted anticholinergic effects include: -wakefulness, mental alertness, and decreased fatigue. -drowsiness or sleep; decreased muscle tone; and decreased ability to move. -increasing hyperactivity, excessive talking, nervousness, and insomnia. -constipation and dry mouth.
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constipation and dry mouth.
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The nurse would monitor a patient receiving a dopaminergic agent for which adverse effects. (Select all that apply.) Nervousness Dysphagia Flushing Hypertension Urinary frequency
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Nervousness Dysphagia Flushing
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A patient is prescribed dicyclomine. The nurse would expect to administer this drug by which route?
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Oral
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A patient is experiencing symptoms of a hyperactive bowel. Which agent would the nurse expect to be ordered?
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Dicyclomine
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Which drug is classified as a catechol-O-methyltransferase (COMT) inhibitor? Entacapone (Comtan) Carbidopa (Lodosyn) Benztropine (Cogentin) Biperiden (Akineton)
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Entacapone (Comtan)
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A patient, newly diagnosed with Parkinson’s disease, has been prescribed an anticholinergic drug. What is a common adverse effect of anticholinergic agents used for the treatment of Parkinson’s disease?
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Urinary retention
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The nurse is writing a plan of care for a patient taking anticholinergic drugs. What is an appropriate goal for this patient’s plan of care? -The patient will ineffectively cope with expected effects of drugs. -The patient will demonstrate ability to self-administer drugs incorrectly. -The patient will experience relief of symptoms for which anticholinergics are given. -Verbalize appropriate knowledge of other drugs, their effects, and side effects.
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The patient will experience relief of symptoms for which anticholinergics are given.
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A nurse is educating a patient newly diagnosed with Parkinson’s disease. Which description would the nurse offer to describe the disease?
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“It is characterized abnormalities in posture.”
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Some anticholinergic drugs have the same clinical indications in the pediatric population as in the adult population. Which statement accurately describes a difference between the populations related to the use of anticholinergics?
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Adverse effects tend to be more severe in children.
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A female client is diagnosed with Parkinson’s disease and is having difficulty performing her activities of daily living. Her physician orders pramipexole. Pramipexole may be used alone for which purpose?
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To improve motor performance and improve ability to participate in usual activities of daily living
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After teaching a group of students about adjunctive therapy used to treat Parkinson’s disease, the instructor determines that the teaching was successful when the students identify which agent as affecting catecholaimine-O-methyl transferase (COMT)?
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Entacapone
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A patient is receiving rasagiline. The nurse would instruct the patient to avoid which of the following? Select all that apply. Aged cheese Pepperoni Pickled herring Sour cream Milk Shellfish
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Aged cheese Pepperoni Pickled herring Sour cream
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While providing patient education for a patient newly diagnosed with Parkinson’s disease and their family, the nurse would explain that Parkinson’s disease is characterized by
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postural instability.
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A patient with asthma will soon begin treatment with atropine as an adjunct to a normal drug regimen. What teaching point should the nurse include in patient education related to this new aspect of drug treatment? -“You might find that you have to urinate more often for the first few days that you take the drug.” -“It’s possible that your eyes will take longer to adjust to bright lights.” -“If you develop diarrhea, it might be related to atropine and you should visit your doctor.” -“You’ll probably find that you are producing more saliva than normal; this is a normal side effect of atropine.”
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“It’s possible that your eyes will take longer to adjust to bright lights.”
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The nurse is educating a patient who has been prescribed atropine, an anticholinergic drug. Which instructions should the nurse provide to the patient?
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“Do not drive or operate machinery.”
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The nurse is aware that cholinergic blocking agents will be used preoperatively for what type of anesthesia?
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General
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A male client asks the nurse why he needs the preoperative anticholinergic medication ordered by the anesthesiologist. The nurse explains that anticholinergic drugs are given preoperatively to prevent which anesthesia associated complication?
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Bradycardia
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A female client begins tolcapone therapy, and her physician arranges for laboratory testing to be completed on a routine basis. The nurse expects which laboratory study to be ordered by the physician?
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Liver transaminase enzymes
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Which action would be a priority for a client receiving apomorphine? -Giving the drug with food -Monitoring cardiac status -Checking for skin lesions -Palpating the bladder
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Monitoring cardiac status
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Clients with what disorder should not be given anticholinergic drugs?
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Glaucoma
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What medications is the antidote for poisoning by insecticides containing organophosphates?
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Atropine
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An instructor is preparing a teaching plan for a group of students about drugs used to treat Parkinson’s disease. The nurse is planning to talk about amantadine. Which would the instructor include as an action?
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Increases the release of dopamine
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The cholinergic blocking drug glycopyrrolate (Robinul) is used in conjunction with anesthesia for which reason?
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Reduction of oral secretions
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The nurse has a patient who is receiving selegiline (Carbex, Eldepryl). The nurse knows that when selegiline (Carbex, Eldepryl) is administered, the nurse should assess for what adverse effects?
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Elevated blood pressure
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A nurse is caring for a 59-year-old patient with Parkinson’s disease. What would indicate to the nurse that the patient is experiencing an adverse reaction related to the drug carbidopa-levodopa? -Altered complete blood count -Blurred vision -Dark urine -Increased urine glucose levels
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Blurred vision
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Because of the systemic effects of anticholinergic drugs, patients using these drugs are more susceptible to:
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heat stroke related to decreased perspiration.
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The nurse is caring for a client with glaucoma and is aware that which category of preanesthetic medication is contraindicated in this client?
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Cholinergic blocking
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When administering entacapone, the nurse understands that this drug affects which enzyme?
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Catecholamine-O-methyl transferase
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What would be considered a peripheral anticholinergic effect of anticholinergic drug therapy? Delirium Blurred vision Agitation Memory loss
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Blurred vision