Charter College, Anchorage - NURSING NU1005

Chapter 26: Drug Therapy for Alzheimer’s and Parkinson’s Diseases

Workman & LaCharity: Understanding Pharmacology: Essentials for Medication Safety, 2nd Edition

MULTIPLE CHOICE

BASIC CONCEPTS

1)Which statement about Alzheimer’s disease is true?

1. 1. The causes of Alzheimer’s disease are known but not treatable.
   2. Physical deterioration occurs before intellectual deterioration.
   3. The onset of the disorder is sudden and dramatic.
   4. It is the most common form of dementia.

2. How do cholinesterase/acetylcholinesterase inhibitors work for treatment of Alzheimer’s disease?
   1. Protecting the neurons from the changes that occur with Alzheimer’s disease.
   2. Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses.
   3. Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain.
   4. Increasing the amount of white matter surrounding neurons to prevent the formation of “tangles.”

3. How does memantine (Namenda) work for treatment of Alzheimer’s disease?
   1. Protecting the neurons from the changes that occur with Alzheimer’s disease
   2. Blocking the enzyme that breaks down the neurotransmitter at the neuron synapses
   3. Blocking the amino acid glutamate at the N-methyl-D-aspartate receptors in the brain
   4. Increasing the amount of white matter surrounding neurons to prevent the formation of “tangles”

4. Which problem is a common side effect of donepezil (Aricept) for treatment of Alzheimer’s disease?
   1. Weight gain
   2. Hypertension
   3. Constipation
   4. Nausea/vomiting

5. What problem is a possible adverse effect of memantine (Namenda) for Alzheimer’s disease?
   1. Seizures
   2. Tachycardia
   3. Severe hypertension
   4. Peripheral neuropathy

6. Which problem is a major symptom of Parkinson’s disease?
   1. Memory loss
   2. Urinary retention
   3. Abnormal gait
   4. Nausea/vomiting

7. Which drug used to treat Parkinson’s disease is a COMT inhibitor?
   1. Rasagiline (Azilect)
   2. Bromocriptine (Parlodel)
   3. Carbidopa (Sinemet)
   4. Tolcapone (Tasmar)

8. Which problem is a common side effect of most drugs used to treat Parkinson’s disease?
   1. Asthma
   2. Hypotension
   3. Constipation
   4. Weight gain

9. Which drug for Parkinson’s disease is not recommended for breastfeeding mothers because it stops the production of breast milk?
   1. Rasagiline (Azilect)
   2. Bromocriptine (Parlodel)
   3. Carbidopa (Sinemet)
   4. Tolcapone (Tasmar)

10. Which symptom is often the earliest to occur in a patient with Alzheimer’s disease?
    1. Difficulty solving simple math problems
    2. Problems performing simple tasks
    3. Mild forgetfulness
    4. Inability to read

11. Which common initial symptom suggests that a patient may be developing Parkinson’s disease?
    1. Pill-rolling tremor
    2. Muscle rigidity
    3. Stooped posture
    4. Stumble-run walk

12. Which drug used to treat Parkinson’s disease is a pure dopamine agonist?
    1. Trihexyphenidyl (Artane)
    2. Tolcapone (Tasmar)
    3. Selegiline (Zelapar)
    4. Rotigotine (Neupro)

ADVANCED CONCEPTS

13. Which is the common underlying pathophysiology of both Alzheimer’s disease and Parkinson’s disease?
    1. Both are neurodegenerative diseases.
    2. Both are forms of dementia.
    3. Both involve interrupted transmission of nerve impulses.
    4. Both are primarily caused and directly related to environmental factors.

14. For which patient do you watch most closely for symptoms of Alzheimer’s disease?
    1. 35-year-old with Down syndrome
    2. 50-year-old with a whiplash injury
    3. 60-year-old with hypertension
    4. 75-year-old with a smoking history

15. Which statement made by a patient with Alzheimer’s disease indicates the need for additional teaching?
    1. “When I have been taking donepezil for 6 weeks I should regain my memories.”
    2. “The only way to be sure that I have Alzheimer’s disease is by autopsy after I die.”
    3. “Even with medication, eventually I will need total care to prevent complications.”
    4. “The rivastigmine I am taking may slow down the progression of my symptoms.”

16. A patient with Alzheimer’s disease has been prescribed memantine (Namenda). The patient has developed the symptoms of vomiting, drooling, heart rate of 56 beats/minute, and muscle weakness. What is your best action?
    1. Contact the prescriber and ask for an order for an as-needed antiemetic drug.
    2. Place the patient on a heart monitor and check the heart rate every 2 hours.
    3. Hold the drug dose and contact the prescriber immediately.
    4. Give the drug exactly as ordered.

17. Which strategy best supports safe medication administration for patients with Alzheimer’s disease?
    1. Include the patient’s care provider when teaching about the patient’s drugs.
    2. Provide written guidelines about each drug to the patient.
    3. Create a chart listing the drugs, dosages, and times they should be taken.
    4. Suggest that the patient set up the drugs each week in labeled boxes.

18. A patient with Alzheimer’s disease is prescribed rivastigmine (Exelon). What action should you suggest to prevent a common side effect?
    1. Give the drug with a full glass of water.
    2. Administer the drug with meals twice a day.
    3. Assess the patient’s level of consciousness.
    4. Keep an accurate record of all patient food intake.

19. What is the most important precaution to teach a patient who is prescribed transdermal rivastigmine (Exelon)?
    1. Always remove old patches daily and apply the new patch to a different site.
    2. Report any difficulty starting the urinary stream to your prescriber immediately.
    3. Place the patch on the neck or forehead so that the drug reaches the brain more quickly.
    4. For best drug absorption, hold a warm washcloth over the patch for 5 minutes after applying it.

20. For which patient should the drug donepezil (Aricept) for Alzheimer’s disease be avoided?
    1. 54-year-old woman with early onset Alzheimer’s disease
    2. 67-year-old man who also takes drugs for type 2 diabetes
    3. 72-year-old woman who is 20 lb underweight
    4. 72-year-old man who is unable to sit or stand

21. Which statement is true about how drugs for Parkinson’s disease work?
    1. Dopaminergic drugs decrease the amount of dopamine activity in the brain.
    2. COMT inhibitors allow a larger amount of levodopa to reach the brain, which lowers the brain’s dopamine levels.
    3. MAO-B inhibitors facilitate the enzyme monoamine oxidase B that breaks down dopamine in the brain.
    4. Anticholinergic drugs block cholinergic nerve impulses to minimize tremors and rigidity.

22. A patient with Parkinson’s disease who has been prescribed entacapone (Comtan) tells you he is experiencing muscle aches, weakness, and has dark cola-colored urine. What is your best action?
    1. Send a urine specimen to the laboratory for urinalysis.
    2. Help the patient back to bed and instruct him or her to rest.
    3. Tell the patient that these are expected side effects of the drug.
    4. Hold the drug and notify the prescriber immediately.

23. Which blood laboratory test result is most important to check before administering the first prescribed dose of carbidopa-levodopa (Sinemet) to a patient?
    1. International normalized ratio (INR)
    2. Blood urea nitrogen (BUN) level
    3. White blood cell (WBC) count
    4. Lactate dehydrogenase (LDH)

24. For which adverse effect should you monitor in a patient with Parkinson’s disease after administering ropinirole (Requip)?
    1. Neuroleptic malignant syndrome
    2. Depression with suicidal tendencies
    3. Central nervous system depression
    4. Narcolepsy or sleep attacks

25. A patient with Parkinson’s disease informs you that the stiffness and slowness of movements associated with the illness have become worse. What should you teach the patient about this change?

1. 1. “These changes are normal and expected as your disease progresses.”
   2. “You will need to use a walker at all times to avoid falls and accidents.”
   3. “Whenever your symptoms worsen, contact your prescriber right away.”
   4. “If your prescriber increases your drug dosage these functions will improve.”

26. A patient taking entacapone (Comtan) for Parkinson’s disease informs you that his urine is now brownish-orange in color. What is your best action?
    1. Explain that this is an expected side effect and is not harmful.
    2. Collect a urine sample and send it to the laboratory for urinalysis.
    3. Hold the drug and immediately notify the prescriber.
    4. Instruct the patient to increase his intake of fluids.

27. What safety precaution should you teach a patient with Parkinson’s disease who is prescribed benztropine (Cogentin)?
    1. Always dress warmly and avoid extended exposure to cold weather.
    2. Stay indoors in an air-conditioned setting during hot weather.
    3. Change positions slowly to avoid dizziness or light-headedness.
    4. Avoid alcohol intake because drowsiness is associated with this drug.

28. A patient who has been prescribed carbidopa-levodopa (Sinemet) informs you that a dark spot on his arm is getting larger. What is your best action?
    1. Measure the size of the spot and document the finding.
    2. Inform the patient that this is an expected side effect of the drug.
    3. Administer the drug as ordered by the prescriber.
    4. Hold the drug and contact the prescriber about this change.

29. Why is bromocriptine (Parlodel) not recommended for women who are breastfeeding?
    1. It stops the production of milk.
    2. It enters the milk and slows infant growth.
    3. It enters the milk and causes symptoms of Parkinson’s disease in the infant.
    4. It is a pregnancy category C drug and has been found to cause birth defects in animals.

30. A patient is prescribed entacapone (Comtan) 800 mg/day. The drug is available in 200 mg tablets. How many tablets should you give?
    1. 2
    2. 4
    3. 6
    4. 8

31. A patient diagnosed with probable Alzheimer’s disease is having his swallowing ability tested. His wife asks you why this is necessary. What is your best response?
    1. “This is a routine assessment that is completed for every patient.”
    2. “The prescriber ordered this test to be done to prevent side effects of a new drug for your husband’s disease.”
    3. “This test tells us where your husband’s swallowing is now, because it may get worse as his disease progresses.”
    4. “We are concerned about whether we will need to place a feeding tube to give his medications.”

32. A patient is prescribed donepezil (Aricept) for Alzheimer’s disease. What assessment is most important after giving this drug?
    1. Blood pressure
    2. Bowel sounds
    3. Peripheral pulses
    4. Signs of bleeding

33. A patient prescribed donepezil (Aricept) is to have surgery requiring general anesthesia. Her husband tells you that he read that taking this drug while having surgery can be dangerous. What is your best response?
    1. “Because of the action of donepezil, she may awaken more slowly and may need to remain in the postanesthesia care unit for a longer period of time.”
    2. “Let me contact your surgeon because the danger of taking donepezil and having general anesthesia is that she may have a massive heart attack.”
    3. “I don’t think there is any danger because if there was your surgeon would certainly have discontinued use of this drug until after the surgery.”
    4. “The most dangerous risk is that after the surgery your wife may lose her ability to swallow and aspirate food or medications, ending up with aspiration pneumonia.”

34. A patient prescribed rasagiline (Azilect) for Parkinson’s disease asks you how this drug will help his disease. What is your best response?
    1. “This drug works by increasing the amount of dopamine activity in the brain and reducing tremor and muscle rigidity to improve movement.”
    2. “This drug works by allowing a larger amount of levodopa to reach the brain, which raises dopamine levels in the brain.”
    3. “This drug works by blocking cholinergic nerve impulses that help control the muscles of the arms, legs, and body.”
    4. “This drug works by helping provide a more stable, constant supply of levodopa, which makes its beneficial effects last longer.”

35. A patient with advanced Parkinson’s disease is prescribed extended-release—50 mg carbidopa/200 mg levodopa capsule twice daily. The patient has difficulty swallowing. What is your best action?
    1. Open the capsule and mix the contents with apple sauce.
    2. Open the capsule and dissolve the contents in water.
    3. Contact the pharmacy to send a liquid form of the drug.
    4. Ask the prescriber to order a different form of the drug.

36. For which common side effects should you monitor after administering any anti-Parkinson’s drug to a patient?
    1. Dizziness and hypotension
    2. Diarrhea and nausea
    3. Hypertension and headache
    4. Body rash and elevated temperature

37. Which precaution should you teach patients prescribed carbidopa-levodopa (Sinemet)?
    1. Avoid crowds and people who are ill.
    2. Take this drug with an antacid to prevent ulcers.
    3. Restrict your fluid intake to less than 1.5 L daily.
    4. Keep the bottle containing the drug in the refrigerator.

38. What is the minimum time period needed before reapplying a rotigotine patch to the same skin site?
    1. 7 days
    2. 14 days
    3. 21 days
    4. 28 days

MULTIPLE RESPONSE

1. What are the major symptoms of Parkinson’s disease? (select all that apply)
   1. Bradycardia
   2. Rigidity