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Chapter 11: Drugs to Treat Parkinson’s Disease and Multiple Sclerosis

Every problem in the chapter beside the book’s answer, a chapter at a time as you scroll.

Chapter 11: Drugs to Treat Parkinson’s Disease and Multiple Sclerosis

12 problems · 0 figures

Case Study 11.2.1 §11.2 source ↗

Table 11.12 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Slight drooling but otherwise unremarkable.

• Cardiovascular: Audible S1, S2. Rhythm irregular. Absent jugular vein distention, no peripheral edema noted bilaterally.

• Respiratory: Clear in all fields bilaterally. Breath sounds unlabored and regular. Equal chest expansion.

• Gastrointestinal: Abdomen flat, soft, and nontender.

• Genitourinary: Difficulty starting urinary stream, weak flow, and dribbling afterward. Mild suprapubic distention.

• Musculoskeletal: Stooped posture while sitting. Gait unsteady with shuffling, slow steps, and reduced arm swing. Increased muscle tone with cogwheel rigidity in upper extremities.

• Neurological: Resting tremor in right hand. Flat affect.

• Integumentary: Skin intact.
Blood pressure: 126/72 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 22 breaths/min
Oxygen saturation: 90% on room air
Height: 5'8"
Weight: 204 lb

Read the following clinical scenario to answer the questions that follow.

Marcus Bell is a 68-year-old client who arrives at the provider’s office reporting a tremor in his right hand that has developed gradually over several months. He notices the tremors disappear when he is concentrating on it; however, they return quickly when he gets distracted. His wife states he has had a difficult time writing. He struggles holding the pen, and his writing is very small and sloppy. The client’s wife also voiced her concerns that he never smiles anymore and he cannot keep up with her when walking. Based on the history and physical examination, the provider diagnoses Marcus with the early stages of PD. The provider prescribes carbidopa/levodopa (Sinemet) 25 mg/100 mg three times daily.

History
Benign prostatic hyperplasia
Atrial fibrillation
Osteoarthritis
Emphysema
Cataracts



Current Medications
Flomax 0.4 mg orally, once daily
Xarelto 2.5 mg orally, twice daily
Lisinopril 20 mg orally, once daily
Advair Diskus 250 mg/50 mg, inhalation, twice daily

Denies nicotine, vaping, alcohol, or illicit drug use

After reviewing the client’s history, which condition would be most concerning when starting levodopa-carbidopa?
  1. a.
    Cataracts
  2. b.
    Emphysema
  3. c.
    Atrial fibrillation
  4. d.
    Osteoarthritis

Answer

C. Atrial fibrillation
This is concerning because this drug has the potential to exacerbate dysrhythmias.

Case Study 11.2.2 §11.2 source ↗

Table 11.12 in the book ↗
Vital Signs Physical Examination
Temperature: 98.4°F

• Head, eyes, ears, nose, throat (HEENT): Slight drooling but otherwise unremarkable.

• Cardiovascular: Audible S1, S2. Rhythm irregular. Absent jugular vein distention, no peripheral edema noted bilaterally.

• Respiratory: Clear in all fields bilaterally. Breath sounds unlabored and regular. Equal chest expansion.

• Gastrointestinal: Abdomen flat, soft, and nontender.

• Genitourinary: Difficulty starting urinary stream, weak flow, and dribbling afterward. Mild suprapubic distention.

• Musculoskeletal: Stooped posture while sitting. Gait unsteady with shuffling, slow steps, and reduced arm swing. Increased muscle tone with cogwheel rigidity in upper extremities.

• Neurological: Resting tremor in right hand. Flat affect.

• Integumentary: Skin intact.
Blood pressure: 126/72 mm Hg
Heart rate: 78 beats/min
Respiratory rate: 22 breaths/min
Oxygen saturation: 90% on room air
Height: 5'8"
Weight: 204 lb

Read the following clinical scenario to answer the questions that follow.

Marcus Bell is a 68-year-old client who arrives at the provider’s office reporting a tremor in his right hand that has developed gradually over several months. He notices the tremors disappear when he is concentrating on it; however, they return quickly when he gets distracted. His wife states he has had a difficult time writing. He struggles holding the pen, and his writing is very small and sloppy. The client’s wife also voiced her concerns that he never smiles anymore and he cannot keep up with her when walking. Based on the history and physical examination, the provider diagnoses Marcus with the early stages of PD. The provider prescribes carbidopa/levodopa (Sinemet) 25 mg/100 mg three times daily.

History
Benign prostatic hyperplasia
Atrial fibrillation
Osteoarthritis
Emphysema
Cataracts



Current Medications
Flomax 0.4 mg orally, once daily
Xarelto 2.5 mg orally, twice daily
Lisinopril 20 mg orally, once daily
Advair Diskus 250 mg/50 mg, inhalation, twice daily

Denies nicotine, vaping, alcohol, or illicit drug use

What medication would the nurse question if they saw it prescribed?
  1. a.
    Benztropine
  2. b.
    Entacapone
  3. c.
    Ropinirole
  4. d.
    Selegiline

Answer

A. Benztropine
This drug is a cholinergic blocker (anticholinergic). According to the Beers Criteria®, these drugs should not be used in those over the age of 60 years and with a history of BPH that causes urinary retention. This could worsen from the anticholinergic.

11-1 §11.RQ source ↗

A 68-year-old diagnosed with Parkinson’s disease is taking entacapone in addition to carbidopa/levodopa. Which of the following would be a priority nursing intervention?
  1. a.
    Check the client’s blood pressure twice a day to make sure it is not elevated.
  2. b.
    Assess the client’s ability to independently carry out their activities of daily living.
  3. c.
    Explain to the client the entacapone should be separated from the carbidopa/levodopa by 2 hours.
  4. d.
    Instruct the client to report brownish-orange urine to their health care provider immediately.

Answer

B. Assess the client’s ability to independently carry out their activities of daily living.
The nurse is evaluating the therapeutic effectiveness of the drugs. The client being able to perform more activities of daily living indicates the drugs are working.

11-2 §11.RQ source ↗

The nurse is caring for a client who was recently diagnosed with PD. The provider wanted to begin the client on pramipexole, but the client has difficulty swallowing medications due to a previous stroke. What other medication in the same class would best meet the client’s needs?
  1. a.
    Ropinirole ER
  2. b.
    Rotigotine
  3. c.
    Apomorphine
  4. d.
    Bromocriptine

Answer

B. Rotigotine
Because the client cannot swallow well, this drug is the best to meet their needs. It is available in a patch form and is administered transdermally.

11-3 §11.RQ source ↗

An 18-year-old is having surgery on their fractured hip after a football injury. During surgery, they develop a fever of 105°F and their muscles become rigid. Which of the following medications would the nurse expect to be administered?
  1. a.
    Gabapentin
  2. b.
    Baclofen
  3. c.
    Dantrolene
  4. d.
    Pregabalin

Answer

C. Dantrolene
This client is experiencing neuroleptic malignant syndrome.

11-4 §11.RQ source ↗

The nurse is caring for a client with the primary-progressive form of multiple sclerosis (PPMS). The nurse expects which of the following drugs to be included in the treatment plan?
  1. a.
    Alemtuzumab
  2. b.
    Natalizumab
  3. c.
    Ocrelizumab
  4. d.
    Siponimod

Answer

C. Ocrelizumab
This drug can be used to manage relapses in clinically isolated syndrome (CIS), primary progressive (PPMS), relapsing-remitting (RRMS), and secondary progressive (SPMS).

11-5 §11.RQ source ↗

A client is complaining of not being able to sleep for the past week. They mention starting a new medication at that time. Which medication could be the cause of their inability to sleep?
  1. a.
    Selegiline
  2. b.
    Entacapone
  3. c.
    Pramipexole
  4. d.
    Benztropine

Answer

A. Selegiline
Insomnia occurs with this drug because it metabolizes to methamphetamine and amphetamine, causing stimulation. If taken too late in the day, sleep could be disrupted.

11-6 §11.RQ source ↗

The nurse is caring for a client who is going to begin therapy with the immunomodulator teriflunomide. Which test is important to have done before the drug is started?
  1. a.
    Serum creatinine
  2. b.
    Hemoglobin A1C
  3. c.
    Tuberculin skin test
  4. d.
    Liver function test

Answer

C. Tuberculin skin test
This drug can exacerbate tuberculosis. If a tuberculin skin test and chest radiograph (x-ray) are positive, the client must be treated for TB before starting the prescribed drug.

11-7 §11.RQ source ↗

A nursing student is preparing a teaching plan for a client with PD who is being treated with carbidopa/levodopa. Which of the following dietary recommendations is correct?
  1. a.
    Intake of green, leafy vegetables should be limited.
  2. b.
    Daily required protein intake should be divided equally among three meals.
  3. c.
    A high-fat diet will interfere with the absorption of carbidopa/levodopa.
  4. d.
    High-fiber products will cause diarrhea.

Answer

B. Daily required protein intake should be divided equally among three meals.
High-protein meals will interfere with levodopa absorption and entrance into the brain.

11-8 §11.RQ source ↗

The nurse is reviewing discharge instructions with a client with a new prescription for pregabalin. Which of the following points should be included in this discussion?
  1. a.
    Weight loss is noted with prolonged use.
  2. b.
    The drug is a first-line treatment for seizure disorders.
  3. c.
    Improvement in suicidal ideation is common.
  4. d.
    Altered impulse control can result at therapeutic doses.

Answer

D. Altered impulse control can result at therapeutic doses.
This drug causes euphoria, which can diminish impulse control.

11-9 §11.RQ source ↗

The nurse is preparing medications for assigned clients. The nurse calls the prescriber concerned about administering benztropine to one of the clients. What would be the reason for the concern?
  1. a.
    58-year-old with diarrhea
  2. b.
    66-year-old with urinary incontinence
  3. c.
    84-year-old with glaucoma
  4. d.
    74-year-old with symptomatic bradycardia

Answer

C. 84-year-old with glaucoma
Benztropine is an anticholinergic. One of the adverse effects of this classification is the potential to increase intraocular pressure; therefore, it should be avoided in clients with glaucoma.

11-10 §11.RQ source ↗

Which class of drugs may reduce the therapeutic effects of levodopa if given concurrently?
  1. a.
    First-generation antipsychotics
  2. b.
    Selective serotonin reuptake inhibitors
  3. c.
    Tricyclic antidepressants
  4. d.
    Sympathomimetics

Answer

A. First-generation antipsychotics
These block dopamine receptors in the striatum, resulting in diminished therapeutic effects of levodopa and augmented Parkinsonian symptoms.

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Problems and answers are adapted from Pharmacology for Nurses by Tina Barbour-Taylor, Leah Mueller (Sabato), Donna Paris and Dorie Weaver, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/pharmacology/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.