Chapter 10 Flashcards
(17 cards)
Which neurotransmitter has an inhibitory action within the central nervous system?
a. Epinephrine
b. Acetylcholine
c. Norepinephrine
d. Gamma-aminobutyric acid
ANS: D
Neurotransmitters can be excitatory or inhibitory. Excitatory neurotransmitters include
acetylcholine (Ach), epinephrine, and norepinephrine. Inhibitory neurotransmitters include
dopamine, some types of serotonin, and GABA (gamma-aminobutyric acid).
How does the drug tolcapone relieve the symptoms of Parkinson disease?
a. Acts as a dopamine agonist, replacing the activity of dopamine
b. Forces the substantia nigra to increase the production and release of natural
dopamine
c. Suppresses the activity of an enzyme that normally breaks down naturally
occurring dopamine
d. Increases the number of dopamine receptors sites throughout the central nervous
system, thus increasing the effectiveness of dopamine and dopamine agonists
ANS: C
Catechol-O-methyltransferase (COMT) is an enzyme that breaks down (metabolizes)
naturally occurring catecholamine-based neurotransmitters, including dopamine. It also
breaks down dopamine agonist drugs. Catechol-O-methyltransferase (COMT) inhibitors are
drugs that suppress the activity of the COMT enzyme so both naturally occurring dopamine
and dopamine agonist drugs remain active in the body longer, helping to restore the
acetylcholine–dopamine balance in the brain. Entacapone (Comtan) and tolcapone (Tasmar)
are two COMT inhibitors that are used currently for PD.
Why are carbidopa and levodopa usually given together?
a. Carbidopa is a dopamine agonist and levodopa is a dopamine antagonist.
b. Levodopa is a dopamine agonist and carbidopa is a dopamine antagonist.
c. Carbidopa enhances the action of levodopa, and less drug is needed.
d. Levodopa reverses or prevents the side effects of carbidopa.
ANS: C
Carbidopa is usually given in combination with levodopa because it enhances the levodopa
so lower doses of levodopa can be used, thus preventing the nausea and vomiting that
accompanies the continual increasing of the levodopa dose to control disease symptoms.
When assessing a patient with Parkinson disease who takes a carbidopa/levodopa
combination drug, you find that he now has almost constant muscle movements that look
like uncoordinated dancing. What is your best action?
a. Document the finding as the only action.
b. Hold the next drug dose and report the finding to the healthcare provider.
c. Give the next dose earlier than scheduled because the drugs are wearing off.
d. Request that the healthcare provider prescribe a one-time dose of a muscle relaxant.
ANS: B
The most common adverse reaction to carbidopa/levodopa is dyskinesia, involuntary muscle
movements that look like uncoordinated dance movements. Dyskinesia is common in
patients on long-term carbidopa/levodopa therapy (longer than 3 years). Usually, this
adverse effect requires the healthcare provider to adjust the drug therapy for Parkinson
disease.
A patient newly diagnosed with Parkinson disease is prescribed an oral dopamine agonist.
Which precaution is most important to teach the patient and family about the timing for
taking this drug?
a. “Take the drug 30 to 60 min before meals on an empty stomach.”
b. “Take the drug 30 to 60 min after eating a high protein meal.”
c. “Take the drug first thing in the morning before getting out of bed.”
d. “Take the drug when your symptoms are at their worst.”
ANS: A
Dopamine agonists should be taken 30 to 60 minutes before a meal, so patients have an
easier time swallowing. An empty stomach is best to enhance absorption. Patients must be
taught to avoid taking the drug with or shortly after eating protein because protein reduces
the effectiveness of these drugs.
When asking the family of a patient with Alzheimer’s disease who takes the drug donepezil
(Aricept) what other prescribed or over-the-counter drugs the patient takes, they list all the
following drugs. Which one will you tell them to stop giving the patient?
a. Aspirin
b. Buspirone
c. Vitamin C
d. Dextromethorphan
ANS: D
Dextromethorphan, a common over-the-counter cough drug, can cause long Q-T syndrome.
When taken with donepezil, a fatal dysrhythmia known as torsade de pointe, a form of
ventricular tachycardia, can occur as a result of the interaction.
When admitting a new patient with Alzheimer’s to a memory unit of a long-term care
facility, you note that she is prescribed both memantine and rivastigmine. What is your best
action?
a. Give both drugs as prescribed.
b. Ask the patient when she usually takes these drugs.
c. Notify the prescriber that both drugs are for Alzheimer’s disease.
d. Give the memantine one odd-numbered days and rivastigmine on even-numbered
days.
ANS: A
Although both drugs are used for Alzheimer’s disease, they have very different actions and
both can be used at the same time. Memantine is usually given with rivastigmine and other
cholinergic agonists because it increases the effectiveness of these other drugs.
A family member of a patient using the rivastigmine patches reports that the patient keeps
taking the patches off his chest. Where will you suggest the family member apply the
patches to avoid this problem?
a. On the forehead
b. On the buttocks
c. On the upper or lower back
d. On the outer aspect of the thigh
ANS: C
Apply the patch to areas that the patient cannot see and would have a hard time reaching.
The recommended area is the upper or lower back to avoid removal by the patient.
A patient is prescribed to receive memantine extended release (XR) 14 mg orally once daily.
You have on hand memantine XR 7-mg capsule and memantine 28-mg capsule. What is the
best way to ensure the patient gets a 14-mg dose?
a. Give the patient two 7-mg capsules every day.
b. Give the patient one 28-mg capsule every other day.
c. Cut the 28-mg capsule in half and give the patient one of the halves.
d. Open a 28-mg capsule, empty it into a drug cup, divide the contents in half, and
give one half to the patient.
ANS: A
Whenever possible, it is best not to open an extended-release capsule. For some drugs, such
as memantine, a capsule can be opened, and the entire contents sprinkled on food if the
patient has difficulty swallowing the capsule whole. However, it is not possible to divide the
contents well enough to ensure an accurate dose. So, the best action in this situation is to
give two 7-mg capsules to equal the 14-mg prescribed dose.
When assessing a patient before starting the first dose of a newly prescribed antiepileptic
drug, what is the most important nursing action to perform?
a. Determine the type of aura a patient usually has before a seizure.
b. Obtain an accurate weight because most drug dosages are based on weight.
c. Ask the patient about all other prescribed or over-the-counter drugs he or she takes
daily.
d. Ensure that oxygen and suction equipment are in the patient’s room and in good
working order.
ANS: C
All actions are reasonable and helpful. The most important assessment information is
determining all other drugs the patients take. Antiepileptic drugs have many drug
interactions that can lead to adverse reactions.
Why is intramuscular (IM) injection of phenytoin avoided?
a. Rapid absorption can cause bradycardia.
b. The drug is very irritating to the tissues.
c. Gum hyperplasia is worsened by IM injection.
d. The drug is a known teratogen that can induce birth defects.
ANS: B
Giving phenytoin by the IM route results in pain and discomfort (and sometimes damaged
tissue) because it is a severe tissue irritant. The best routes are oral and intravenous. All
routes of this drug can cause bradycardia, gum hyperplasia, and birth defects.
When reviewing the preoperative laboratory results of a patient taking oxcarbazepine for
seizure control, you note all of the following values. For which one will you notify the
surgeon immediately?
a. White blood cell count 8700 per mm3
b. Serum sodium level of 128 mEq/L
c. International normalized ratio (INR) 0.9
d. Serum chloride level of 100 mEq/L
ANS: B
The serum sodium level is well below normal (136–145 mEq/L), which means the patient
has hyponatremia. This problem is a common side effect of oxcarbazepine and must be
corrected before surgery to prevent serious complications.
Which precaution is most important to tell parents of young children prescribed lamotrigine
for epilepsy?
a. “Give this drug to your child at night only to prevent dizziness.”
b. “Ensure that your child takes a multiple vitamin daily while he or she is on this
drug.”
c. “Check your child daily for a rash and call your healthcare provider immediately if
one develops.”
d. “Weigh your child weekly and be sure to report a weight loss of 2 lb or more to
ANS: C
Lamotrigine can cause life-threatening rashes (including Stevens–Johnson syndrome and
toxic epidermal necrolysis). It has a black box warning that states to discontinue the drug
immediately if any rash appears during treatment. Although this problem can occur at any
age, it is more likely to occur in children. Although the drug interferes with the formation of
folic acid, an important vitamin, and some patients may become folic acid deficient, a
typical multiple vitamin does not contain enough folic acid to prevent this problem. Weight
loss is not associated with this drug.
A patient taking lacosamide tells you that he never forgets to take his prescribed doses
because he feels so good and happy when he is on the drug. What is your best response?
a. “Anything that helps you remember to take your drug on time is helpful in
preventing seizures.”
b. “Even though you feel good on this drug, do not increase the dose or number of
times you take it.”
c. “Probably knowing that you are less likely to have a seizure is contributing to these
positive feelings.”
d. It is important to remember that taking the drug at a different time of day may
change your feelings.”
ANS: B
Many people taking lacosamide experience euphoria, a feeling of intense well-being and
happiness. This is considered an adverse reaction because it can lead to psychological
dependence (but not addiction). Patients must be warned not to take more of the drug or take
it more often to maintain these feelings.
Which drug to manage multiple sclerosis should be avoided by patients who also have
epilepsy?
a. Beta-interferon
b. Daclizumab
c. Dalfampridine
d. Tecfidera
ANS: C
Dalfampridine lowers the seizure threshold and increases the risk for seizure activity.
What is the most important precaution to teach patients taking any monoclonal antibody or
neurologic drug to manage multiple sclerosis?
a. “Avoid crowds and people who are sick.”
b. “Always wear protective clothing or sunscreen when outdoors.”
c. “Report any weight loss immediately to your healthcare provider”.
d. “Rest as much as possible and avoid any weight-bearing activities.”
ANS: A
The monoclonal antibodies and neurologic drugs currently prescribed to help manage
multiple sclerosis all reduce immunity and inflammation, increasing the risk for infection.
- A patient placed on the drug tolcapone (Tasmar) for the relief of symptoms of Parkinson’s disease asks you how this drug works for the disease. What is your best response?
a. “Tolcapone acts as a dopamine agonist, replacing the activity of dopamine.”
b. “Tolcapone forces the substantia nigra to increase production of natural dopamine.”
c. “Tolcapone suppresses the enzyme that breaks down naturally occurring dopamine.”
d. “Tolcapone increases the number of dopamine receptors sites.”
c. “Tolcapone suppresses the enzyme that breaks down naturally occurring dopamine.
