Nokea
When reviewing the medication records of several clients, the nurse notes documentation of nonergot dopamine receptor agonists. Which of the following would the nurse most likely note? Select all that apply.
- A. Pramipexole (Mirapex)
- B. Entacapone (Comtan)
- C. Amuitadine (Symmetrel)
- D. Ropinirole (Requip)
- E. Benztropine (Cogentin)
Correct Answer: A,D
Rationale: Pramipexole (Mirapex) and ropinirole (Requip) are nonergot dopamine receptor agonists.
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A nurse is caring for a 55-year-old client with Parkinson's disease who is prescribed entacapone. The nurse would monitor this client for which adverse reaction?
- A. Increased hand tremor
- B. Constipation
- C. Urinary retention
- D. Dyskinesia
Correct Answer: D
Rationale: The nurse should monitor for dyskinesia, which is an adverse reaction of the COMT inhibitors, in the client. The other adverse reactions include dizziness, hypersinesia, nausea, anorexia, diarrhea, orthostatic hypotension, sleep disorders, excessive dreaming, somnolence, and muscle cramps. A serious, and possibly fatal, adverse reaction that can occur with the administration of tolcapone, one of the COMT inhibitors, is liver failure. Increased hand tremor and constipation are adverse effects associated with the use of dopaminergic drugs. Urinary retention is an adverse reaction associated with the administration of cholinergic blocking drugs.
A nurse is caring for a 70-year-old client who is receiving anticholinergic drug therapy for Parkinson's disease. The nurse would be alert for the development of which of the following in this client?
- A. Confusion and disorientation
- B. Choreiform movements
- C. Suicidal tendencies
- D. Psychotic episodes
Correct Answer: A
Rationale: The nurse should assess for confusion and disorientation when caring for this elderly client receiving anticholinergic drug therapy. Individuals older than 60 years frequently develop increased sensitivity to anticholinergic drugs and require careful monitoring. Lower doses may also be required in such cases. Choreiform movements, suicidal tendencies, and psychotic episodes are serious adverse reactions associated with the use of levodopa, which is a dopaminergic drug.
A nurse is caring for a client who has been prescribed pramipexole for the treatment of Parkinson's disease. From the client's medical records, the nurse understands that the client is taking verapamil. The nurse understands that the client is at increased risk for which effect from the interaction of the two drugs?
- A. Cardiac symptoms
- B. Agonist effectiveness
- C. Toxicity of both drugs
- D. Psychotic behavior
Correct Answer: B
Rationale: The nurse should assess for an increased risk of agonist effectiveness in the client. Increased risk of cardiac symptoms and increased risk of toxicity of both drugs are the effects of the interaction of COMT inhibitors with MAOI antidepressants and adrenergic drugs. Increased risk of psychotic behavior is the effect of the interaction of cholinergic blocking drugs with haloperidol.
A client is prescribed ropinirole (Requip). The nurse would anticipate an increase in dopamine agonist effects if which of the following medications are initiated? Select all that apply.
- A. Ranitidine (Zantac)
- B. Verapamil (Calan)
- C. Estradiol (Estrace)
- D. Perphenazine (Trilafon)
- E. Lisinopril (Prinivil)
Correct Answer: A,B,C
Rationale: A client taking ropinirole (Requip) will have increased dopamine agonist effects if ranitidine, verapamil, or estrogens such as estradiol are initiated.
A client is prescribed carbidopa/levodopa. The nurse understands that this drug should be administered cautiously to clients with which condition? Select all that apply.
- A. Hyperthyroidism
- B. Seizure disorder
- C. Renal disease
- D. Asthma
- E. Peptic ulcer disease
Correct Answer: C,D,E
Rationale: Carbidopa/levodopa (Sinemet) is used cautiously in clients with cardiovascular or pulmonary disease (asthma), peptic ulcer disease, renal or hepatic disease, and psychosis.