Introduction to Clinical Pharmacology 9th Edition TEST BANK by Visovsky
Chapter 09: Drug Therapy for Central Nervous System Problems
Visovsky: Introduction to Clinical Pharmacology, 9th Edition
1.Which neurotransmitter has an inhibitory action within the central nervous system?
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).
DIF: Cognitive Level: Knowing REF: p. 159
2.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|
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.
DIF: Cognitive Level: Understanding REF: p. 162
3.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.|
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.
DIF: Cognitive Level: Understanding REF: p. 163
4.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.|
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.
DIF: Cognitive Level: Applying REF: p. 163
5.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.”|
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.
DIF: Cognitive Level: Applying REF: p. 162
6.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?
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.
DIF: Cognitive Level: Applying REF: p. 167
7.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.|
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.
DIF: Cognitive Level: Applying REF: p. 167
8.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|
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.
DIF: Cognitive Level: Applying REF: p. 168
9.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.|
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.
DIF: Cognitive Level: Understanding REF: p. 168
10.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.|
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.
DIF: Cognitive Level: Applying REF: p. 171
11.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.|
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.
DIF: Cognitive Level: Understanding REF: p. 172
12.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|
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.
DIF: Cognitive Level: Applying REF: p. 174
13.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 your healthcare provider at your next visit.”|
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.
DIF: Cognitive Level: Applying REF: p. 175
14.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.”|
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.
DIF: Cognitive Level: Applying REF: p. 177
15.Which drug to manage multiple sclerosis should be avoided by patients who also have epilepsy?
Dalfampridine lowers the seizure threshold and increases the risk for seizure activity.
DIF: Cognitive Level: Knowing REF: p. 179
16.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.”|
The monoclonal antibodies and neurologic drugs currently prescribed to help manage multiple sclerosis all reduce immunity and inflammation, increasing the risk for infection.
DIF: Cognitive Level: Applying REF: p. 180
1.Which symptoms in a patient taking levodopa for Parkinson disease indicate the drug is “wearing off?” (Select all that apply.)
|a.||Decreased muscle tone|
ANS: B, E, F
Levodopa is a dopamine agonist that restores balance between excitatory and inhibitory input to motor responses. When it wears off, the symptoms of Parkinson disease return or become worse. These include muscle movements that are hard to control and jerky with rigidity because they fail to relax sufficiently. The gait becomes slow and shuffling with short steps. Other common symptoms of PD include tremors, stooped posture, difficulty stopping motion once it has started, difficulty chewing and swallowing, and drooling.
DIF: Cognitive Level: Applying or higher REF: p. 163
2.Which changes are most important to assess for in a patient who is taking topirimate for seizure control? (Select all that apply.)
|b.||Decreased seizure activity|
|c.||Warm flushed skin|
|e.||Pain at the IV site|
|f.||Decreased heart rate|
ANS: B, C, F
Patients taking any antiepileptic drug should be assessed for changes in seizure activity to determine drug effectiveness. Topirimate can cause metabolic acidosis and the patient should be assessed for its symptoms on a regular basis. These symptoms include slow heart rate, hypotension, muscle weakness, and warm, flushed skin.
DIF: Cognitive Level: Applying REF: p. 175
1.A patient in your long-term care facility is prescribed to receive a total of 24 mg of ropinirole daily in three divided doses. The drug on hand is ropinirole 4 mg/tablet. How many tablets will you give for one dose? _______
24 mg/day in 3 divided doses = 24/3 or 8 mg/dose
Want 8 mg
Have 4 mg/tablet 8 mg divided by 4 mg = 2 tablets
2.The healthcare provider orders valproic acid at 10 mg/kg orally every 12 hours. The patient weighs 160 lb. How many mg will you give for each dose? How many mg is the total daily dose? _______
Patient weight in lb is 160. 1 kg = 2.2 lb. 160 lb divided by 2.2 kg = 74.7 kg, round up to 75 kg.
10 mg × 75 kg = 750 mg/dose
750 mg × 2 doses = 1500 mg total daily dose
3.Order: lamotrigine 250 mg orally twice daily.
Have: lamotrigine 100-mg tablets
How many tablets of lamotrigine are needed for the correct dose? _______
Want lamotrigine 250 mg; have lamotrigine 100 mg
Divide 250 mg by 100 mg/tablet = 2.5 tablets