A client with a history of benign prostatic hyperplasia (BPH), ...

[mwit1967]

A client with a history of benign prostatic hyperplasia (BPH), gout, hyperlipidemia, and palpitations is being seen for symptoms of narcolepsy.
 
  Before starting on methylphenidate (Concerta) for treatment of narcolepsy, which testing would the nurse anticipate?
  1. A PSA and digital prostate exam
  2. A 12-lead EKG and further cardiac workup pending results
  3. Urinalysis and lab tests to determine control of gout
  4. Labs for cholesterol and triglyceride levels

Question 2

An older adult client with Parkinson disease is seen because the daughter states the client cannot stay awake in the daytime.
 
  The client is sleeping most of the day, and is having trouble sleeping at night. The client has no history of cardiac events or psychiatric disorders. Vital signs, electrolytes, liver and renal test results are within normal limits. The client is slightly underweight for height. The nurse would anticipate a prescription for which medication?
  1. Sodium oxybate (gammahydroxybutyrat e, Xyrem)
  2. Modafinil (Provigil, Alertec)
  3. Methylphenidate (Ritalin)
  4. Selegiline (Eldepryl)

[bulacsom]

Answer to Question 1

Correct Answer: 2
Rationale 1: There is no documentation indicating that Concerta creates anticholinergic activity that is contraindicated in BPH.
Rationale 2: Clients should be screened for preexisting cardiac disease before starting this medication, as sudden unexplained cardiac death has occurred in some people taking this medication.
Rationale 3: Gout is not affected by treatment with Concerta.
Rationale 4: Concerta does not affect lipid levels.
Global Rationale: Clients should be screened for preexisting cardiac disease before starting this medication, as sudden unexplained cardiac death has occurred in some people taking this medication. There is no documentation indicating that Concerta creates anticholinergic activity that is contraindicated in BPH. Gout is not affected by treatment with Concerta. Concerta does not affect lipid levels.

Answer to Question 2

Correct Answer: 2
Rationale 1: Sodium oxybate, which is used to treat cataplexy, has a strong hypnotic effect that would be problematic in the client with Parkinson disease.
Rationale 2: Modafinil is approved for treatment of fatigue related to Parkinson disease and circadian rhythm disruption, and it does not appear to suppress appetite or promote weight gain.
Rationale 3: Methylphenidate is not approved for circadian rhythm disruption and is more apt to cause weight loss, and this client is underweight before medicating.
Rationale 4: Eldepryl has been used off label to treat cataplexy, which is not described in this situation.
Global Rationale: Modafinil is approved for treatment of fatigue related to Parkinson disease and circadian rhythm disruption, and it does not appear to suppress appetite or promote weight gain. Sodium oxybate, which is used to treat cataplexy, has a strong hypnotic effect that would be problematic in the client with Parkinson disease. Methylphenidate is not approved for circadian rhythm disruption and is more apt to cause weight loss, and this client is underweight before medicating. Eldepryl has been used off label to treat cataplexy, which is not described in this situation.

[mwit1967]

Excellent

[sailorcrescent]

Thanks for the timely response, appreciate it