A patient on levodopa (Dopar) for Parkinson's disease comes to ...

[HudsonKB16]

A patient on levodopa (Dopar) for Parkinson's disease comes to the emergency department complaining of a severe headache.
 
  The vital signs are: temperature 98.8 F, pulse 92/minute, blood pressure 202/107, and respirations 18/minute. A nurse should be most concerned if which of the following drugs is on the patient's current list?
  a. Carbidopa
  b. Phenelzine (Nardil)
  c. Citalopram (Celexa)
  d. Amitriptyline

Question 2

A nurse checks on a patient with Parkinson's disease who recently began taking levodopa (Dopar).
 
  She finds the patient trying to get out of bed. The patient tells the nurse that every time she gets out of bed, she gets dizzy and light-headed. The nurse explains that this symptom is known as orthostatic hypotension, and she should instruct the patient to
  a. maintain bed rest for at least 2 weeks.
  b. sleep on her left side to improve her circulation.
  c. lie down and put her feet up on pillows.
  d. try increasing the salt and water in her diet.

[Ksh22]

Answer to Question 1

ANS: B
Levodopa can cause a hypertensive crisis if administered to an individual taking a monoamine oxidase inhibitor, such as phenelzine. The drug-to-drug interaction caused by these medications can cause massive vasoconstriction that leads to a hypertensive crisis, which is clearly what this patient is experiencing.
Carbidopa increases the beneficial effects of levodopa.
Celexa is a selective serotonin reuptake inhibitor; it does not cause hypertensive crisis when taken concurrently with levodopa, although it can decrease levodopa's effectiveness.
Amitriptyline is a tricyclic antidepressant; it does not promote hypertensive crisis when taken with levodopa, but it can decrease levodopa's effectiveness.

Answer to Question 2

ANS: D
Postural hypotension is common early in treatment. Hypotension can be reduced by increasing the intake of salt and water.
Postural hypotension can be easily treated with dietary changes, as well as by instructing the patient to rise slowly from lying to sitting to standing position. She does not need 2 weeks of bed rest.
Although sleeping on her left side may improve her circulation, it is not related to postural hypotension.
Lying down with the feet up is a more appropriate intervention for hypertension.

[HudsonKB16]

Gracias!

[pratush dev]

TYSM