A patient with Parkinson's disease is taking levodopa/carbidopa ...

[DelorasTo]

A patient with Parkinson's disease is taking levodopa/carbidopa (Sinemet). The prescriber orders bromocriptine (Parlodel) to treat dyskinesias.
 
  The nurse notes that the patient is agitated, and the patient reports having frequent nightmares. The nurse will contact the provider to discuss:
  a. adding an antipsychotic medication.
  b. changing from bromocriptine to cabergoline (Dostinex).
  c. reducing the dose of bromocriptine.
  d. reducing the dose of levodopa/carbidopa.

Question 2

A 25-year-old patient has been newly diagnosed with Parkinson's disease, and the prescriber is considering using pramipexole (Mirapex). Before beginning therapy with this drug, the nurse will ask the patient about:
 
  a. any history of alcohol abuse or compulsive behaviors.
  b. any previous history of hypertension.
  c. difficulty falling asleep or staying asleep.
  d. whether any family members have experienced psychoses.

[adammoses97]

Answer to Question 1

ANS: C
Bromocriptine is used to treat levodopa-induced dyskinesias and has dose-dependent psychologic side effects. The nurse should suggest reducing the dose of this drug to minimize these side effects. Adding an antipsychotic medication is not indicated. Cabergoline is not approved for this use. Reducing the dose of levodopa/carbidopa is not indicated.

Answer to Question 2

ANS: A
Pramipexole has been associated with impulse control disorders, and this risk increases in patients with a history of alcohol abuse or compulsive behaviors. Pramipexole increases the risk of hypotension and sleep attacks, so a history of hypertension or insomnia would not be cautionary. Unlike with levodopa, the risk of psychoses is not increased.

[DelorasTo]

Thanks for the timely response, appreciate it

[gcook]

Gracias!