A patient newly diagnosed with Parkinson's disease has been ...

[javeds]

A patient newly diagnosed with Parkinson's disease has been taking levodopa/carbidopa (Sinemet) for several weeks and complains of nausea and vomiting. The nurse tells the patient to discuss what with the provider?
 
  a. Taking a lower dose on an empty stomach
  b. Taking an increased dose along with a high-protein snack
  c. Taking a lower dose with a low-protein snack
  d. Taking dopamine in addition to levodopa/carbidopa

Question 2

A patient has been diagnosed with Parkinson's disease (PD) and begins treatment with levodopa/carbidopa (Sinemet). After several months of therapy, the patient reports no change in symptoms. The nurse will expect the provider to:
 
  a. add a dopamine agonist.
  b. discuss the on-off phenomenon.
  c. increase the dose of Sinemet.
  d. re-evaluate the diagnosis.

[lou]

Answer to Question 1

ANS: C
Because levodopa activates the chemoreceptive trigger zone (CTZ) of the medulla, causing nausea and vomiting (N/V), the patient may need to take a lower dose temporarily until tolerance develops. A meal helps slow absorption to minimize this side effect. A high protein intake contributes to abrupt loss of effect, so meals should be low in protein. Taking a dose on an empty stomach increases absorption and also N/V. An increased dose with a high-protein snack increases N/V and also abrupt loss of effect. Dopamine increases N/V, because it activates the CTZ of the medulla.

Answer to Question 2

ANS: D
Patients beginning therapy with levodopa/carbidopa should expect therapeutic effects to occur after several months of treatment. Levodopa is so effective that a diagnosis of PD should be questioned if the patient fails to respond in this time frame. Adding a dopamine agonist is not indicated. The on-off phenomenon occurs when therapeutic effects are present. Increasing the dose of levodopa/carbidopa is not indicated.

[javeds]

Excellent

[amit]

TYSM