Chapter 16: Antiparkinsonian Drugs
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice
MULTIPLE CHOICE
1. A patient has been taking selegiline (Anipril) for a month and says he understands the “cheese effect”
that the doctor explained to him. When the nurse questions him about it, he tells her (correctly) that the
cheese effect results in which symptom?
a. Hypotension b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset
ANS: B
The cheese effect causes severe hypertension. This is a major adverse effect of monoamine oxidase
inhibitors (MAOIs) because they interact with tyramine-containing foods (cheese, red wine, beer, and
yogourt).
DIF: Cognitive Level: Comprehension
2. A patient newly diagnosed with Parkinson’s disease has been given a prescription for levodopa–
carbidopa (Sinemet®). The patient comments, however, that a friend was given a prescription for “plain
levodopa.” What should the nurse explain to this patient about her prescription?
a. Levodopa alone cannot cross the blood–brain barrier.
b. There is no real difference between the two prescriptions.
c. The combination drug is more efficient in increasing the dopamine level in the brain. d.
Concerns about drug–food interactions with levodopa therapy do not exist with the combination therapy.
ANS: C
, The addition of carbidopa allows for more of the levodopa to reach the site of action without being
broken down. Thus, lower doses of levodopa are needed, and the combination is more efficient in
increasing the dopamine level in the brain. Dopamine, unlike levodopa, cannot cross the blood–brain
barrier. Drug–food interactions with levodopa therapy alone are not a concern. If a substance interacts
with levodopa, it will also interact with the combination of levodopa–carbidopa because the levodopa is
the common component in both drugs.
DIF: Cognitive Level: Application
3. When a patient is taking an anticholinergic, such as benztropine, as part of treatment for Parkinson’s
disease, what important information should the nurse give the patient as part of the teaching plan?
a. Avoid vitamin B6 supplements and vitamin-fortified foods.
b. Discontinue the medication immediately if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Take the medication at bedtime to prevent drowsiness during the day.
ANS: D
Anticholinergics should be taken at bedtime to prevent drowsiness during the day. Vitamin B6 interferes
with dopaminergics, not anticholinergics. Anticholinergics should not be discontinued suddenly and
should be taken with or after meals in order to minimize gastrointestinal upset.
DIF: Cognitive Level: Analysis
4. A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic
responses should the nurse look for when assessing this patient?
Sealock: Lilley’s Pharmacology for Canadian Health Care Practice
MULTIPLE CHOICE
1. A patient has been taking selegiline (Anipril) for a month and says he understands the “cheese effect”
that the doctor explained to him. When the nurse questions him about it, he tells her (correctly) that the
cheese effect results in which symptom?
a. Hypotension b. Hypertension
c. Urinary discomfort
d. Gastrointestinal upset
ANS: B
The cheese effect causes severe hypertension. This is a major adverse effect of monoamine oxidase
inhibitors (MAOIs) because they interact with tyramine-containing foods (cheese, red wine, beer, and
yogourt).
DIF: Cognitive Level: Comprehension
2. A patient newly diagnosed with Parkinson’s disease has been given a prescription for levodopa–
carbidopa (Sinemet®). The patient comments, however, that a friend was given a prescription for “plain
levodopa.” What should the nurse explain to this patient about her prescription?
a. Levodopa alone cannot cross the blood–brain barrier.
b. There is no real difference between the two prescriptions.
c. The combination drug is more efficient in increasing the dopamine level in the brain. d.
Concerns about drug–food interactions with levodopa therapy do not exist with the combination therapy.
ANS: C
, The addition of carbidopa allows for more of the levodopa to reach the site of action without being
broken down. Thus, lower doses of levodopa are needed, and the combination is more efficient in
increasing the dopamine level in the brain. Dopamine, unlike levodopa, cannot cross the blood–brain
barrier. Drug–food interactions with levodopa therapy alone are not a concern. If a substance interacts
with levodopa, it will also interact with the combination of levodopa–carbidopa because the levodopa is
the common component in both drugs.
DIF: Cognitive Level: Application
3. When a patient is taking an anticholinergic, such as benztropine, as part of treatment for Parkinson’s
disease, what important information should the nurse give the patient as part of the teaching plan?
a. Avoid vitamin B6 supplements and vitamin-fortified foods.
b. Discontinue the medication immediately if adverse effects occur.
c. Take the medication on an empty stomach to enhance absorption.
d. Take the medication at bedtime to prevent drowsiness during the day.
ANS: D
Anticholinergics should be taken at bedtime to prevent drowsiness during the day. Vitamin B6 interferes
with dopaminergics, not anticholinergics. Anticholinergics should not be discontinued suddenly and
should be taken with or after meals in order to minimize gastrointestinal upset.
DIF: Cognitive Level: Analysis
4. A patient has been treated with antiparkinsonian medications for 3 months. What therapeutic
responses should the nurse look for when assessing this patient?
