Chapter 10: Drugs for Central Nervous System Problems Visovsky: Introduction to Clinical Pharmacology, 10th Edition

Chapter 10: Drugs for Central Nervous System Problems Visovsky: Introduction to Clinical Pharmacology, 10th Edition 1. Which neurotransmitter has an inhibitory action within the CNS? a. Epinephrine b. Acetylcholine c. Norepinephrine d. Gamma -aminobutyric acid - ANSWER d. Gamma -aminobutyric acid 2. A 73 -year-old male patient newly diagnosed with Par kinson's disease (PD) is prescribed a dopamine agonist. The patient's wife asks you to explain how this class of drugs will work to help her husband. What is your best response? a. "Dopamine agonists reduce levels of acetylcholine to restore gait and balan ce." b. "Dopamine agonists use an enzyme to break down dopamine to improve PD symptoms." c. "Dopamine agonists prevent the buildup of beta amyloid plaques to improve coordination." d. "Dopamine agonists reduce muscle rigidity and tremors by increasing dopamine levels." - ANSWER d. "Dopamine agonists reduce muscle rigidity and tremors by increasing dopamine levels." 3. A patient placed on the drug tolcapone (Tasmar) for the relief of symptoms of Parkinson's disease asks you how this drug works for the dise ase. What is your best response? a. "Tolcapone acts as a dopamine agonist, replacing the activity of dopamine." b. "Tolcapone forces the substantia nigra to increase production of natural dopamine." c. "Tolcapone suppresses the enzyme that breaks down naturally occurring dopamine." d. "Tolcapone increases the number of dopamine receptors sites." - ANSWER c. "Tolcapo ne suppresses the enzyme that breaks down naturally occurring dopamine." 4. Why are carbidopa and levodopa usually given together? a. Carbidopa is a dopamine agonist and levodopa is a dopamine antagonist. b. Levodopa is a dopamine agonist and carbidopa i s a dopamine antagonist. c. Carbidopa enhances the action of levodopa, and less drug is needed. d. Levodopa reverses or prevents the side effects of carbidopa. - ANSWER c. Carbidopa enhances the action of levodopa, and less drug is needed. 5. When assess ing a patient with Parkinson's disease who takes a carbidopa/levodopa combination drug, you find that he now has almost constant muscle movements that look like uncoordinated dancing. What is your best action? a. Document the finding as the only action. b. Hold the next drug dose and report the finding to the healthcare provider. c. Give the next dose earlier than scheduled because the drugs are wearing off. d. Request that the healthcare provider prescribe a one -time dose of a muscle relaxant. - ANSWER b. Hold the next drug dose and report the finding to the healthcare provider. 6. A patient newly diagnosed with Parkinson's disease is prescribed an oral dopamine agonist. Which precaution is most important to teach the patient and family about the timing fo r taking this drug? a. "Take the drug 30 to 60 minutes before meals on an empty stomach." b. "Take the drug 30 to 60 minutes after eating a high protein meal." c. "Take the drug first thing in the morning before getting out of bed." d. "Take the drug whe n your symptoms are at their worst." - ANSWER a. "Take the drug 30 to 60 minutes before meals on an empty stomach." 7. You are assessing the drug list of a patient who has been started on a dopamine agonist. You discover the patient is also taking an oral antihypertensive drug. Which of the following statements should you make to this patient? a. "Taking an antihypertensive and a dopamine antagonist will increase your blood pressure." b. "Taking an antihypertensive and a dopamine antagonist will decrease y our blood pressure." c. "Taking an antihypertensive and a dopamine antagonist will have no adverse effects." d. "Taking an antihypertensive and a dopamine antagonist will reduce your dopamine levels." - ANSWER b. "Taking an antihypertensive and a dopamine antagonist will decrease your blood pressure." 8. A patient with diagnosed Parkinson's disease is prescribed a monoamine oxidase type B inhibitor reports not adhering to a tyramine -restricted diet. What signs/symptoms would you expect this patient to pres ent with? a. Hypertension b. Severe bradycardia c. Bone marrow failure d. Edema of the lower extremities - ANSWER a. Hypertension 9. When asking the family of a patient with Alzheimer's disease who takes the drug donepezil (Aricept) what other prescribed or over -the-counter drugs the patient takes, they list all the following drugs. Which one will you tell them to stop giving the pat ient? a. Aspirin b. Buspirone c. Vitamin C d. Dextromethorphan - ANSWER d. Dextromethorphan 10. When admitting a new patient with Alzheimer's to a memory unit of a long -term care facility, you note that she is prescribed both memantine and rivastigmine. W hat is your best action? a. Give both drugs as prescribed. b. Ask the patient when she usually takes these drugs. c. Notify the prescriber that both drugs are for Alzheimer's disease.