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NR568 / NR 568 Midterm Exam (Latest 2024 / 2025): Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|Questions and Verified Answers - Chamberlain$17.99
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NR568 / NR 568 Midterm Exam (Latest 2024 / 2025): Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|Questions and Verified Answers - Chamberlain
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NR568 / NR 568 Midterm Exam (Latest 2024 / 2025): Advanced Pharmacology for the Adult-Gerontology Primary Care Nurse Practitioner|Questions and Verified Answers - Chamberlain
NR568 / NR 568 Midterm Exam (Latest ):
Advanced Pharmacology for the Adult-Gerontology
Primary Care Nurse Practitioner|Questions and Verified
Answers - Chamberlain
Dopamine agonists - ANSWER may cause excessive daytime sleepiness in 50%
of PD patients. Sudden sleep attacks are potentially dangerous during driving.
Parkinson's disease (PD) - ANSWER a slow, progressive neurodegenerative
disease that affects the extrapyramidal motor system. Specifically, the dopamine
neurons in the substantia nigra are primarily affected, and degeneration of these
neurons disrupts effortless motor control. The hallmark features of PD are resting
tremors, rigidity, akinesia/bradykinesia, and postural instability. There is no cure, and
treatment targets to control symptoms and maintain the quality of life (QOL) or
functioning
Levodopa, a dopamine precursor, is the most effective medication for PD. -
ANSWER Initiating pharmacotherapy for PD remains controversial. Patients
experience approximately 50% improvement in motor function with levodopa
compared to 30% with dopamine agonists. Increased gastric acid, food, or
anticholinergic medications delay gastric emptying and decrease the amount of
levodopa absorbed. Antacids improve levodopa absorption, whereas iron products
bind levodopa and reduce bioavailability. An extended-release (ER) formulation of
levodopa (Rytary) is also approved, but the ideal time to initiate this medication has
not been determined.
Dopamine agonists - ANSWER bind to postsynaptic dopamine receptors and are
practical for PD initial therapy. The advantages of dopamine agonists are most
effective in the advanced stages of the disease. These medications can be added to
levodopa to minimize variations in response, improve wearing-off symptoms,
decrease in levodopa dose, and improve overall functioning
MAO-B inhibitors - ANSWER are recommended for treatment of PD in conjunction
with levodopa to inhibit the breakdown of both dopamine and levodopa in the brain;
which ultimately increases levodopa in the brain and enhances its effect. MAOIs
work through selective blockade of dopamine metabolism through MAO-B,
particularly for those patients who choose to delay dopaminergic medications and
use MAO-B inhibitors as initial therapy. Combining these medications with levodopa
in early treatment may delay motor complications. Neuroprotection is an additional
benefit for using MAOIs when medication therapy is initiated early in the disease
process (
,COMT inhibitors - ANSWER Inhibitors of COMT, an enzyme that catalyzes
levodopa to 3-o-methyldopa, are added to levodopa/carbidopa to increase levodopa
concentrations, extend its half-life, and decrease wearing off time
Amantadine (Symmetrel) - ANSWER Amantadine (Symmetrel) is an N-methyl-D-
aspartate (NMDA)-receptor antagonist that blocks glutamate (excitatory
neurotransmitter) transmission, promotes dopamine release, and blocks
acetylcholine. It is likely effective as monotherapy and adjunct therapy for off time
and dyskinesia. The Food and Drug Administration (FDA) has approved an
extended-release version of amantadine (Gocovri), specifically for dyskinesias in PD,
making it the only approved option for this complication
Benztropine (Cogentin) - ANSWER Ach medications block acetylcholine and
decrease the acetylcholine to dopamine concentration ratio. Ach minimizes resting
tremor and drooling but are not as efficacious as other medications in treating
rigidity, bradykinesia, and problems with gait
Dopamine agonists are the most effective medications for Parkinson's Disease. -
ANSWER F: Levodopa, a dopamine precursor, is the most effective medication for
PD. Initiating pharmacotherapy for PD remains controversial. Patients experience
approximately 50% improvement in motor function with levodopa compared to 30%
with dopamine agonists.
Combining _______ medications with levodopa in early treatment may delay motor
complications. - ANSWER MAO-B Inhibitors
Patients should be educated on dopamine dysregulation syndrome (DDS) which can
manifest as - ANSWER Impulse control disorder
What is the therapeutic goal for Helen and others with Parkinson's Disease (PD)? -
ANSWER The therapeutic goal for Helen and others with Parkinson's disease is
symptom management. The ideal treatment would reverse neuronal degeneration or
at least prevent further degeneration and control symptoms. Unfortunately, the ideal
treatment does not exist; no drugs prevent neuronal damage or reverse the damage
that has occurred. Drugs can only provide symptomatic relief, not cure PD.
Furthermore, there is no convincing proof that any current drug can delay disease
progression
Parkinsons education - ANSWER The educational point that will help Helen's
family understand the pharmacological approach to symptom management in PD is:
Medications increase the level of dopamine and decrease the level of acetylcholine
in CNS responses can take several months to occur. Given the neurochemical basis
of parkinsonism—too little striatal dopamine and too much acetylcholine—the
approach to treatment is direct: use drugs that can restore the functional balance
between dopamine and acetylcholine. To accomplish this, two types of drugs are
used: (1) dopaminergic agents (i.e., drugs that directly or indirectly activate
dopamine receptors) and (2) anticholinergic agents (i.e., drugs that block receptors
for acetylcholine
, carvidopa and levodopa therapy - ANSWER carbidopa reduces cardiovascular
responses to levodopa. By reducing the production of dopamine at the periphery,
carbidopa reduces cardiovascular responses to levodopa as well as nausea and
vomiting
PD management of symptoms medication - ANSWER Donepezil may be used for
symptom management in PD. Dementia occurs in 40% of PD patients. AAN
guidelines recommend treatment with two drugs: donepezil and rivastigmine. Both
drugs are cholinesterase inhibitors developed for Alzheimer's disease. In patients
with PD, these drugs can produce a modest improvement in cognitive function
without causing significant worsening of motor symptoms, even though these drugs
increase the availability of acetylcholine at central synapses
Rasagiline - ANSWER Both rasagiline and selegiline are MAO-B inhibitors and
work by inhibiting the breakdown of dopamine by MAO-B.
Which of the following is needed to monitor the effects of carbidopa/levodopa
therapy? Select all that apply - ANSWER orthostatic vital signs, motor function,
and palpatations
Orthostatic vital signs: reports of palpitations, and motor function assessments are
needed to monitor the effects of carbidopa/levodopa therapy. If palpitations are
reported or dysrhythmias are suspected, an electrocardiogram (ECG) may be
indicated. Motor function tests must be evaluated at each visit and compared with
baseline values
Levodopa education - ANSWER Levodopa is administered orally and undergoes
rapid absorption from the small intestine. Food delays absorption by slowing gastric
emptying. Furthermore, because neutral amino acids compete with levodopa for
intestinal absorption (and for transport across the blood-brain barrier as well), high-
protein foods will reduce therapeutic effects
contraindication with Selegline - ANSWER Sertraline 75mg PO daily is
contraindicated with selegiline. Selegiline should not be combined with selective
serotonin reuptake inhibitors (SSRIs) such as fluoxetine (Prozac). The combination
of an MAO-B inhibitor plus an SSRI can cause fatal serotonin syndrome.
Accordingly, SSRIs should be withdrawn at least 5 weeks before giving selegiline
AD treatment - ANSWER Treatment for AD includes cholinesterase inhibitors
(ChEIs) and memantine.
side effects: gastrointestinal symptoms (nausea and diarrhea), headache, dizziness,
muscle weakness
precautions sick sinus syndrome and seizure disorder
Donepezil (Aricept) is approved to treat moderate to severe AD at 23 mg/day dose,
but there is minimal improvement in cognitive functioning when compared to a 10
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