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Worksheetscheek4
Total questions: 150
Worksheet time: 1hrs 15mins
Which statement best describes the antacid mechanism of action for these agents?
React with gastric acid to form neutral salts
Inhibit proton pumps to reduce acid secretion
Increase gastric acid secretion via parietal cells
Block histamine H2 receptors in the stomach
Magnesium hydroxide is characterized by which property compared with Maalox?
Rapid-acting with high neutralizing capacity
Slow-acting with low neutralizing capacity
Primarily binds pepsin to facilitate healing
Minimal effect on gastric acid neutralization
Which antacid commonly causes diarrhea and is often combined with aluminum compounds to balance bowel effects?
Magnesium hydroxide
Calcium carbonate
Maalox (aluminum)
Bismuth subsalicylate
A patient using calcium carbonate develops constipation and milk-alkali syndrome risk. What contributes to this risk?
Excess calcium intake with chronic high doses
Magnesium accumulation in renal failure
Histamine receptor blockade
Aluminum binding of dietary phosphate
Maalox (aluminum compound) has which distinguishing affinity that can lead to hypophosphatemia?
High affinity for bicarbonate
High affinity for magnesium salts
High affinity for calcium ions
High affinity for phosphates
Which timing maximizes antacid effectiveness while minimizing interactions?
Take in the morning regardless of meals
Take immediately with high-fat meals
Take 1–3 hours after meals and at bedtime
Take only on an empty stomach before meals
For patients with renal impairment, which caution is most appropriate with magnesium hydroxide?
Avoid due to risk of magnesium toxicity
Increase dose to overcome acid rebound
Combine with calcium carbonate routinely
Use with histamine blockers to reduce risk
Which assessment should nurses perform before initiating calcium carbonate therapy?
Evaluate calcium levels and kidney stone history
Measure pepsin activity and bile salts
Assess hemoglobin and platelet counts
Test for H. pylori serology routinely
Which common symptom relief timeframe is expected after taking these antacids with food?
Within 20–30 minutes
Immediately within 1 minute
Not until the next day
After 2–3 hours only
Which adverse effect is shared by magnesium hydroxide and Maalox but differs in bowel pattern?
Sodium loading; diarrhea vs constipation
Hypokalemia; vomiting vs nausea
Hypermagnesemia; urticaria vs rash
Hypocalcemia; dizziness vs vertigo
Why should antacids be administered separately from many medications by at least 2 hours?
They raise systemic pH significantly
They can reduce absorption of other drugs
They cause immediate drug degradation
They directly increase drug potency
Which patient counseling point is correct for calcium carbonate use to reduce acid reflux-related discomfort?
Release of CO2 may cause belching
Works best only on an empty stomach
Suppresses acid production via H2 blockade
Prevents GERD progression permanently
A patient reports chronic indigestion and plans long-term antacid use. What is the best strategy?
Combine all three antacids daily long-term
Increase antacid dose progressively over months
Rely on bedtime dosing indefinitely
Use short-term and consider H2 blockers or PPIs
Which nursing assessment is shared across antacid therapies to minimize complications?
Perform neurological reflex testing
Check hepatic enzymes weekly
Measure fasting insulin levels
Review current medications for interactions
Which side effect is most associated with chronic high-dose calcium carbonate use?
Severe hypomagnesemia with arrhythmia
Profound metabolic acidosis universally
Peptic ulcer perforation routinely
Milk-alkali syndrome with hypercalcemia
Maalox is slow-acting and can facilitate ulcer healing primarily by which action?
Binding to pepsin and protecting mucosa
Stimulating gastric acid secretion strongly
Blocking proton pumps in parietal cells
Increasing systemic bicarbonate levels
Which instruction regarding meals is consistent across these antacids?
Take after meals and before bed
Take strictly with high-protein meals
Take only before meals and skip bedtime
Avoid taking near any food intake
In patients with heart failure or hypertension, which antacid-related issue requires monitoring?
Sodium loading from formulations
Excess pepsin activation risk
Histamine rebound phenomena
Hypokalemia from bicarbonate loss
Which scenario best reflects acid rebound risk?
Single dose causing immediate gastric perforation
Prolonged use leading to increased acid secretion
Use with meals eliminating all reflux symptoms
Short course permanently suppressing acid output
Which combination is often used to balance bowel effects in antacid therapy?
Magnesium hydroxide with aluminum compounds
Calcium carbonate with proton pump inhibitors
Bismuth subsalicylate with H2 blockers
Sucralfate with bicarbonate alone
Which best describes the mechanism of bulk-forming laxatives like psyllium?
Lubricate mucosa to ease passage
Lower surface tension to soften stool
Stimulate intestinal motility directly
Swell with water to form stool gel
A patient starting psyllium should be instructed to take each dose with at least how much water to prevent choking or obstruction?
240 mL of water
480 mL of water
60 mL of water
120 mL of water
What is the typical onset for formed stool after initiating psyllium?
Within 1–3 hours
Within 12–72 hours
Within 4–6 days
Immediate after first dose
Which clinical use is most appropriate for psyllium?
Long-term substitute for dietary fiber entirely
Rapid bowel evacuation before surgery
Primary therapy for acute bowel obstruction
Preferred temporary treatment of constipation
Which adverse effect is specifically cautioned with psyllium and requires taking with cold water or juice?
Hepatic toxicity
Renal impairment
Esophageal obstruction risk
Electrolyte imbalance
Which assessment is essential before administering a bulk-forming laxative?
Serum liver enzyme levels
Visual analog pain score
Recent dietary fat intake
Presence of bowel sounds and no obstruction
Which administration note for psyllium helps minimize gas and bloating?
Separate from meals by 4 hours
Avoid taking with any fluids
Start low and increase gradually
Start with high dose immediately
Which patient population benefits from psyllium to avoid straining?
Patients with active GI bleeding
Patients with severe diarrhea from infection
Patients with cardiovascular disease or hemorrhoids
Patients with acute pancreatitis
Which is a realistic counseling point for psyllium regarding onset of effect?
Works only when taken fasting
Takes 1–3 days for full effect
Requires concomitant stimulant laxative
Effects are immediate after first dose
Which mechanism best describes docusate sodium (a surfactant laxative)?
Forms a bulk gel mass with fiber
Inhibits opioid receptors in gut
Directly stimulates peristalsis in colon
Lowers surface tension to allow water into stool
What is the expected onset for a soft stool after starting docusate sodium?
Within 12–24 hours consistently
After two weeks of continuous use
Within minutes of first dose
Within 1–3 days of therapy
Which common preventative indication favors docusate sodium rather than treating established constipation?
Irritable bowel syndrome flare
Bowel obstruction management
Opioid-induced constipation prevention
Active infectious diarrhea
Which combination or co-administration should be avoided with docusate due to increased mineral oil absorption and toxicity risk?
Polyethylene glycol
Antacids
Probiotics
Mineral oil
Which counseling point for docusate sodium is accurate?
Must be taken fasting for best effect
Not recommended after spinal surgery
Safe for long-term use without dependency
Causes urgency and cramping like stimulants
Which side effect profile is most typical for docusate sodium when used appropriately?
Mild abdominal cramping and nausea
Profound hypotension frequently
Parasthesias and neuropathy
Severe electrolyte disturbances common
Which best describes the mechanism of stimulant laxatives like bisacodyl?
Directly stimulate intestinal peristalsis
Neutralize gastric acid to speed transit
Coat stool to ease passage
Bind bile acids to reduce motility
Magnesium citrate primarily promotes bowel evacuation by which mechanism?
Blocking opioid receptors in the gut
Drawing water into the intestinal lumen
Increasing mucous secretion in colon
Inhibiting sodium-potassium ATPase
A nurse should avoid giving bisacodyl when the patient reports which symptom suggestive of an acute abdomen?
Undiagnosed abdominal pain
Mild flatulence
Recent weight gain
Low-grade fever only
Which administration guidance is correct for enteric-coated bisacodyl tablets?
Split tablet and take with food
Crush and mix with antacid
Chew thoroughly with warm milk
Swallow whole without milk or antacids
For pre-procedure bowel prep requiring semisolid stool within 6–12 hours, which agent is appropriate at low dose?
Sucralfate
Magnesium citrate
Docusate sodium
Loperamide
Which patient factor must be assessed before giving magnesium citrate due to risk of toxicity?
Liver enzyme levels
Thyroid hormone levels
Pulmonary function tests
Renal function status
Which common adverse effect is shared by bisacodyl and magnesium citrate?
Photosensitivity
Tinnitus
Gingival hyperplasia
Abdominal cramping
Chronic use of bisacodyl is discouraged primarily because it can lead to which outcome?
Irreversible mucosal ulceration
Dependency and decreased bowel function
Permanent malabsorption of fats
Severe hypokalemia always
Which scenario justifies using bisacodyl for constipation management?
Severe dehydration with edema
Active appendicitis symptoms
Suspected bowel obstruction present
Opioid‑induced slowed intestinal transit
Which teaching is essential when a patient takes high-dose magnesium citrate for rapid bowel evacuation?
Ensure bathroom access due to dramatic effect
Avoid fluids to prevent dilution
Combine with antacids routinely
Expect relief only after 48 hours
Magnesium citrate at high doses poses a particular risk of which condition in susceptible patients?
Acute renal failure from magnesium load
Acute liver failure from bile stasis
Thyroid storm from iodine excess
Pulmonary edema from bronchospasm
Which co‑medication increases the risk of complications when using magnesium citrate?
ACE inhibitors or ARBs
H2 receptor antagonists
Inhaled beta‑agonists
Topical antifungals
Before giving bisacodyl, which timing consideration helps maintain its enteric coating?
Take with citrus juice immediately
Give alongside proton pump inhibitors
Administer with iron supplements
Avoid milk or antacids within 1 hour
Which evaluation finding indicates effective therapy after bisacodyl suppository use?
Reduced urinary frequency
Stable blood glucose levels
Resolution of heartburn symptoms
Bowel movement within 15–60 minutes
Which teaching supports safe hydration when using magnesium citrate for bowel prep?
Drink plenty of fluids during use
Limit fluids to prevent edema
Avoid oral intake for 12 hours
Use diuretics to maintain balance
Which best describes the mechanism of action of magnesium hydroxide as a laxative?
Hyperosmolar salts draw water into intestinal lumen
Stimulates enteric nerves to increase peristalsis
Blocks chloride channels reducing fluid secretion
Lubricates stool by coating intestinal mucosa
For bowel preparation before a diagnostic procedure, which dosing approach is appropriate for magnesium hydroxide?
Single microdose with immediate effect
Low dose over 12–18 hours
Continuous dosing for 3–5 days
High dose producing watery stool in 2–6 hours
Which patient assessment is MOST critical before giving magnesium hydroxide to a patient with chronic kidney disease?
Thyroid levels for metabolic rate
Liver enzymes for hepatotoxicity risk
Serum magnesium for accumulation risk
Platelet count for bleeding risk
Which side effect is a major concern with magnesium-based laxatives in patients with renal impairment?
Hypokalemia causing arrhythmias
Magnesium toxicity causing weakness
Hyponatremia causing seizures
Hypercalcemia causing constipation
A patient using high-dose magnesium hydroxide reports severe diarrhea. Which nursing action is most appropriate?
Encourage low fluid intake to reduce stool
Increase fluid intake to prevent dehydration
Add stimulant laxative to enhance effect
Discontinue all fiber to slow transit
Which instruction helps minimize straining during defecation when using magnesium hydroxide?
Avoid any fluids for six hours after dose
Plan for constipation relief after one week
Expect passage of soft or semiliquid stool
Take with anticholinergic medications
Long-term use of osmotic laxatives like magnesium hydroxide can lead to which outcome?
Improved bowel tone and motility
Dependence and electrolyte imbalances
Enhanced nutrient absorption of medications
Reduced risk of dehydration over time
Which scenario indicates pantoprazole is preferred over other PPIs due to drug interaction profile?
Patient prescribed levothyroxine daily
Patient using metformin for diabetes
Patient taking clopidogrel after stent placement
Patient taking digoxin for heart failure
Pantoprazole’s mechanism involves which cellular target?
Reversible H2 receptor blockade
Irreversible ATPase inhibition on parietal cells
Cholinergic muscarinic receptor antagonism
Prostaglandin analog activation
Which therapeutic outcome best reflects effective pantoprazole therapy in GERD?
Immediate relief of dysphagia within minutes
Resolution of esophagitis confirmed by endoscopy
Increased gastric acid secretion during meals
Frequent nocturnal reflux episodes
What is a recognized risk of long-term proton pump inhibitor use?
Fractures due to osteoporosis risk
Increased vitamin B12 levels
Reduced risk of C. difficile infection
Hypermagnesemia in all patients
Which adverse effect may occur after stopping chronic PPI therapy abruptly?
Rapid bacterial overgrowth
Immediate hypoglycemia
Permanent achlorhydria
Rebound acid hypersecretion
For ICU stress ulcer prophylaxis, pantoprazole is indicated for which patients?
Only patients with chronic constipation
All postoperative patients routinely
Patients with multiple additional risk factors
Low-risk patients without additional factors
Which mechanism best explains misoprostol’s gastric protection?
Stimulates bicarbonate and mucus secretion
Coats ulcers with sucrose–aluminum complex
Blocks H2 receptors reducing acid release
Neutralizes acid with aluminum hydroxide
What is the only approved gastrointestinal indication for misoprostol?
Prevention of NSAID-induced gastric ulcers
Treatment of active bleeding duodenal ulcers
Eradication of Helicobacter pylori infection
Relief of functional abdominal pain syndromes
Which patient assessment is critical before initiating misoprostol?
Pregnancy status and childbearing potential
Serum amylase and lipase levels
History of pancreatitis episodes
Baseline platelet aggregation study
Which adverse effect most commonly occurs with misoprostol?
Profound bradycardia episodes
Severe hypomagnesemia
Photosensitivity with rash
Diarrhea with abdominal pain
Why is misoprostol contraindicated in pregnancy?
Produces neonatal opioid withdrawal signs
Leads to maternal cholestasis and pruritus
Causes fetal hypothyroidism and goiter
Can induce uterine contractions and miscarriage
For cervical ripening, misoprostol may cause what serious event if overdosed?
Placental calcification with fetal hypoxia
Acute maternal pulmonary edema
Uterine tachysystole with excessive contractions
Cervical laceration requiring surgical repair
Which counseling point is essential for women of childbearing age using misoprostol?
Stop all H2 blockers prior to use
Increase dietary magnesium supplements
Avoid grapefruit to reduce toxicity
Use effective contraception during therapy
Which dosing instruction optimizes misoprostol’s gastric protection and tolerability?
Double dose when taking low-dose aspirin
Crush delayed-release tablets for absorption
Take at bedtime with antacids
Take with food to minimize diarrhea
Sucralfate’s mechanism in ulcer management is best described as:
Forms a protective viscous barrier adhering to ulcers
Neutralizes acid via ANC with magnesium
Blocks muscarinic receptors reducing motility
Directly inhibits proton pump acid secretion
Which timing instruction is correct for sucralfate administration?
Take with antacids to enhance mucosal binding
Administer with meals to improve absorption
Give on an empty stomach before meals and at bedtime
Dose only once daily due to long half-life
Which drug interaction precaution applies to sucralfate?
Separate from digoxin, warfarin, and fluoroquinolones
Co-administer with theophylline to reduce acid
Combine with NSAIDs to accelerate healing
Avoid spacing from antacids within ten minutes
Which adverse effect is most frequently associated with sucralfate?
Constipation occurring in a minority of patients
Profound diarrhea with dehydration risk
Renal failure due to acute tubular necrosis
Severe hypoglycemia requiring dextrose
What monitoring is recommended when a patient with CKD takes sucralfate?
Measure thyroid function for hypothyroidism
Check INR due to anticoagulant effect
Track serum potassium for hyperkalemia
Assess for aluminum accumulation and toxicity
Which teaching reinforces sucralfate effectiveness?
Take antacids at the same time for relief
Use milk products to neutralize acidity
Increase caffeine to stimulate mucosal flow
Avoid smoking, alcohol, and NSAIDs to aid healing
Diphenoxylate is classified pharmacologically as:
Opioid used solely for diarrhea
Peripheral anticholinergic antidiarrheal
H2 receptor antagonist antidiarrheal
Prokinetic dopamine antagonist
Why is atropine added to diphenoxylate therapy?
Discourages abuse by causing unpleasant effects at high doses
Enhances opioid binding for stronger analgesia
Prevents constipation through prokinetic action
Neutralizes intestinal acid to improve comfort
Which assessment is prioritized before starting diphenoxylate/atropine for severe diarrhea?
Verify vitamin B12 levels for anemia screening
Check serum calcium for hypocalcemia risk
Measure liver enzymes for cholestatic patterns
Rule out infectious etiology with pseudomembranous colitis
Which patient safety warning is appropriate for diphenoxylate/atropine?
Increase dose until euphoria then taper slowly
Use freely in hepatic failure without adjustment
Take during acute infection to slow motility
Avoid alcohol and CNS depressants due to sedation
Which class best describes metoclopramide?
Anticholinergic antispasmodic
Serotonin agonist antiemetic
GABAergic sedative antiemetic
Dopamine antagonist prokinetic
Which mechanism is central to ondansetron’s antiemetic action?
Blocks 5-HT3 receptors
Stimulates D2 receptors
Inhibits acetylcholine release
Enhances GABA binding
Metoclopramide primarily increases which GI function?
Bile salt reabsorption
Pancreatic enzyme output
Gastric acid secretion
Gastric emptying and motility
Which adverse effect is most associated with metoclopramide?
Extrapyramidal symptoms
Hemolytic anemia
Nephrotoxicity
Photosensitivity rash
Which patient factor requires caution before giving ondansetron?
Past appendectomy
Mild seasonal allergies
Long QT syndrome history
Lactose intolerance
Which timing maximizes metoclopramide effectiveness?
Thirty minutes before meals
Only at bedtime
Every other morning
Immediately after meals
Ondansetron is FIRST approved for preventing which condition?
Radiation-induced diarrhea
Gastroparesis-related reflux
Postoperative ileus
Chemotherapy-induced nausea and vomiting
Which risk increases when ondansetron is combined with other QT-prolonging drugs?
Pulmonary embolism
Hypoglycemia
Torsades de pointes
Hyperkalemia
Which symptom signals acute dystonia from metoclopramide?
Involuntary muscle contractions
Diffuse pruritic rash
Polyuria and thirst
Dry persistent cough
Which treatment can reverse acute dystonia due to metoclopramide?
NSAID plus fluids
Diphenhydramine IM dose
Activated charcoal orally
High-dose loperamide
Which population faces higher risk of EPS with metoclopramide?
Patients with eczema
Pregnant in second trimester
Middle-aged athletes
Children and older adults
Which nursing assessment is essential before IV ondansetron in high‑risk patients?
Skin prick testing
Baseline ECG tracing
Spirometry test
Liver biopsy panel
Which black box warning relates to metoclopramide?
Tardive dyskinesia risk with long use
Anaphylaxis in penicillin allergy
Severe hypoglycemia episodes
Acute renal failure risk
Which common adverse effect occurs with ondansetron?
Headache and diarrhea
Photosensitivity and tinnitus
Cough and rhinorrhea
Polyuria and edema
Which statement best describes metoclopramide’s CNS action?
Enhances GABA activity broadly
Blocks dopamine receptors in CTZ
Stimulates serotonin release centrally
Inhibits opioid receptors in medulla
Which condition is a contraindication for metoclopramide?
Iron‑deficiency anemia
GI obstruction or perforation
Uncomplicated migraine
Mild GERD without symptoms
Which monitoring priority applies when starting metoclopramide in a depressed patient?
Check fasting lipid panel weekly
Watch for mood changes and suicidality
Assess for ankle edema daily
Measure peak flow hourly
Which scenario shows appropriate ondansetron use beyond chemotherapy?
Relief of chronic constipation
Management of peptic ulcer pain
Prevention of postoperative nausea
Treatment of bacterial colitis
Which electrolyte abnormality heightens ondansetron’s QT risk?
Hypernatremia or hypercalcemia
Hyperkalemia or hyponatremia
Hypocalcemia or hyperphosphatemia
Hypokalemia or hypomagnesemia
Which instruction helps minimize sedation with metoclopramide?
Avoid alcohol and CNS depressants
Take with high‑fat meals only
Increase daytime caffeine intake
Limit fluid intake before dosing
Which receptor subtype does ondansetron primarily antagonize to prevent nausea and vomiting?
M1 muscarinic receptors in gut
5-HT3 serotonin receptors centrally
H1 histamine receptors in vestibule
D2 dopamine receptors in striatum
Ondansetron is first-line for chemotherapy-induced nausea and vomiting because it has which key advantage?
No extrapyramidal adverse effects
Stimulates dopamine release centrally
Stronger sedation than promethazine
Induces gastric emptying consistently
A patient on ondansetron should be monitored most closely for which cardiac risk, especially with IV use?
Shortened PR interval episodes
QT interval prolongation risk
Wolff–Parkinson–White syndrome
Chronic atrial flutter onset
Which statement best explains why ondansetron does not cause acute dystonia or akathisia?
It blocks alpha-1 adrenergic receptors
It does not block dopamine receptors
It enhances GABAergic transmission
It increases acetylcholine activity
For a patient receiving ondansetron, which nursing action is most appropriate before administration?
Correct hypokalemia and hypomagnesemia
Check fasting blood glucose levels
Measure serum amylase and lipase
Administer anticholinergic premedication
High-risk patients receiving IV ondansetron should be monitored for which specific rhythm concern?
Ventricular bigeminy pattern
Multifocal atrial tachycardia
Torsades de pointes risk
Sinus bradycardia only
Which drug interaction increases the risk of QT prolongation when combined with ondansetron?
Opioid analgesics
Short-acting benzodiazepines
Antiarrythmics that prolong QT
Proton pump inhibitors
Levodopa reduces Parkinson’s symptoms primarily by which mechanism in the brain?
Inhibiting MAO-B in substantia nigra
Activating GABA receptors in cortex
Increasing dopamine synthesis in striatum
Blocking COMT in the periphery
Which statement describes how levodopa reaches the brain for therapeutic action?
Transport via albumin-bound pathway
Pinocytosis through endothelial cells
Active transport system across BBB
Passive diffusion without carriers
Why is levodopa given with carbidopa in standard Parkinson’s therapy?
Carbidopa blocks dopamine receptors centrally
Carbidopa inhibits peripheral decarboxylase
Carbidopa stimulates cholinergic receptors
Carbidopa enhances MAO-B metabolism
What is the effect of high-protein meals on levodopa therapy?
Increase intestinal absorption markedly
Have no significant clinical influence
Reduce transport across blood–brain barrier
Accelerate central conversion to dopamine
Which dosing issue reflects levodopa’s acute loss of effect that can be minimized by regimen changes?
Progressive tolerance only
Irreversible receptor downregulation
Shortening dosing interval episodes
Fixed-interval withdrawal syndrome
Entacapone is used adjunctively with levodopa to produce which pharmacokinetic effect?
Prolong plasma half-life of levodopa
Increase renal excretion of dopamine
Block central D2 receptors directly
Enhance acetylcholine receptor activity
Carbidopa’s inability to cross the blood–brain barrier results in which benefit?
Enhanced cholinergic signaling centrally
Faster central receptor activation
Direct agonism at striatal D1 receptors
Reduced peripheral dopamine production
Which adverse effect is commonly associated with levodopa due to dopaminergic activation?
Persistent hypercalcemia episodes
Chronic pancreatitis development
Severe neutropenia consistently
Visual hallucinations or nightmares
Which patient counseling point helps optimize levodopa absorption when meals are needed?
Use calcium supplements concurrently
Avoid fluids for two hours after dose
Split protein intake evenly all day
Take with high-fat snacks consistently
Which combination is appropriate for initial therapy in moderate Parkinson’s disease?
Carbidopa alone daily
Levodopa/carbidopa combination
Entacapone monotherapy
Ondansetron with carbidopa
Which side effect of levodopa can be reduced by lowering the dosage, though beneficial effects may also diminish?
Alpha-adrenergic agonism signs
Malignant melanoma formation
Psychosis with vivid hallucinations
Permanent memory impairment
Which nursing assessment is essential before initiating levodopa/carbidopa therapy?
Test for G6PD deficiency status
Evaluate narrow-angle glaucoma risk
Measure serum lithium concentrations
Assess thyroid-stimulating hormone
Which best describes carbidopa’s role when combined with levodopa in Parkinson’s therapy?
Antagonizes NMDA receptors to reduce excitotoxicity
Inhibits MAO-B to prevent dopamine breakdown
Stimulates dopamine release from striatal neurons
Blocks peripheral decarboxylase to boost CNS delivery
High-protein meals affect levodopa therapy primarily by
Competing for intestinal and BBB transport
Enhancing renal excretion via alkalinization
Inducing hepatic enzymes to clear levodopa
Increasing gastric pH to degrade levodopa
Which interaction is a notable concern with levodopa preparations containing pyridoxine?
Pyridoxine blocks NMDA receptors, reducing dyskinesia
Pyridoxine inhibits COMT, raising levodopa levels
Pyridoxine increases peripheral metabolism of levodopa
Pyridoxine enhances cholinergic tone, worsening tremor
Entacapone’s mechanism of action is best described as
D2 receptor agonism in basal ganglia
Irreversible MAO-B inhibition in CNS
Selective reversible COMT inhibition in periphery
Dopamine reuptake blockade in striatum
A key therapeutic goal achieved by entacapone in combination therapy is
Complete remission of Parkinson’s symptoms
Cure of dopaminergic neuron loss
Reduced "off" time with more consistent motor control
Elimination of levodopa-induced dyskinesias
Which adverse effect is characteristically associated with entacapone?
Hyperkalemia with muscle weakness
Photosensitivity with rash and pruritus
Severe agranulocytosis with fever
Yellow–orange urine discoloration with diarrhea
Which drug interaction pattern is correct for entacapone?
Increases levels of drugs metabolized by COMT
Induces CYP3A4 to lower statin exposure
Chelates iron to reduce absorption
Blocks P-gp to raise digoxin levels
Nursing assessment before entacapone initiation should include
Serum lithium concentration monitoring
Thyroid function testing panel
Eye exam for retinopathy screening
Baseline motor function and wearing-off history
Donepezil belongs to which pharmacologic class?
Dopamine agonist stimulating D2 receptors
Cholinesterase inhibitor improving acetylcholine
COMT inhibitor prolonging levodopa action
NMDA antagonist reducing glutamate activity
Donepezil’s expected clinical benefit in Alzheimer’s disease is
Long-term disease modification and regeneration
Rapid reversal and cure of dementia symptoms
Modest cognitive improvement and slowed decline
No change in cognition but improved motor tone
An important cardiovascular adverse effect to monitor with donepezil is
Hypertension with tachycardia
Bradycardia with syncope risk
Pulmonary hypertension progression
Ventricular fibrillation routinely
Which patient factor warrants caution when prescribing donepezil due to bronchoconstriction risk?
Renal calculi history
Benign prostatic hyperplasia
Asthma or COPD history present
Type 2 diabetes mellitus
Memantine is best characterized pharmacologically as a
GABA agonist enhancing inhibitory tone
MAO-B inhibitor preventing dopamine breakdown
NMDA receptor antagonist modulating glutamate
Cholinesterase inhibitor raising acetylcholine
Compared with cholinesterase inhibitors, memantine is generally
Better tolerated with fewer cholinergic effects
Less tolerated with more GI upset
Equally sedating with marked bradycardia
More hepatotoxic requiring frequent LFTs
Which clinical outcome is consistent with memantine use in moderate to severe Alzheimer’s disease?
Improved motor function without cognitive change
Permanent prevention of disease progression
Immediate recovery of memory and orientation
Slowed decline in cognitive and functional status
Memantine’s primary mechanism in Alzheimer’s disease involves blocking which receptor pathway to limit excitotoxicity while preserving normal signaling?
NMDA receptor channel blockade
Acetylcholinesterase inhibition
GABA-A receptor potentiation
AMPA receptor influx modulation
Which clinical benefit is most consistently associated with memantine in moderate to severe Alzheimer’s disease?
Prevention of amyloid formation
Improved day-to-day functioning
Complete cognitive restoration
Reversal of disease progression
A nurse should adjust memantine dosing primarily in which clinical situation?
Uncontrolled hypothyroidism
Active peptic ulcer disease
Renal impairment present
Hepatic impairment present
When combined with donepezil, memantine may show which outcome compared to donepezil alone?
Worsened cognitive scores
Complete symptom resolution
Similar decline rates
Slower cognitive decline
Which adverse effect is most characteristic of memantine therapy?
Profound myelosuppression
Blue-green urine tint
Severe neutropenia
Constipation common
Interferon-beta agents for multiple sclerosis are best described pharmacologically as which class?
NMDA antagonists
Topoisomerase inhibitors
Cholinesterase inhibitors
Immunomodulators
Which interferon-beta formulation contains glycoproteins identical to natural human interferon?
Memantine
Mitoxantrone
Interferon beta-1b
Interferon beta-1a
Key therapeutic goals of interferon-beta in relapsing MS include which effect measured by imaging?
Increase in lesion detectability
Induction of remyelination on MRI
Reduction in detectable brain lesions
Complete elimination of plaques
Baseline monitoring for interferon-beta should include which assessment to track hepatotoxicity risk?
Thyroid function tests
Liver function tests
Echocardiography
Pulmonary function tests
Which side effect is commonly associated with interferon-beta injections and may be mitigated with acetaminophen?
Profound cardiotoxicity
Blue-green skin staining
Flu-like symptoms
Severe neutropenia
Neutralizing antibodies developing against interferon-beta most likely lead to which clinical issue?
Enhanced drug potency
Permanent remission
Reduced therapeutic effect
Immediate hypersensitivity
Which patient characteristic warrants caution or additional monitoring during interferon-beta therapy?
History of glaucoma
Active alcohol use or hepatotoxic meds
Penicillin allergy only
High vitamin D intake
Mitoxantrone’s mechanism in MS involves which primary molecular action?
Enhancing myelin synthesis
Binding DNA and inhibiting topoisomerase
Stimulating interferon receptors
Blocking sodium channels
A critical pre-infusion requirement for mitoxantrone includes which cardiac assessment threshold?
Ejection fraction above 50%
Ejection fraction above 30%
Heart rate below 60 bpm
Ejection fraction above 60%
Which cumulative dose limit is associated with mitoxantrone due to cardiotoxicity risk?
100 mg/m2 lifetime
No defined limit
140 mg/m2 lifetime
200 mg/m2 lifetime
