3.
Anticholinergic adverse effects
Option 3:
Anticholinergic adverse effects are a common problem of tricyclic antidepressants [TCAs]. They include dry mouth, constipation, urinary hesitancy or retention, blurred vision, sedation, orthostatic hypotension, weight gain, nausea, vomiting, gynecomastia, and changes in libido. This is more problematic for the very young or old and when combined with more than one anticholinergic drug.
Rationales
Option 1:
Hyperpyrexia is another term for a very high fever. This occurs when tricyclic antidepressants [TCAs] are combined with monoamine oxidase inhibitors [MAOIs].
Option 2:
Physical dependence can cause an abstinence syndrome, which includes cramping, delirium, tremors, hypertension, tachycardia, fever, and possibly seizures. This is not described in the question.
Option 4:
The symptoms described are anticholinergic. Parkinsonism can be induced by antipsychotic
drugs and can be treated with anticholinergic drugs, such as diphenhydramine [Benadryl]. The symptoms of parkinsonism include bradykinesia, resting tremor, posture instability, and rigidity.
1.
Avoid cured meats.
Option 1:
Concurrent MAOIs and ingestion of foods rich in tyramine may cause sudden and extreme hypertension. These foods include aged cheeses, cured meats, fava beans, soy sauce, alcohol, dried fish, sour cream, caffeine, and fermented
vegetables, such as sauerkraut.
Rationales
Option 2:
Peanut products do not need to be avoided with use of MAOIs.
Option 3:
Grapefruit juice does not need to be avoided with use of MAOIs.
Option 4:
Fresh, dark green, leafy vegetables do not need to be avoided with use of MAOIs.
Which medications are first-line agents to treat Parkinson's disease in its mild to moderate stages?
1.
Levodopa, entacapone, or
selegiline
2.
Bromocriptine, pergolide, pramipexole, or ropinirole
3.
Entacapone, pergolide, pramipexole, or ropinirole
4.
Selegiline, amantadine, or bromocriptine
2.
Bromocriptine, pergolide, pramipexole, or ropinirole
Option 2:
Bromocriptine, pergolide, pramipexole, or ropinirole are first-line agents in treating mild to moderate Parkinson's disease.
Rationales
Option 1:
Levodopa is an agent that is reserved as symptoms
worsen because it is the cornerstone of Parkinson's disease management, yet it has a "wearing off" effect. It is not a first-line agent for these reasons.
Option 3:
Entacapone is an agent that is given with levodopa and carbidopa to reduce the "wearing off" effect. Levodopa is reserved as symptoms worsen because it is the cornerstone of Parkinson's disease management, yet it has a "wearing off" effect. Therefore, entacapone would not be used early in treatment.
Option 4:
Selegiline
and amantadine are used to improve the levodopa response, which is usually not introduced in the early phases of Parkinson's disease.
Ingestion of foods or drinks with tyramine leads to hypertensive crisis, which may lead to cerebral hemorrhage, stroke, coma, or death
Avoid foods that contain tyramine!
Aged, mature cheeses [cheddar, blue, Swiss]
Smoked/pickled or aged meats, fish, poultry [herring, sausage, corned beef, salami, pepperoni, paté]
Yeast extracts
Red wines [Chianti, burgundy, sherry, vermouth]
Italian broad beans
[fava beans]
Body System Effects
CNS
Headache, dizziness, tremor, nervousness, insomnia*, fatigue
GI
Nausea, diarrhea, constipation, dry mouth
Other
Sexual dysfunction, weight gain, weight loss, sweating
Don't gain weight with welbutrin
Insomnia for the first couple of weeks
Symptoms
Delirium, tachycardia, hyperreflexia, shivering, agitation, sweating, muscle spasms, coarse
tremors
Symptoms of severe cases
Hyperthermia, seizures, renal failure, rhabdomyolysis, dysrhythmias, disseminated intravascular coagulation [DIC]
Three varieties; has been used for over 5000 years
Uses: stress reduction, improvement of physical endurance and concentration
May cause elevated BP, chest pain, palpitations, anxiety, insomnia, headache, GI symptoms
Interactions with anticoagulants, immunosuppressants, anticonvulsants, antidiabetic
drugs
A, C, D, E
Rationale:
Serotonin syndrome can occur if a selective serotonin reuptake inhibitor is combined with a monoamine oxidase inhibitor, a tryptophan-serotonin precursor, or St. John's wort. Signs and symptoms of serotonin syndrome include restlessness or agitation, headache, diaphoresis, ataxia, myoclonus, shivering, tremor, diarrhea, nausea, abdominal cramps, and hyperreflexia. Constipation is not associated with
serotonin syndrome.
D] Edema
Rationale:
Assess for and identify signs and symptoms of lithium toxicity, which include diarrhea, lethargy, slurred speech, muscle weakness, ataxia, seizures, edema, hypotension, and circulatory collapse. Hypertension, energetic behavior, and elevated muscle response are not signs of lithium poisoning.