A 64-year-old man with Parkinson disease complained of periods of complete immobility, followed by involuntary movements. The patient's current medications included levodopa/carbidopa. To reduce these rapid fluctuations, the neurologist reduced the daily dose of levodopa/carbidopa and added a drug. Which of the following drugs was most likely prescribed?

Correct Answer: D

Rationale: The correct answer is D) Pramipexole. In this scenario, the patient is experiencing motor fluctuations and dyskinesias, which are common complications of long-term levodopa therapy in Parkinson's disease. Pramipexole, a dopamine agonist, is often prescribed in conjunction with levodopa to help smooth out these fluctuations by providing a more continuous stimulation of dopamine receptors. A) Amantadine is another drug used in Parkinson's disease, primarily for its antiviral properties, but it is not typically used to address motor fluctuations like those described in the case. B) Benztropine is an anticholinergic agent used to treat extrapyramidal symptoms caused by antipsychotic medications but is not indicated for the management of motor fluctuations in Parkinson's disease. C) Haloperidol is an antipsychotic medication that can worsen motor symptoms in Parkinson's disease patients and is not recommended in this case. Educationally, understanding the rationale behind choosing Pramipexole in this situation highlights the importance of combination therapy and individualized treatment plans in managing complex conditions like Parkinson's disease. It underscores the need for healthcare providers to consider the mechanism of action of each drug, the specific symptoms being addressed, and potential drug interactions when making treatment decisions for patients.

Correct Answer: F

Rationale: Haloperidol is the most appropriate choice for this patient with Huntington chorea as it is a typical antipsychotic that can help suppress choreic movements and agitated behavior. Haloperidol is commonly used to manage the motor symptoms associated with Huntington's disease, making it the best option in this case. Additionally, the patient's symptoms of persecutory delusions and auditory hallucinations may also be alleviated by haloperidol, further supporting its use in this scenario.

Correct Answer: C

Rationale: The patient most likely exhibited akathisia, which is a common adverse effect of antipsychotic medications like haloperidol. Akathisia is characterized by restlessness, an inability to sit still, and a feeling of wanting to jump out of one's skin. This aligns with the patient's symptoms of increased agitation and confusion, as well as the fact that she had recently started therapy with uphenazine, an antipsychotic medication. The other choices are less likely to cause the specific symptoms described.

Correct Answer: C

Rationale: The patient complained of abnormal growth of his breast after receiving a psychotropic drug for 6 months. The most likely cause of this adverse effect is Amitriptyline, as it is known to cause gynecomastia (abnormal breast growth) as a side effect. Amitriptyline is a tricyclic antidepressant that can lead to hormonal imbalances and breast enlargement in males. The other options, such as Haloperidol and Risperidone, are less likely to cause this specific symptom.

Correct Answer: C

Rationale: In this scenario, the most likely drug prescribed for the 43-year-old man with major depressive disorder is Venlafaxine (Option C). Venlafaxine is a serotonin-norepinephrine reuptake inhibitor (SNRI) commonly used to treat major depressive disorder due to its effectiveness in addressing both serotonin and norepinephrine imbalances associated with depression. Option A, Amitriptyline, is a tricyclic antidepressant that is not typically the first choice for treating major depressive disorder in current practice due to its side effect profile and the availability of newer, better-tolerated options like SSRIs and SNRIs. Option B, Citalopram, is a selective serotonin reuptake inhibitor (SSRI) commonly used to treat depression. While it is effective for many individuals with major depressive disorder, in this case, the man's likely presentation of norepinephrine-related symptoms would make an SNRI like Venlafaxine a more suitable choice. Option D, Lorazepam, is a benzodiazepine primarily used for anxiety and not a first-line treatment for major depressive disorder. It may be prescribed for comorbid anxiety symptoms but would not be the primary choice for treating major depressive disorder. Educationally, understanding the rationale behind selecting specific medications for different mental health conditions is crucial for nursing practice. It is essential to consider individual patient factors, symptom presentation, pharmacological mechanisms of action, and potential side effects when making prescribing decisions to ensure optimal patient outcomes.