An older adult client with Parkinson disease is seen because the daughter states the client cannot stay awake in the daytime
The client is sleeping most of the day, and is having trouble sleeping at night. The client has no history of cardiac events or psychiatric disorders. Vital signs, electrolytes, liver and renal test results are within normal limits. The client is slightly underweight for height. The nurse would anticipate a prescription for which medication?
1. Sodium oxybate (gammahydroxybutyrate, Xyrem)
2. Modafinil (Provigil, Alertec)
3. Methylphenidate (Ritalin)
4. Selegiline (Eldepryl)
Correct Answer: 2
Rationale 1: Sodium oxybate, which is used to treat cataplexy, has a strong hypnotic effect that would be problematic in the client with Parkinson disease.
Rationale 2: Modafinil is approved for treatment of fatigue related to Parkinson disease and circadian rhythm disruption, and it does not appear to suppress appetite or promote weight gain.
Rationale 3: Methylphenidate is not approved for circadian rhythm disruption and is more apt to cause weight loss, and this client is underweight before medicating.
Rationale 4: Eldepryl has been used off label to treat cataplexy, which is not described in this situation.
Global Rationale: Modafinil is approved for treatment of fatigue related to Parkinson disease and circadian rhythm disruption, and it does not appear to suppress appetite or promote weight gain. Sodium oxybate, which is used to treat cataplexy, has a strong hypnotic effect that would be problematic in the client with Parkinson disease. Methylphenidate is not approved for circadian rhythm disruption and is more apt to cause weight loss, and this client is underweight before medicating. Eldepryl has been used off label to treat cataplexy, which is not described in this situation.
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