A patient with Parkinson's disease who takes levodopa (Dopar) and pramipexole (Mirapex) was admitted with a peptic ulcer
A nurse is providing discharge instructions a week later and notes that the prescriber has added cimetidine (Tagamet) to the patient's drug regimen. What statement made by the patient indicates a need for further teaching?
a. "I should take the Tagamet at least 1 hour before the other medications."
b. "I should rise slowly from seated or lying positions."
c. "I very likely could experience dyskinesias."
d. "I should see an improvement in dyskinesias."
ANS: D
Cimetidine can inhibit renal excretion of pramipexole, resulting in an increase in the drug's blood level. The patient needs further teaching, because he will not see an improvement in dyskinesias, but rather, more dyskinesias.
Cimetidine should be taken at least 1 hour prior to any other medications; no further teaching is needed.
Postural hypotension is common in patients taking levodopa and pramipexole; no further teaching is indicated.
This patient will experience an increase in dyskinesias; no further teaching is needed.
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