A patient with Parkinson disease asks the nurse what an "on–off" problem means with medications. What should the nurse explain to the patient?
1. "The ‘on' times will be when your symptoms are under control; the ‘off' times are when you will have increased problems with symptom management."
2. "There will be times when you are depressed (off) and when you are happy (on)."
3. "You will have to take breaks from this medicine by stopping (off) and starting it (on) again, so you don't build up a tolerance to it."
4. "I'm not a pharmacist, so I shouldn't be answering this question."
Correct Answer: 1
The "on–off" phenomenon occurs after the patient takes levodopa for several years; this phenomenon is characterized by unexpected dyskinesias (abnormal movements) and lack of symptom control. The "on–off" phenomenon has nothing to do with depressive episodes and the medication for Parkinson disease should not be started and stopped. A nurse should be able to answer questions about the patient's medications, or at least attempt to find the answer if it is not known.
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