A nurse is assessing a client who is receiving androgen therapy to treat endometriosis.
For which of the following adverse effects should the nurse monitor?

Choice A rationale

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that can exacerbate gastric ulcers by inhibiting prostaglandin synthesis, which normally protects the gastric mucosa. Continuing ibuprofen would counteract the therapeutic effects of esomeprazole, a proton pump inhibitor, and increase the risk of gastrointestinal bleeding and ulcer perforation.

Choice B rationale

Esomeprazole delayed-release capsules contain enteric-coated pellets to protect the active ingredient from gastric acid degradation, allowing absorption in the small intestine. Crushing the medication would destroy this protective coating, leading to premature drug release in the stomach and reduced bioavailability, thereby diminishing its therapeutic efficacy.

Choice C rationale

Esomeprazole is a proton pump inhibitor that irreversibly binds to and inhibits the H+/K+-ATPase pump in gastric parietal cells, thereby reducing gastric acid secretion. Taking it 60 minutes before a meal ensures that peak plasma concentrations coincide with the maximal activity of these pumps, which are stimulated by food intake, optimizing its acid-suppressing effect.

Choice D rationale

While some medications can cause insomnia, it is not a commonly reported adverse effect of esomeprazole. Common adverse effects of proton pump inhibitors typically include headache, nausea, diarrhea, abdominal pain, and flatulence, reflecting their primary actions on the gastrointestinal system and potential systemic effects.

Choice A rationale: Orthostatic hypotension is a common side effect of carbidopa-levodopa due to its vasodilatory effects and impact on the autonomic nervous system. Patients may experience dizziness or lightheadedness when standing up quickly, caused by a drop in blood pressure. Normal blood pressure ranges around 120/80 mm Hg, and sudden decreases can lead to falls, especially in Parkinson’s disease patients who already have balance issues.

Choice B rationale: Wearing-off phenomenon is common with carbidopa-levodopa therapy. This occurs when medication effects diminish before the next dose, causing symptom recurrence such as bradykinesia and tremor. The medication has a relatively short half-life, and patients often report fluctuation in symptom control, especially as disease progresses. Understanding this helps manage expectations and medication timing.

Choice C rationale: High-protein diets can interfere with the absorption of levodopa, as dietary amino acids compete with levodopa for transport across the intestinal mucosa and the blood-brain barrier. Patients are typically advised to moderate protein intake during dosing times to maximize medication effectiveness, rather than increase protein consumption.

Choice D rationale: Levodopa is best absorbed on an empty stomach because food, particularly proteins, delays gastric emptying and competes with levodopa for absorption. Taking the medication 30 minutes before or 1 hour after meals improves bioavailability and symptom control. This knowledge helps optimize medication efficacy.

Choice E rationale: Parkinson’s symptoms usually do not resolve within days of starting carbidopa-levodopa. It often takes weeks to months for optimal symptom control and dose adjustments. Patients should understand that this medication manages symptoms but is not a cure and requires ongoing therapy.