A nurse is caring for a 45-year-old male client in an acute care unit.

For each provider prescription, click to specify if the intervention is anticipated or contraindicated for this client.

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.

The client is at risk for developing hallucinations and weight loss.

Rationale for correct answers:
Bupropion is an atypical antidepressant used for smoking cessation that acts by inhibiting the reuptake of norepinephrine and dopamine. It is known to potentially cause neuropsychiatric side effects, including hallucinations, especially in patients with a history of psychiatric disorders such as bipolar disorder. Weight loss is a common adverse effect due to bupropion’s appetite suppression and increased metabolism. Normal weight is assessed by BMI, and this client has a normal BMI, but bupropion may exacerbate weight loss. Hallucinations indicate serious CNS involvement and require close monitoring.

Rationale for incorrect Response 1 options:
Dependence is not typically associated with bupropion; it has a low abuse potential. Somnolence or drowsiness is not a prominent side effect; bupropion is generally stimulating rather than sedating. Hypotension is also not a common effect; bupropion may actually increase heart rate and blood pressure slightly.

Rationale for incorrect Response 2 options:
Somnolence is not common; patients may experience insomnia rather than sedation. Hallucinations are already selected as a correct response. Hypotension is rare; instead, bupropion can cause hypertension in some cases. Weight loss is a known side effect and thus the correct choice.

Take home points:

• Bupropion can cause neuropsychiatric side effects, especially in clients with bipolar disorder.
• Weight loss may occur due to appetite suppression and increased metabolism.
• Monitor closely for CNS symptoms such as hallucinations during therapy.
• Smoking cessation pharmacotherapy must be tailored considering psychiatric history to avoid adverse effects.