Review Practice Exercise 3

Drugs Used for Degenerative Diseases of the Nervous System > Pharmacology

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Practice Exercise 3

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Question 1:

The nurse discusses the disease process of multiple sclerosis with the client and caregiver. The client will begin taking glatiramer acetate (Copaxone), and the nurse is teaching the client about the drug. Which of the following points should be included?

A. Drink extra fluids while this drug is given. B. Local injection site irritation is a common effect. C. Take the drug with plenty of water and remain in an upright position for at least 30 minutes. D. The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet. E. A client who has not responded well to other drug therapy for Alzheimer’s disease is placed on tacrine (Cognex).

Answer and Explanation

Choice A:

Drink extra fluids while this drug is given.Increased fluid intake is not required for glatiramer acetate therapy. Hydration does not influence the drug’s effectiveness or safety.

Choice B:

Local injection site irritation is a common effect.Glatiramer acetate is given by subcutaneous injection, and the most common side effects include injection site reactions such as redness, pain, swelling, or itching. Clients should rotate injection sites and use proper technique to minimize irritation and prevent complications like lipoatrophy.

Choice C:

Take the drug with plenty of water and remain in an upright position for at least 30 minutes.This teaching applies to oral bisphosphonates (e.g., alendronate) to prevent esophageal irritation, not to subcutaneous injections like glatiramer acetate.

Choice D:

The drug causes a loss of vitamin C so include extra citrus and foods containing vitamin C in the diet.
Glatiramer acetate does not deplete vitamin C, and no dietary supplementation is needed.

Choice E:

A client who has not responded well to other drug therapy for Alzheimer’s disease is placed on tacrine (Cognex).
This statement is unrelated and refers to Alzheimer’s disease treatment, not MS or glatiramer acetate. Including it here indicates a need for teaching clarification.

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Question 2:

Which oral disease-modifying therapy for MS requires strict pregnancy precautions due to teratogenicity?

A. Fingolimod B. Dimethyl fumarate C. Teriflunomide D. Glatiramer acetate

Answer and Explanation

Choice A:

Fingolimod
● Fingolimod can also pose risks in pregnancy, but it is not the primary oral MS drug associated with strict teratogenic precautions; contraception is recommended, and it is contraindicated in pregnancy.

Choice B:

Dimethyl fumarate● Dimethyl fumarate has limited human data but is not classified as highly teratogenic, though use is generally avoided in pregnancy.

Choice C:

Teriflunomide● Teriflunomide is teratogenic and embryotoxic, associated with fetal malformations if taken during pregnancy.● Pregnancy prevention programs are mandatory for patients of reproductive potential.● If pregnancy occurs, accelerated elimination procedures using cholestyramine or activated charcoal may be required to reduce drug levels quickly.

Choice D:

Glatiramer acetate● Glatiramer acetate is considered safe in pregnancy, with no known teratogenic effects.Take-home points:
● Teriflunomide requires strict pregnancy precautions due to its teratogenic potential.● Effective contraception and drug elimination protocols are critical for patients planning pregnancy.● Other oral MS therapies may have pregnancy considerations, but teriflunomide carries the highest risk.

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Practice Exercise 3

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