Treatment of restless legs syndrome in patients with chronic kidney disease: a focus on medications.
Restless legs syndrome
(Tests, problems and exercises)
Chronic kidney failure (Tests, problems and exercises)
Raymond, Colette B.
Wazny, Lori D.
Sood, Amy R.
Orsulak, Cali D.
|Publication:||Name: CANNT Journal Publisher: Canadian Association of Nephrology Nurses & Technologists Audience: Trade Format: Magazine/Journal Subject: Health care industry Copyright: COPYRIGHT 2010 Canadian Association of Nephrology Nurses & Technologists ISSN: 1498-5136|
|Issue:||Date: April-June, 2010 Source Volume: 20 Source Issue: 2|
|Geographic:||Geographic Scope: Canada Geographic Code: 1CANA Canada|
1. Clinical manifestations of restless legs syndrome (RLS) include:
(a) urge to move the legs, leg cramps, sudden jerking leg movements, varicose veins
(b) urge to move the legs, worse at night, worse with rest or inactivity and relieved by movement
(c) urge to move the legs, sudden jerking leg movements, skin sensitivity, pain and tingling in the legs
(d) urge to move the legs, insomnia, mood disorders, obstructive sleep apnea
2. Mr. S.R. is a 58-year-old male receiving hemodialysis with anemia, diabetes, diabetic gastroparesis, obstructive sleep apnea, hypertension, hyperphos-phatemia and hyperparathyroidism. Mr. S.R. receives the following medications: epoetin alfa, intravenous iron, insulin, metoclopramide, calcium carbonate and calcitriol. He has just been diagnosed with intermittent RLS.What risk factors does Mr. S.R. have for RLS?
(a) end stage renal disease, hyperphosphatemia
(b) anemia, hyperparathyroidism, obstructive sleep apnea
(c) end stage renal disease, hypertension, obstructive sleep apnea
(d) end stage renal disease, diabetes, anemia
3. The medication that could possibly contribute to his RLS includes:
(b) intravenous iron
4. Ms. C.O. is a 69-year-old female receiving hemodialysis. She was diagnosed with RLS after she presented an urge to move her legs, which occurred during dialysis sessions and also occasionally at night, but is relieved by movement. Therapeutic options for Ms. C.O. include:
(a) reduce caffeine, alcohol and nicotine, perform mentally alerting activities during dialysis, perform calfstretching exercises
(b) increase caffeine intake, especially before dialysis sessions, sleep during dialysis sessions
(c) reduce caffeine, alcohol and nicotine, perform relaxation exercises during dialysis, avoid intradialytic aerobic exercise
(d) reduce caffeine, alcohol and nicotine, perform mentally alerting activities during dialysis, apply hot compresses to legs during dialysis sessions
5. Pharmacotherapeutic alternatives for Ms. C.O. include:
(a) dopamine, ropinirole, gabapentin
(b) levodopa/carbidopa, ropinirole
(c) metoclopramide, ropinarole, pramipexole
(d) hydromorphone, gabapentin, quinine
6. Ms. J.K. is a 63-year-old female with stage 4 chronic kidney disease and RLS. Her RLS occurs every night and causes sleep disruption and, as a result, she feels tired and depressed. Medication options to treat Ms. J.K. include:
(a) levodopa/carbidopa, gabapentin, oxycodone
(b) levodopa/carbidopa, ropinirole, gabapentin
(c) pramipexole, gabapentin, tramacet
(d) ropinirole, zopiclone, quinine
7. Mr. J.T. is a 47-year-old hemodialysis patient who was recently diagnosed with RLS. He has received a prescription for ropinirole 0.25 mg daily at bedtime. He should be aware of the following adverse effects:
(a) gastrointestinal disturbances, insomnia, orthostatic hypotension, nasal stuffiness, impulse control disorders
(b) decreasing response to therapy, insomnia, worsening of RLS symptoms in the daytime, gastrointestinal disturbances, insomnia, orthostatic hypotension
(c) dizziness, drowsiness, ataxia, hallucinations, fatigue, gastrointestinal disturbances, insomnia, orthostatic hypotension
(d) sedation, pruritis, hallucinations, constipation, gastrointestinal disturbances
8. The correct pairing of type of RLS and most commonly recommended treatment options listed below is:
(a) intermittent RLS: levodopa/carbidopa, dopamine agonists
(b) intermittent RLS: benzodiazepines, opioids
(c) daily RLS: levodopa/carbidopa, dopamine agonists
(d) daily RLS: levodopa/carbidopa, gabapentin
9. The true statement below about the epidemiology of RLS is:
(a) 6% to 60% of patients with CKD not receiving dialysis experience RLS
(b) the prevalence of RLS among dialysis patients is 7% to 33%
(c) up to 33% of the general population experiences RLS at least once in their lifetime
(d) younger adults experience more RLS than older adults
10. The true statement about the pathophysiology of RLS listed below is:
(a) altering the dialysis membrane can improve RLS symptoms
(b) RLS is related to elevated serotonin and norepinephrine
(c) RLS is related to altered dopaminergic function
(d) RLS symptoms is worsened by iron overload
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By Colette B. Raymond, PharmD, MSc, Lance Breland, BScPharm, Lori D.Wazny, PharmD,Amy R. Sood, PharmD and Cali D. Orsulak, BScPharm
Post-test answer grid Please circle your answer choice: 1. a b c d 2. a b c d 3. a b c d 4. a b c d 5. a b c d 6. a b c d 7. a b c d 8. a b c d 9. a b c d 10 a b c d Evaluation Evaluation Strongly Strongly disagree agree 1. The offering met the stated objectives. 1 2 3 4 5 2. The content was related to the objectives. 1 2 3 4 5 3. This study format was effective for the content. 1 2 3 4 5 4. Minutes required to read and complete: 50 75 100 125 150
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