# Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medical ward with community-acquired pneumonia. At home she takes carbidopa-levodopa 25/100 mg by mouth at 06:00, 10:00, 14:00, and 18:00. She has no drug allergies. She will go home in 2 days. Her husband asks how to plan her meals around the medicine. Which advice is correct?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630322  
> language: ko  
> subject: Nursing Practice IV — Care of Clients with Problems in Nutrition and Gastrointestinal, Metabolism and Endocrine, Perception and Coordination

## 문제

Situation: A 72-year-old woman with Parkinson disease for 9 years is admitted to the medical ward with community-acquired pneumonia. At home she takes carbidopa-levodopa 25/100 mg by mouth at 06:00, 10:00, 14:00, and 18:00. She has no drug allergies.

She will go home in 2 days. Her husband asks how to plan her meals around the medicine. Which advice is correct?

## 보기

1. Give each dose with a glass of milk to protect her stomach
2. Serve most of the day's protein at breakfast with the first dose
3. Avoid foods rich in vitamin B6, which block the medicine's effect
4. Give doses 30 to 60 minutes before meals; spread protein evenly **✔ 정답**

**정답: 4**

## 해설

Dietary protein competes with levodopa for absorption, so doses are taken 30 to 60 minutes before meals and protein is spread across the day rather than removed. If nausea occurs, a small non-protein snack may be taken with the dose. Pyridoxine (vitamin B6) does not reduce the effect when carbidopa is part of the drug.

## 심화 해설

Correct meal planning advice
Dietary protein competes with levodopa for absorption from the small intestine and for transport into the brain, because both use the same carriers for large neutral amino acids. Taking doses 30 to 60 minutes before meals and spreading protein evenly through the day keeps absorption consistent. Protein is not removed from the diet; it is distributed so that no single large protein load blocks a dose.

Why timing protects the dose
After years of treatment, many clients with Parkinson disease notice that a dose taken with a protein-rich meal works poorly or late, leaving them stiff and slow. Giving each dose on an emptier stomach, before meals, lets levodopa be absorbed before amino acids from the meal arrive. Spreading protein avoids long periods of poor response. If nausea occurs, a small non-protein snack, such as crackers, may be taken with the dose. Her schedule of 06:00, 10:00, 14:00, and 18:00 can be matched to meals planned about 30 to 60 minutes after each dose.

| Advice | Effect | Assessment |
| --- | --- | --- |
| Each dose with a glass of milk | Adds protein with every dose | Reduces levodopa absorption |
| Most protein at breakfast | Large protein load with the first dose | Can leave her stiff and slow through the morning |
| Avoid vitamin B6-rich foods | Unnecessary restriction | B6 affects levodopa given alone, not with carbidopa |
| Doses before meals; protein spread evenly | Consistent absorption | Correct |

The vitamin B6 myth
Watch out! Pyridoxine (vitamin B6) speeds the conversion of levodopa to dopamine outside the brain, which reduced the effect of levodopa when it was given alone. Carbidopa blocks this peripheral conversion, so in carbidopa-levodopa the effect of vitamin B6 is not clinically important, and B6-rich foods do not need to be avoided. Older teaching about B6 restriction applies only to levodopa without carbidopa.

Other teaching for the husband
The nurse reinforces giving doses on time every day, because delays can cause sudden worsening of mobility, and never stopping the drug abruptly, which can precipitate a severe reaction resembling neuroleptic malignant syndrome. He is taught to watch for orthostatic hypotension, dyskinesias, and hallucinations, and to report them. Dark urine or sweat may occur and is harmless. Because she is recovering from pneumonia, swallowing safety and adequate fluids also matter.

Exam takeaway
Key point! Levodopa: take 30 to 60 minutes before meals, spread protein evenly, avoid large protein loads with doses. Vitamin B6 restriction is not needed when levodopa is combined with carbidopa.

## 임상 시나리오

Carbidopa-Levodopa and MealsDischarge teaching for a client with Parkinson disease
Dietary protein competes with levodopa for absorption. Give each dose 30 to 60 minutes before meals and spread protein evenly through the day.

If nausea occurs, a small non-protein snack such as crackers may be taken with the dose. Avoid milk or large protein meals with doses.

Vitamin B6 does not reduce the effect when levodopa is combined with carbidopa, so B6-rich foods need not be avoided.

CautionGive doses on time and never stop the drug abruptly. Report orthostatic dizziness, dyskinesias, or hallucinations.

## 핵심 개념

- **Carbidopa-levodopa** — A combination drug for Parkinson disease; carbidopa prevents peripheral breakdown of levodopa.
- **Levodopa** — A dopamine precursor that crosses the blood-brain barrier and is converted to dopamine.
- **Protein-levodopa interaction** — Competition between dietary amino acids and levodopa for absorption and brain entry.
- **Pyridoxine** — Vitamin B6, which reduces the effect of levodopa only when levodopa is given without carbidopa.
- **Dyskinesia** — Involuntary writhing or jerking movements, a common effect of long-term levodopa therapy.

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