A 25-year-old patient with newly diagnosed Parkinson disease is started on pramipexole. Before beginning therapy, the nurse will ask about which history?

• A. Any history of alcohol abuse or compulsive behaviors
• B. Hypertension
• C. Allergies to penicillin
• D. Prior history of psychosis

Answer: (A)

Dopamine agonists like pramipexole can trigger impulse-control disorders, so screening for histories of compulsive behaviors and risky use (such as gambling, shopping, binge eating, or problematic alcohol use) is essential before starting therapy. These drugs boost dopamine signaling in brain circuits that regulate reward and impulse control, which can lead to new or worsened compulsive behaviors even in patients who don’t previously have them. Identifying a history of alcohol abuse or compulsive behaviors helps the clinician anticipate these risks, monitor behavior after initiation, and adjust treatment if needed.

Hypertension and penicillin allergy aren’t directly tied to the common adverse effects of pramipexole, so they’re less critical pre-treatment concerns in this context. A prior history of psychosis is relevant because dopamine agonists can sometimes exacerbate or precipitate psychotic symptoms, but the most immediate, well-documented risk with this class is impulse-control disorders, making that history the most pertinent to ask about first.