| Cholinesterase Inhibitors and Their Use in Myasthenia Gravis | Cholinesterase Inhibitors and Their Use in Myasthenia Gravis |
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INCORRECT
Urinary retention A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, broncho constriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis. CORRECT •Stool incontinence• A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis. Mydriasis A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis. Flushed, dry skin A toxic condition has been produced, which results in stimulation of the cholinergic nervous system and cholinergic crisis. The symptoms of cholinergic crisis include profuse salivary and bronchial secretions, urinary and stool incontinence, laryngospasm, bronchoconstriction, paralysis, and death. Miosis (pupil constriction), not mydriasis, occurs, as well as diaphoresis.
A patient goes to the emergency department after using organophosphate insecticides improperly. What assessment finding would the nurse expect?
1.Urinary retention 2.Stool incontinence 3.Mydriasis 4. Flushed, dry skin |
Obtain a measurement of the plasma level of neostigmine.
Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority. INCORRECT Teach the patient to wear a Medic Alert bracelet. Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority. CORRECT Assess the patient's ability to swallow. Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority. Check the patient's deep tendon reflexes (DTRs). Patients with myasthenia gravis have decreased muscle strength and may have impaired swallowing. If swallowing is insufficient, the medication must be given by the parenteral route. Plasma levels are not as important when beginning medication. Neostigmine typically is dosed to symptoms. The patient should be taught to wear a Medic Alert bracelet and may need to have DTRs monitored, but assessing swallowing is a higher priority.
What is The nurse is caring for a patient with myasthenia gravis who is beginning a new prescription of neostigmine [Prostigmin], 75 mg PO twice daily. What is the most important initial nursing action?
Obtain a measurement of the plasma level of neostigmine. Teach the patient to wear a Medic Alert bracelet. Assess the patient's ability to swallow. Check the patient's deep tendon reflexes (DTRs). |
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CORRECT
***It is an antidote to organophosphate poisoning. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension.** INCORRECT It is an antidote to reversible cholinesterase inhibitors. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension. CORRECT It cannot cross the blood-brain barrier. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension. It reverses cholinesterase inhibition in the CNS. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension. CORRECT Doses should be infused slowly. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Since pralidoxime is a quaternary ammonium compound, it cannot cross the blood-brain barrier and therefore cannot reverse cholinesterase inhibition in the CNS. Intravenous doses should be infused slowly (over 20 to 30 minutes) to avoid hypertension.
What is Which of the following statements about Pralidoxime are true? Select all that apply.
1. It is an antidote to organophosphate poisoning. 2. It is an antidote to reversible cholinesterase inhibitors. 3. It cannot cross the blood-brain barrier. It reverses cholinesterase inhibition in the CNS. 4. Doses should be infused slowly. |
Neostigmine [Prostigmin]
The provider may elect to administer a challenging dose of edrophonium, an ultrashort-acting cholinesterase inhibitor. If edrophonium-induced elevation of ACh levels alleviates symptoms, the crisis is myasthenic. Conversely, if edrophonium intensifies symptoms, the crisis is cholinergic. CORRECT Edrophonium The provider may elect to administer a challenging dose of edrophonium, an ultrashort-acting cholinesterase inhibitor. If edrophonium-induced elevation of ACh levels alleviates symptoms, the crisis is myasthenic. Conversely, if edrophonium intensifies symptoms, the crisis is cholinergic. Pralidoxime [DuoDote] The provider may elect to administer a challenging dose of edrophonium, an ultrashort-acting cholinesterase inhibitor. If edrophonium-induced elevation of ACh levels alleviates symptoms, the crisis is myasthenic. Conversely, if edrophonium intensifies symptoms, the crisis is cholinergic. Dobutamine [Dobutrex] The provider may elect to administer a challenging dose of edrophonium, an ultrashort-acting cholinesterase inhibitor. If edrophonium-induced elevation of ACh levels alleviates symptoms, the crisis is myasthenic. Conversely, if edrophonium intensifies symptoms, the crisis is cholinergic.
What is The provider elects to administer a medication to distinguish myasthenic crisis from cholinergic crisis. What medication would the nurse anticipate giving?
Neostigmine [Prostigmin] Edrophonium Pralidoxime [DuoDote] Dobutamine [Dobutrex] |
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It inhibits acetylcholine at all cholinergic synapses.
Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions. CORRECT It prevents inactivation of acetylcholine. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions. It prevents activation of muscarinic receptors. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions. INCORRECT It stimulates activation of adrenergic receptors. Neostigmine is a cholinesterase inhibitor. As such, it prevents the inactivation of acetylcholine, allowing it to linger at the synapses. It lacks selectivity and thus intensifies transmission at all cholinergic junctions.
What is The nurse is preparing to give neostigmine [Prostigmin]. What best describes the action of this drug?
1. It inhibits acetylcholine at all cholinergic synapses. 2. It prevents inactivation of acetylcholine. 3. It prevents activation of muscarinic receptors. 4. It stimulates activation of adrenergic receptors. |
It promotes neuromuscular blockade in the periphery.
Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness. INCORRECT It promotes emptying of the bladder and sphincter relaxation. Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness. It reduces intraocular pressure and protects the optic nerve. Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness. CORRECT It increases the force of skeletal muscle contraction. Neostigmine is a cholinesterase inhibitor; therefore, at therapeutic doses it increases the force of contraction of skeletal muscles. Myasthenia gravis is a neuromuscular disease characterized by muscle weakness.
What is What best describes the rationale for using neostigmine [Prostigmin] in the treatment of myasthenia gravis?
It promotes neuromuscular blockade in the periphery. It promotes emptying of the bladder and sphincter relaxation. It reduces intraocular pressure and protects the optic nerve. It increases the force of skeletal muscle contraction. |
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Neostigmine [Prostigmin]
Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used. INCORRECT Atropine Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used. Pralidoxime [DuoDote] Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used. Dobutamine [Dobutrex] Because neostigmine inhibits cholinesterase, it allows acetylcholine to accumulate at synapses. This action can help reverse neuromuscular blockade in postoperative patients, especially when a nondepolarizing neuromuscular blocker, such as pancuronium, has been used.
What is The nurse is caring for a patient with a suspected overdose of pancuronium, which was used during surgery. Which drug does the nurse anticipate will be used as a reversal agent?
1. Neostigmine [Prostigmin] 2. Atropine 3. Pralidoxime [DuoDote] 4. Dobutamine [Dobutrex] |
Xerostomia
Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect. CORRECT Excessive muscarinic stimulation Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect. INCORRECT Constipation Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect. CORRECT Respiratory depression Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect. CORRECT Cholinergic crisis Overdose with cholinesterase inhibitors causes excessive muscarinic stimulation and respiratory depression. The state produced by cholinesterase inhibitor poisoning is sometimes referred to as cholinergic crisis. Xerostomia and constipation are incorrect.
What is Overdose of cholinesterase inhibitors causes which of the following?
Select all that apply. Xerostomia Excessive muscarinic stimulation Constipation Respiratory depression Cholinergic crisis |
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Neostigmine [Prostigmin]
Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. CORRECT Atropine Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Pralidoxime [DuoDote] Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Dobutamine [Dobutrex] Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors.Neostigmine [Prostigmin] Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. CORRECT Atropine Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Pralidoxime [DuoDote] Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors. Dobutamine [Dobutrex] Intravenous atropine can alleviate the muscarinic effects of cholinesterase inhibition. Pralidoxime is a specific antidote to poisoning by the irreversible (organophosphate) cholinesterase inhibitors; the drug is not effective against poisoning by reversible cholinesterase inhibitors.
What is The nurse prepares to administer the antidote to a patient in cholinergic crisis. What medication does the nurse anticipate the healthcare provider to order?
1. Neostigmine [Prostigmin] 2. Atropine 3. Pralidoxime [DuoDote] 4. Dobutamine [Dobutrex] |
Hopefully yes!:-)
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