Pharm - Chapter 20 - Cholinergic Drugs

Which is the first nursing intervention for a patient who has experienced an overdose of rivastigmine and is having difficulty breathing? 1 Administer epinephrine. 2 Monitor the patient's heart rate. 3 Assess the patient's breath sounds. 4 Measure the patient's urinary output.

1 Administer epinephrine. Rivastigmine is a cholinergic drug used for the treatment of Alzheimer's disease. Overdosage of cholinergic drugs may lead to bronchoconstriction and difficulty in breathing. Epinephrine is given to cause bronchial dilation. This is the nurse's primary intervention. After this is completed, the nurse should monitor the patient's heart rate and breath sounds, respiratory rate, oxygenation level, etc.

Which drug is the antidote to a cholinergic overdose? 1 Atropine 2 Memantine 3 Epinephrine 4 Rivastigmine

1 Atropine Atropine is the antidote to a cholinergic overdose. Memantine, epinephrine, and rivastigmine are not used to treat a cholinergic overdose.

Which medication should be administered to a patient who has a cholinergic crisis? 1 Atropine 2 Donepezil 3 Echothiophate 4 Pyridostigmine

1 Atropine Overdose of a cholinergic drug causes a cholinergic crisis. Atropine is a cholinergic antagonist; therefore it is administered to reverse the action of a cholinergic drug. Donepezil is used to treat Alzheimer's disease. Echothiophate is used to reduce intraocular pressure. Pyridostigmine is used as an antidote for neuromuscular blocker toxicity.

Which information is essential to include in the teaching care plan for a patient who has been prescribed donepezil? Select all that apply. 1 Get up slowly. 2 Eat something if you feel nauseated. 3 You may have some trouble sleeping. 4 Stop the medication if you have headaches. 5 Tell your health care provider if you have stomach pains.

1 Get up slowly. 2 Eat something if you feel nauseated. 3 You may have some trouble sleeping. 5 Tell your health care provider if you have stomach pains. This medication may cause dizziness and syncope. The patient should be careful standing up. It can cause gastric upset, so the patient should eat something if she feels nauseated. Stomach pains may indicate gastric ulcer, which is also a risk. Insomnia may be an early symptom. Side effects are generally tolerated, and if the patient has her dose titrated slowly upward, this usually helps the tolerance. It is not necessary to teach the patient to discontinue the medication if she has a headache.

Which route of administration is preferred for treating xerostomia with pilocarpine? 1 Oral 2 Ocular 3 Intravenous 4 Intramuscular

1 Oral Pilocarpine is a direct-acting cholinergic drug that is given orally for treating xerostomia, or dry mouth. It is used topically (ocular) in the treatment of glaucoma. Pilocarpine is not given through ocular, intravenous, or intramuscular routes to treat xerostomia because the drug may not be effective through these routes.

Which medications are direct-acting cholinergic drugs? Select all that apply. 1 Pilocarpine 2 Galantamine 3 Neostigmine 4 Edrophonium 5 Succinylcholine

1 Pilocarpine 5 Succinylcholine Pilocarpine and succinylcholine are direct-acting cholinergic drugs. Pilocarpine is used to treat xerostomia and glaucoma. Succinylcholine is used as a neuromuscular blocker during general anesthesia. Galantamine, neostigmine, and edrophonium are indirect-acting cholinergic drugs.

Which assessment findings are adverse effects associated with the administration of cholinergic medications? Select all that apply. 1 Sweating 2 Dizziness 3 Dry cough 4 Bradycardia 5 Hypotension

1 Sweating 2 Dizziness 4 Bradycardia 5 Hypotension The adverse effects of cholinergic therapy include bradycardia or tachycardia, hypotension, dizziness, and sweating. The adverse effects result from the stimulation of nicotinic receptors. Dry cough is not an adverse effect associated with cholinergic therapy.

Which assessment finding indicates an adverse reaction in a patient receiving bethanechol for the treatment of urinary retention? Select all that apply. 1 Syncope 2 Hair loss 3 Mydriasis 4 Constipation 5 Hypertension

1 Syncope 5 Hypertension Adverse effects include syncope, hypotension or hypertension, tachycardia or bradycardia, headache, seizures, cramps, diarrhea, nausea, and asthmatic attacks. Anticholinergic agents, as opposed to cholinergic agents like bethanechol, cause constipation. Hair loss should not occur. Miosis, not mydriasis, may result from use of bethanechol.

Which condition is a contraindication to the administration of bethanechol? 1 Gastric atony 2 Hyperthyroidism 3 Urinary retention 4 Chronic refractory heartburn

2 Hyperthyroidism Contraindications to the administration of bethanechol include known drug allergy, hyperthyroidism, peptic ulcer, active bronchial asthma, cardiac disease or coronary artery disease, epilepsy, and parkinsonism. Bethanechol produces parasympathomimetic action and may exacerbate the symptoms of hyperthyroidism. Gastric atony, urinary retention, and chronic refractory heartburn are indications to administer bethanechol.

Which assessment is essential before a patient is started on memantine therapy? Select all that apply. 1 Pain assessment 2 Neurologic status 3 Complete blood count 4 Cardiovascular status 5 Gastrourinary (GU) status 6 Assess for suicidal tendencies

2 Neurologic status 4 Cardiovascular status 5 Gastrourinary (GU) status 6 Assess for suicidal tendencies Before a drug such as donepezil or memantine is used for Alzheimer's disease, assess the patient for allergies, cautions, contraindications, and drug interactions. Perform a close assessment and documentation of the patient's neurologic status with attention to short- and long-term memory; level of alertness, motor, cognitive and sensory functioning; any suicidal tendencies or thoughts; musculoskeletal intactness; and gastrointestinal, GU, and cardiovascular functioning. Assess urinary patterns so that any problems with urinary retention may be identified. Report any abnormalities and/or complaints to the prescriber immediately. It is important to note the presence or absence of family support systems because of the chronic nature of this illness. Once the patient has begun taking the medication, it is critical for you to continue to assess the patient's response to the drug. Especially note any changes in symptoms within the first 6 weeks of therapy. It is not essential to perform a pain assessment or get a complete blood count before starting a patient on memantine therapy.

Which assessment findings indicate potential interactions of bethanechol and pyridostigmine? Select all that apply. 1 Ataxia 2 Cramps 3 Diarrhea 4 Bleeding 5 Syncope

3 Diarrhea 5 Syncope Bethanechol is a direct-acting cholinergic drug. The patient was also given pyridostigmine, which is an indirect-acting cholinergic drug. Indirect-acting cholinergic drugs interact with bethanechol, resulting in an increase in the adverse effects of bethanechol. Therefore the nurse has to monitor symptoms such as syncope and diarrhea (gastrointestinal upset) in the patient. Ataxia, bleeding, and muscle cramps are not related to bethanechol.

Which is an expected therapeutic outcome for a patient with Parkinson's disease and dementia who is prescribed rivastigmine? 1 Decreased tremors 2 Decreased salivation 3 Improvement in memory 4 Increased muscle strength

3 Improvement in memory Rivastigmine is an indirect-acting cholinergic drug that is used to treat dementia in patients diagnosed with Parkinson's disease. A therapeutic effect would be improvement in the dementia, possibly seen by an improvement in memory or conversation and recognition. Decreased tremors, decreased salivation, and increased muscle strength are not expected therapeutic outcomes for a patient who has Parkinson's disease and dementia and is prescribed rivastigmine.

The nurse administers 10 mg bethanechol to a patient after surgery. The patient has not voided. Which intervention is needed next? 1 Assessment of bowel sounds 2 Assessment of blood pressure 3 Administration of a second drug 4 Administration of another dose in an hour

4 Administration of another dose in an hour Bethanechol is administered by starting with 5 to 10 mg, repeated hourly, until urination occurs. A maximum dose per cycle is 50 mg. A second drug is not added to the regimen.

The nurse administers physostigmine to a patient who has been exposed to pesticides. Which therapeutic effect is expected? 1 Pupil dilation 2 Pupil constriction 3 Elevated heart rate 4 Decreased heart rate

4 Decreased heart rate Pesticides contain organophosphates, which have anticholinergic actions. This may cause the patient to have an increased heart rate and dilated pupils. To reverse these actions, an antidote must be administered to the patient. Physostigmine is an indirect-acting cholinergic drug. It helps constrict the pupils and reduce the heart rate by increasing the acetylcholine concentration at the receptor site. A reduced (not elevated) heart rate is a therapeutic effect. Although the medication will cause pupil constriction, this is not necessarily a therapeutic effect.

After administration of edrophonium, which evaluation is a positive result? 1 Able to speak clearly 2 Decreased respiration 3 Able to swallow without difficulty 4 Increased arm strength

4 Increased arm strength Edrophonium is an indirect-acting cholinergic drug that is used to differentiate between myasthenia gravis and cholinergic crisis. If a patient has myasthenia gravis, after receiving edrophonium, the patient's muscles would be stronger, indicating she most likely has myasthenia and is possibly having a myasthenic crisis. Clear speech, difficulty breathing, and swallowing without difficulty are not indicative of a positive result after administration of edrophonium.

Which effect is caused by stimulation of the parasympathetic nervous system by a cholinergic drug? 1 Mydriasis 2 Vasoconstriction 3 Urinary retention 4 Increased gastrointestinal (GI) motility

4 Increased gastrointestinal (GI) motility Cholinergic effects mimic the parasympathetic nervous system (rest and digest) as opposed to the sympathetic nervous system (fight or flight). Increasing GI motility helps the digestive process. Miosis, urinary frequency, and vasodilation are all effects of cholinergic drugs. Mydriasis, vasoconstriction, and urinary retention are effects of cholinergic blockers.

Which therapeutic outcome is expected from the administration of cevimeline to a patient with Sjögren's syndrome? 1 Improved vision 2 Relief of dry skin 3 Increased muscle strength 4 Moist oral mucous membranes

4 Moist oral mucous membranes Sjögren's syndrome causes excessive dryness of mouth. Cevimeline is a direct-acting drug that acts on the parasympathetic nervous system and stimulates secretion of saliva by salivary glands. Improved vision, relief of dry skin, and increased muscle strength are not expected therapeutic outcomes with cevimeline.