Pharmacology Ch 24
A patient taking pyridostigmine (Mestinon) develops symptoms of a cholinergic crisis. What action does the nurse anticipate performing next? Administer atropine. Administer epinephrine (Adrenalin). Increase the dose of pyridostigmine (Mestinon). Monitor the patient's blood pressure.
Administer atropine. Atropine is the antidote for treating a cholinergic crisis. Administering epinephrine (Adrenalin) will not be effective nor will increasing the dosage of the pyridostigmine (Mestinon). Monitoring the patient's blood pressure will not alleviate the cholinergic crisis.
Which medication acts as an antidote for pyridostigmine (Mestinon) toxicity? 1 Azathioprine (Imuran) 2 Edrophonium (Tensilon) 3 Neostigmine (Prostigmin) 4 Atropine sulfate (Isopto Atropine)
Atropine sulfate (Isopto Atropine) Overdose of pyridostigmine (Mestinon) causes cholinergic crisis. Atropine sulfate (Isopto Atropine) acts as an antidote for pyridostigmine (Mestinon) by decreasing acetylcholine. Neostigmine (Prostigmin) is administered to manage myasthenia gravis. Azathioprine (Imuran) is an immunosuppressant that is used to suppress immune reactions. Edrophonium (Tensilon) is an acetylcholinesterase inhibitor that is used in the diagnosis of myasthenia gravis.
The patient is scheduled to receive a dose of pancuronium bromide (Pavulon) prior to undergoing tracheal intubation. The nurse recognizes that this is an appropriate choice for the patient because pancuronium is which type of drug? Anxiolytic Anti-spasticity drug Central acting muscle relaxant Depolarizing muscle relaxant
Depolarizing muscle relaxant The drug is a neuromuscular blocking agent that functions as a depolarizing muscle relaxant and thus is appropriate to be used prior to tracheal intubation.
Which medication is used in the diagnosis of myasthenia gravis? 1 Edrophonium (Tensilon) 2 Ambenonium (Mytelase) 3 Neostigmine (Prostigmin) 4 Pyridostigmine (Mestinon)
Edrophonium (Tensilon) Myasthenia gravis is an autoimmune neuromuscular disease that is caused by a defect in the transmission of nerve impulses to muscles. Edrophonium (Tensilon) is an acetylcholinesterase inhibitor that is used in the diagnosis of myasthenia gravis. Ambenonium (Mytelase) is used to treat myasthenia gravis if the client does not respond to neostigmine and pyridostigmine. Neostigmine (Prostigmin) is used to prevent myasthenia crisis. Pyridostigmine (Mestinon) is used to control and treat myasthenia gravis.
Which is the only oral drug available for the treatment of recurring forms of multiple sclerosis? 1 Fingolimod (Gilenya) 2 Daclizumab (Zenapax) 3 Azathioprine (Imuran) 4 Basiliximab (Simulect)
Fingolimod (Gilenya) The only oral form of drug that can cure a relapsing form of multiple sclerosis is fingolimod (Gilenya). The Food and Drug Administration (FDA) approved the drug in 2010. Daclizumab (Zenapax) is administered as an intravenous injection. Azathioprine (Imuran) is a drug of choice in treating inflammatory conditions. Basiliximab (Simulect) is also used intravenously.
The health care provider orders pyridostigmine bromide (Mestinon) for a patient. Which assessment will help confirm the therapeutic outcome for this medication? Ability to walk Increased muscle strength Decrease in pain Clear vision
Increased muscle strength Pyridostigmine (Mestinon) is given to increase muscle strength. It will not actually provide the ability to walk and will not decrease pain or provide clear vision.
The patient is being treated with the drug fingolimod (Gilenya). What disease or disorder would the nurse expect the patient to have? 1 Guillain-Barré syndrome 2 Amyotrophic lateral sclerosis 3 Multiple sclerosis 4 Parkinson's disease and dementia
Multiple sclerosis Fingolimod (Gilenya), which failed as an antirejection drug, was approved in 2010 for multiple sclerosis. It is the only oral drug for relapsing forms of multiple sclerosis. It has significant adverse effects, including headache, hepatotoxicity, flulike symptoms, back pain, atrioventricular block, bradycardia, hypertension, and macular edema.
The nurse is caring for a patient who has been diagnosed with multiple sclerosis. The health care provider opts to include baclofen (Lioresal) as part of this patient's treatment regimen. The nurse recognizes that this is an appropriate medication for this patient because the drug will treat which symptom? Muscle deterioration Muscle spasticity Muscle aching Muscle wasting
Muscle spasticity Baclofen (Lioresal) is a muscle relaxant that is used to treat the spasticity of the muscles that occurs with multiple sclerosis. It does not specifically address muscle aching nor deterioration of muscle tissue.
The primary health care provider has prescribed cyclobenzaprine (Amrix) to a patient who has muscle spasms. After reviewing the patient's medical history, the nurse requests the primary health care provider to revise the prescription. Which finding would most likely be the rationale for the nurse's action? Select all that apply. A The patient has asthma. B The patient has peptic ulcers. C The patient has hyperthyroidism. D The patient has hepatic impairment. E The patient has narrow-angle glaucoma.
hyperthyroidism and glaucoma The administration of cyclobenzaprine (Amrix) may cause hypertension and tachycardia in a patient who has hyperthyroidism. This medication may also cause an increase in intraocular pressure and is therefore contraindicated in patients who have narrow-angle glaucoma. Pyridostigmine (Mestinon) may not be administered in patients who have conditions such as asthma, peptic ulcers, and hepatic impairment, because the medication may aggravate these conditions.
A transplant patient taking glatiramer acetate (Copaxone) therapy inquires about the correct dosage of the medicine. What is the correct dosage to be administered? 1 1 mg/kg IV/PO 2 20 mg Subcut 3 1 g IV/PO 4 0.03 to 0.05 mg/kg/day IV
20 mg Subcut Glatiramer acetate (Copaxone) is administered subcutaneously as 20 mg once daily. One mg per kg 24 hours preoperatively as bolus injection is the dosage of daclizumab (Zenapax). One gm twice daily IV or PO is the dosage for mycophenolate mofetil (CellCept) and 0.03 to 0.05 mg/kg/day as continuous IV infusion is the dosage for tacrolimus (Prograf).
What should the nurse advise a patient who is prescribed cyclobenzaprine (Amrix)? Select all that apply. A "Avoid the consumption of alcohol." B "Avoid administration of anesthetics." C "Avoid consumption of barbiturates. D "Avoid administration of aminoglycosides." E "Avoid consumption of tricyclic antidepressants."
A, C, E Cyclobenzaprine (Amrix) is a medication that acts as a central nervous system (CNS) depressant. The consumption of alcohol during the course of cyclobenzaprine therapy may result in severe CNS depression; therefore, the nurse should advise the patient who is prescribed cyclobenzaprine to avoid alcohol consumption. Concomitant administration of barbiturates and cyclobenzaprine may result in coma. The administration of tricyclic antidepressants along with cyclobenzaprine may also cause severe CNS depression; therefore, these medications should not be prescribed concurrently. Anesthetics and aminoglycosides do not interact with cyclobenzaprine and can be safely prescribed together.
A patient is prescribed carisoprodol (Soma) for relief of muscles spasms. What does the nurse instruct the patient to avoid while taking carisoprodol? Beer Coffee Grape juice Orange juice
Beer Alcohol can cause central nervous system depression and should be avoided while taking carisoprodol (Soma). There is no need to avoid coffee, grape juice, or orange juice while taking the drug.
A patient newly diagnosed with myasthenia gravis (MG) is started on neostigmine (Prostigmin). What is the most important nursing intervention for this patient? Administer the drug on time. Teach the patient to take the drug with food. Assess the patient's temperature daily. Teach the patient to rise slowly.
Administer the drug on time. Neostigmine (Prostigmin) is an acetylcholinesterase inhibitor with a short half-life. It is administered every 2 to 4 hours and must be given on time to prevent muscle weakness. It is not required to administer the drug with food, and the drug should not affect the patient's temperature nor result in orthostatic hypotension.
A primary health care provider has prescribed neostigmine (Prostigmin) to a patient who has myasthenia gravis. During a follow-up visit, the nurse finds that symptoms of myasthenia gravis still persist in the patient. Which medication should the nurse expect the primary health care provider to prescribe? A Methocarbamol (Robaxin) B Dantrolene sodium (Dantrium) C Ambenonium chloride (Mytelase) D Edrophonium chloride (Tensilon) 00:00:02
Ambenonium chloride (Mytelase) The persistence of symptoms of myasthenia gravis (MG) after administration of neostigmine (Prostigmin) indicates that the patient is not responding to the medication. The nurse should expect the primary health care provider to prescribe ambenonium chloride (Mytelase) in the treatment of MG, because it is a long-acting acetylcholinesterase inhibitor. Methocarbamol (Robaxin) is used to treat muscle spasms and tetanus. Dantrolene sodium (Dantrium) is used to treat muscle spasms associated with spinal cord injuries, multiple sclerosis, and other neurological disorders. Edrophonium chloride (Tensilon) is used to distinguish between myasthenia crisis and cholinergic crisis. It is also used to diagnose MG.
The nurse is caring for a patient with myasthenia gravis (MG) who has been prescribed pyridostigmine bromide (Mestinon). During a follow-up visit, the patient reports symptoms of increased salivation, sweating, and extreme muscle weakness. Which medication should the nurse expect the primary health care provider to prescribe? A Phenytoin (Dilantin) B Methocarbamol (Robaxin) C Atropine sulfate (Atropisol) D Edrophonium chloride (Tensilon)
Atropine sulfate (Atropisol) Pyridostigmine bromide (Mestinon) is used in the treatment of myasthenia gravis (MG), because it increases the amount of the neurotransmitter acetylcholine available to stimulate the receptors. Increased availability of neurotransmitters facilitates transmission of signals from and to the brain and promotes muscular function. Signs such as increased salivation, sweating, and severe muscle weakness indicate an overdose of pyridostigmine bromide; therefore, atropine sulfate (Atropisol) should be prescribed to the patient, because it acts to reverse the effects of pyridostigmine bromide. The administration of phenytoin (Dilantin) may result in myasthenic crisis; however, phenytoin is not used in the treatment of MG and would not be prescribed. Methocarbamol (Robaxin) is used to treat muscle spasms that are associated with tetanus. Edrophonium chloride (Tensilon) is used to distinguish between myasthenia crisis and cholinergic crisis, and is used to diagnose MG.
Which medication is used to treat spasticity? A Baclofen (Lioresal) B Diazepam (Valium) C Mupirocin (Bactroban) D Beclomethasone (Beclovent)
Baclofen (Lioresal)
Which medication is beneficial for a patient in the chronic progressive phase of multiple sclerosis? 1 Diazepam (Valium) 2 Cyclophosphamide (Cytoxan) 3 Dantrolene sodium (Dantrium) 4 Pancuronium bromide (Pavulon)
Cyclophosphamide (Cytoxan) Multiple sclerosis is an autoimmune disorder that attacks the myelin sheath of nerve fibers in the brain and spinal cord, and causes lesions. Cyclophosphamide (Cytoxan) is an immunosuppressant that is used to treat the chronic progressive phase of multiple sclerosis. Diazepam (Valium) is a muscle relaxant that is used to relieve muscle spasms associated with paraplegia and cerebral palsy. Dantrolene sodium (Dantrium) is a muscle relaxant that is used for chronic neurologic disorders and spinal cord injuries. Pancuronium bromide (Pavulon) is used in surgery for relaxation of skeletal muscle.
Which medication is most effective in treating the remission-exacerbation phase of multiple sclerosis in a patient? A Baclofen (Lioresal) B Terifluomide (Aubagio) C Cyclophosphamide (Cytoxan) D Glatiramer acetate (Copaxone)
Glatiramer acetate (Copaxone) The remission-exacerbation phase of multiple sclerosis is characterized by spasticity. Glatiramer acetate (Copaxone) relieves spasticity and is used to treat the remission-exacerbation phase of multiple sclerosis in a patient. Baclofen (Lioresal) is used to treat muscle spasms associated with spasticity that are caused by muscle sclerosis and spinal cord injury. Terifluomide (Aubagio) is used to treat the acute attack phase of multiple sclerosis. Cyclophosphamide (Cytoxan) is used to treat the chronic progressive phase of multiple sclerosis.
The patient has been prescribed tizanidine (Zanaflex) and complains of experiencing a dry mouth. What is the nurse's highest priority action? Notify the health care provider; this is indicative of an anaphylactic reaction. Monitor the patient closely for additional unexpected side effects of the drug. Notify the pharmacist; the patient may be receiving too high a dosage of the drug. Instruct the patient to use sugar-free lozenges to moisten his mouth.
Instruct the patient to use sugar-free lozenges to moisten his mouth. Dry mouth is an expected side effect of treatment with tizanidine (Zanaflex) and should not be considered to be indicative of anaphylactic reaction or an overdosage of the drug.
A patient is diagnosed with multiple sclerosis. The primary health care provider prescribes intramuscular administration of 30 mcg of an interferon once per week to the patient. Which is the interferon most likely prescribed to the patient? 1 Interferon beta-1a (Avonex) 2 Interferon alfa-n3 (Alferon-N) 3 Interferon alfacon-1 (Infergen) 4 Interferon gamma-1b (Actimmune)
Interferon beta-1a (Avonex) Interferon beta-1a (Avonex) is the interferon most likely prescribed in the treatment of multiple sclerosis. It is administered intramuscularly at a dose of 30 mcg once per week. Interferon alfa-n3 (Alferon-N) is an interferon used in the treatment of condylomataacuminata. It is given intralesionally 250,000 units (0.05 mL) into the base of each wart twice per week. Interferon alfacon-1 (Infergen) is an interferon used in the treatment of chronic hepatitis C. It is given at 9 mcg three times per week subcutaneously. Interferon gamma-1b (Actimmune) is an interferon used in the treatment of chronic granulomatous disease and osteopetrosis. It is given subcutaneously (50 mcg/m2) three times per week for body surface area more than 0.5 m2.
The nurse conducts preoperative teaching with a patient scheduled to undergo a laparotomy who will receive pancuronium during the procedure. What explanation does the nurse give for the administration of pancuronium? 1 It will maintain a stable blood pressure. 2 It will reduce upper respiratory secretions. 3 It will keep the heartbeat slow and regular. 4 It will relax the abdominal muscles for the surgery.
It will relax the abdominal muscles for the surgery. Pancuronium (Pavulon) is a neuromuscular blocking agent that is used during surgery to relax muscles for exposure of the surgical site and for intubation and mechanical ventilation. Pancuronium acts by blocking the action of acetylcholine. The nurse avoids describing the muscle relaxation as paralysis, which could cause unnecessary fear in the patient. Pancuronium (Pavulon) does not help maintain stable blood pressure, reduce upper respiratory secretions, or keep the heartbeat slow and regular.
The nurse is caring for a patient who is experiencing a myasthenic crisis. What is the primary nursing intervention? Maintain the patient's airway. Administer atropine. Administer naloxone hydrochloride (Narcan). Monitor muscle strength.
Maintain the patient's airway. Muscle weakness can affect the airway, and maintaining the airway is the primary priority. Asphyxiation is the primary threat to the patient's life; therefore, maintaining the airway is paramount. Neither atropine nor naloxone hydrochloride (Narcan) will alleviate the crisis.
The primary healthcare provider prescribes a medication to a patient who reports muscle pain and spasm. On the follow-up visit, the patient reports green-colored urine. Which medication does the nurse suspect to be cause of the patient's condition? 1 Ambenonium (Mytelase) 2 Methocarbamol (Robaxin) 3 Succinylcholine (Anectine) 4 Mitoxantrone (Novantrone)
Methocarbamol (Robaxin) Methocarbamol (Robaxin) is a centrally acting muscle relaxant used to treat acute muscle spasms. It may result in green-, brown-, or black-colored urine. Ambenonium (Mytelase) is an acetylcholinesterase inhibitor used to treat myasthenia gravis. Succinylcholine (Anectine) is a muscle relaxant used for surgical skeletal muscle relaxation and endoscopy. It does not change the color of urine. Mitoxantrone (Novantrone) is an antineoplastic agent used to treat acute nonlymphocytic leukemia.
A nurse is caring for a patient prescribed neostigmine (Prostigmin) orally. Which instruction will the nurse include in the patient's plan of care? Administer neostigmine every 8 hours. Monitor for onset of action in 4 hours. Monitor the patient for respiratory depression. Make sure that naloxone hydrochloride (Narcan) is readily available.
Monitor the patient for respiratory depression. Neostigmine (Prostigmin) is a fast-acting AChE inhibitor that, when administered orally, has an onset of action of 0.5 to 1 hour; it is given every 2 to 4 hours. The nurse should monitor the patient for respiratory depression, which is a life-threatening adverse effect. Atropine is the antidote for a cholinergic crisis.
The nurse is caring for a patient who has myasthenic crisis. Which medication should the nurse expect a primary health care provider to prescribe for the patient? A Diazepam (Valium) B Baclofen (Lioresal) C Azathioprine (Imuran) D Neostigmine (Prostigmin)
Neostigmine (Prostigmin) Myasthenic crisis is characterized by muscle weakness and is caused by an inadequate dosage of cholinesterase inhibitors. Neostigmine (Prostigmin) is a fast-acting anticholinesterase inhibitor, which may reverse myasthenic crisis; therefore, the nurse should expect the primary health care provider to prescribe neostigmine to a patient who has myasthenic crisis. Diazepam (Valium) is a centrally acting muscle relaxant that is used to treat muscle spasms. Baclofen (Lioresal) is used to treat spasticity. Azathioprine (Imuran) is an immunosuppressant.
A mechanically ventilated patient receiving a neuromuscular blocking agent has tearing in the eyes and increased heart rate and blood pressure. What is the nurse's initial action? Stop the medication; the patient is having an adverse reaction to the medication. Notify the physician; patient's level of sedation is inadequate. Notify the physician; patient's dose of the neuromuscular blocking agent is too high. Document findings and monitor; these effects are expected.
Notify the physician; patient's level of sedation is inadequate. Tearing in eyes and increased heart rate and blood pressure are symptoms of increased anxiety and/or pain. A patient receiving a neuromuscular blocking agent cannot move or communicate; thus, the nurse must rely on subtle changes to assess adequate sedation. Simply documenting findings or monitoring will not relieve the patient's symptoms.
The nurse is caring for a patient with myasthenia gravis who has been prescribed cholinergic medications. Which nursing action should the nurse adopt while caring for the patient? 1 The nurse should administer the medication 30 minutes before meals. 2 The nurse should avoid giving fruit juices and corn soup to the patient. 3 The nurse should avoid giving oats and beet root to the patient. 4 The nurse should administer the medication at bedtime.
The nurse should administer the medication 30 minutes before meals. Patients with myasthenia gravis have difficulty in swallowing food. To prevent discomfort, the nurse should administer the medication 30 minutes before meals so that the drug exerts its effects (i.e., decreases dysphagia in the patient). The nurse should not avoid giving fluids such as fruit juices and fiber-rich food like oats and beet root, unless this is recommended by the primary health care provider. The drug does not have sedative effects. Therefore, administering the drug at bedtime will not be helpful for the patient.
The nurse is caring for a patient who has muscle spasms and who is prescribed orphenadrine citrate (Norflex). After reviewing the medical history of the patient, the nurse requests the primary health care provider to revise the prescription. What is the reason behind this nursing action? A The patient has asthma. B The patient has peptic ulcers. C The patient has hyperthyroidism. D The patient has narrow-angle glaucoma.
The patient has narrow-angle glaucoma Orphenadrine (Norflex) is a centrally acting muscle relaxant that is used to treat muscle spasms in a patient. Because this medication increases intraocular pressure, it is not advised for a patient who has narrow-angle glaucoma; therefore, the nurse should request that the primary health care provider revise the prescription. A patient who has asthma and peptic ulcers should not be prescribed pyridostigmine (Mestinon) because its cholinergic action may aggravate the symptoms of bronchial asthma and peptic ulcers. The administration of pyridostigmine (Mestinon) to a patient who has hyperthyroidism may result in increased blood pressure.
The nurse who is caring for a patient who is prescribed diazepam (Valium) finds that the patient is taking an herbal therapy. Which instructions should the nurse provide the patient? Select all that apply. A "Avoid consuming garlic." B "Avoid consuming ginger." C "Avoid consuming valerian." D "Avoid consuming aloe vera." E "Avoid consuming kava kava."
valerian and kava kava Diazepam (Valium) is a skeletal muscle relaxant, which acts to depress the central nervous system (CNS). Herbs, such as valerian and kava kava, may potentiate CNS depression if consumed during the administration of diazepam. Garlic, ginger, and aloe vera do not interact with diazepam and are not contraindicated when a patient is prescribed diazepam; however, garlic may thin the blood, ginger may cause gastrointestinal distress, and aloe vera may cause abdominal cramps or diarrhea.