Myasthenia Gravis
A client is taking a proton pump inhibitor (PPI)
medication for GERD. Which of the following
medications will the nurse correctly identify is a PPI?
a. Aluminum hydroxide (Maalox)
b. Famotidine (Pepcid)
c. Pantoprazole (Protonix)
d. Sucralfate (Carafate)
C) Pantoprazole
Rationale: PPI drugs can be identified by looking for the suffix "prazole"
and the prototype drug for this class in our lecture was Pantoprazole.
Incorrect: Aluminum hydroxide (Maalox) is an antacid medication,
Famotidine (Pepcid) is an H2 Blocker, and Sucralfate is a mucosal
protectant agent.
Selectively blocks the 5-HT3 serotonin receptor in the upper GI tract and in the chemoreceptor trigger zone in the brain.
Ondansetron Zofran
A newborn patient is in respiratory distress. The nurse anticipates preparation for which medication to be given?
a)Modafinil (Provigil)
b)Levodopa/Carbidopa (Sinemet)
c)Caffeine (Vivarin)
d)Rivastigmine (Exelon)
c. caffeine (vivarin)
Rationale: Analeptics are a drug class that will act on the brain stem and spinal cord to stimulate respirations. Caffeine is the drug of choice for neonatal apnea.
Modafinil is the drug that will increase wakefulness in patients with sleep disorders. Also used to promote wakefulness in patients with opioid dependence.
Levodopa/Carbidopa - Levodopa is converted into dopamine via an enzyme called dopa decarboxylase and Carbidopa will prevent inhibit dopa decarboxylase from converting Levodopa to Dopamine in the gut and in the periphery to increase the % that will reach the brain. This drug combination is used to treat Parkinson’s Disease
Rivastigmine is an acetylcholinesterase inhibitor used in the treatment of Alzheimer’s Disease
The nurse administered an benzodiazepine through the IV. Which evaluation would be most
appropriate for the nurse to initiate?
A.Evaluate vital signs
B.Check for GI distress
C.Monitor daily weights
Evaluate for changes in personality
A. Evaluate vital signs
Rationale: When benzodiazepines are administered through the IV there is a big risk of respiratory depression, hypotension, and tachycardia. This can be so severe it can lead to respiratory or cardiac arrest.
Your patient is being discharged with instructions to take Psyllium (Metamucil) for constipation. Which of the following are appropriate instructions to provide for the patient?
a)Take with 8 ounces of water or juice
b)Psyllium may decrease the activity of your intestines
c)Psyllium is not safe for you, let me clarify this order with the provider
d)It is preferred that you take Psyllium without water to make it most effective
a)Take with 8 ounces of water or juice
Rationale: Psyllium (Metamucil) should be mixed with 8 oz. of juice or water and drank immediately followed by a half to a full glass of water. Insufficient fluid volume intake can cause the drug to solidify in the GI tract leading to bowel obstruction! The medication is contraindicated by those that cannot take in a large volume of water, like those with heart failure.
A patient with myasthenia gravis comes to the emergency department in respiratory distress. To determine if the patient is in myasthenic crisis or cholinergic crisis, the nurse anticipates administration of which drug?
A.Beta Interferon (Betaseron)
B.Baclofen (Lioresal)
C.Edrophonium (Tensilon)
D.Pyridostigmine (Mestinon)
C.Edrophonium (Tensilon)
Rationale: Edrophonium is ultrashort-acting and most commonly used to differentiate between myasthenic crisis and cholinergic crisis. Pyridostigmine is an acetylcholinesterase inhibitor, baclofen is a muscle relaxant, and beta interferon is an immunomodulator used in the treatment of multiple sclerosis.
Suppresses emesis by blocking the dopamine receptors in the chemoreceptor trigger zone of the brain AND it also increases upper GI motility by increasing the actions of acetylcholine.
Metoclopramide (Reglan)
A patient with myasthenia gravis comes to the emergency department in respiratory distress. He has been diagnosed with myasthenic crisis. The nurse anticipates administration of which drug?
A.Atropine (Isopto Atropine)
B.Baclofen (Lioresal)
C.Edrophonium (Tensilon)
D.Pyridostigmine (Mestinon)
D. Pyridostigmine (Mestinon)
Rationale: Pyridostigmine is an acetylcholinesterase inhibitor which can relieve
myasthenic crisis and is used for maintenance treatment Edrophonium (Tensilon) is
most commonly used to diagnose or differentiate between myasthenic crisis and
cholinergic crisis; atropine is an anticholinergic, and baclofen is a muscle relaxant.
An older adult complains of insomnia. Which suggestion would be most appropriate for the nurse to provide as an initial method to deal with this issue?
A.“Take antihistamine pills each evening before bedtime.”
B.“Try drinking warm milk or chamomile tea before bedtime.”
C.“Develop a strenuous exercise regimen to do before bed.”
D.“Take naps during the day whenever you feel drowsy.”
B.“Try drinking warm milk or chamomile tea before bedtime.”
Rationale: Before medications are used, various nonpharmacologic methods should be used to promote sleep, including avoiding strenuous exercise before bedtime and avoiding naps during the day. Drinking warm milk or chamomile tea before bedtime has been found to promote sleep.
You are caring for a patient admitted to the
oncology floor for persistent nausea and
vomiting. The physician orders Metoclopramide
(Reglan). Which of the following would be a
contraindication to receive this drug?
a) Nausea
b) Vomiting
c) GI perforation
d) Gastroparesis
c) GI perforation
Rationale: Metoclopramide (Reglan) suppresses emesis by
blocking the dopamine receptors in the chemoreceptor trigger
zone of the brain AND it also increases upper GI motility by
increasing the actions of acetylcholine. Because it can
increase upper GI motility it is contraindicated in GI
obstruction, perforation, or GI hemorrhage.
A patient with myasthenia gravis is prescribed Pyridostigmine. The nurse identifies that the medication is effective when the patient demonstrates which of the following?
A.Increased muscle strength
B.Decrease in sweating and salivation
C.Change in vital signs to within normal limits
D.A decrease in generalized pain
A.Increased muscle strength
Rationale: Improved muscle strength indicates that Pyridostigmine therapy is producing a therapeutic effect.
Competitively blocks H1 receptor sites, blocks alpha receptors, and inhibits the dopamine receptors in the chemoreceptor trigger zone in the brain
Promethazine Hydrochloride (Phenergan)
The patient is admitted to the emergency department with cholinergic crisis. The nurse anticipates administration of which agent?
A.Atropine (Isopto Atropine)
B.Baclofen (Lioresal)
C.Edrophonium (Tensilon)
D.Pyridostigmine (Mestinon)
A.Atropine (Isopto Atropine)
Rationale: Atropine sulfate is the treatment of choice for cholinergic crisis and is the antidote for patients that receive too much acetylcholinesterase inhibitor medication
What would indicate to the nurse that the child taking methylphenidate requires more teaching? Select all that apply.
A.The child is seen drinking a cola product
B.The child checks his weight twice a week
C.The child takes the drug 45 minutes before a meal
D.The child takes the drug before bedtime
E.The child reports trying to keep the drug dosing a regular schedule
A.The child is seen drinking a cola product
D.The child takes the drug before bedtime
Rationale: The nurse should teach the child to avoid caffeine because of its potentiation of methylphenidate. The child should closely monitor for weight loss. The drug should be taken about 30 to 45 minutes before a meal to promote absorption. The drug should be taken before breakfast and lunch and not within 6 hours of sleeping or the child will not be able to sleep at night. Keeping any scheduled drug dosing on a regular schedule will help with compliance of the medication.
A patient arrives to the emergency department complaining of
gastrointestinal distress for 2 days. The physician orders
sublingual Ondansetron (Zofran). The patient asks why the
provider prescribed this drug, what is the nurses best
response?
a) Ondansetron will increase the activity in your bowel to
promote a bowel movement
b) Ondansetron will help you sleep so you don’t notice
the GI distress
c) Ondansetron will help alleviate the nausea and
vomiting
d) Ondansetron will stimulate your appetite because you
are malnourished
Ondansetron will help alleviate the nausea and
vomiting
A patient reports taking Dimenhydrinate (Dramamine),
what would be an appropriate indication for the patient to
take this over-the-counter drug? Select all that apply.
a. Motion sickness
b. Nausea
c. Muscle rigidity
d. Anesthesia
e. Seizures
a) motion sickness
b) Nausea
Rationale: Dimenhydrinate (Dramamine) is an antihistamine drug that is
indicated to treat nausea and motion sickness. It will inhibit the vestibular
stimulation in the middle ear to decrease stimulation of the vomiting center in
the brain. It is best to administer this drug 30min to 1 hour prior to the trigger
for motion sickness to receive the greatest benefit from the drug.
Blocks the action of acetylcholine at parasympathetic sites in smooth muscle, secretory glands, and the CNS to suppress nausea and vomiting
Scopolamine (TransdermScop)
Which of the following are side effects or adverse effects of Acetylcholinesterase Inhibitors?
Would it make most sense that an adverse effect of a parasympathomimetic agent would be…
¤Diarrhea or constipation?
¤Dry mouth or excess saliva?
¤Abdominal cramping or Diminished GI motility?
¤Constricted pupil or Dilated pupil?
¤Tachycardia or Bradycardia?
¤Hypertension or hypotension?
Diarrhea, excess saliva, abdominal cramping, constricted pupil, bradycardia, hypotension.
A patient arrives to the emergency department and admits to
ingesting 40 “heart medicine” pills about 20 minutes ago. The
provider orders activated charcoal via NG tube. Why would
activated charcoal be helpful in this situation?
a) Activated charcoal will line the GI tract to protect the
esophagus from further damage
b) Activated charcoal binds with toxic agents in the GI tract to
prevent absorption into the blood
c) Activated charcoal will induce vomiting so the client clears the
toxins from their system
d) The nurse will question the order since it is outside the
therapeutic window to administer this agent
B) Activated charcoal binds with toxic agents in the GI tract to prevent
absorption into the blood
Rationale: Activated charcoal’s mechanism of action is that it will bind with substances in the digestive tract to prevent GI absorption of the toxic contents
Not fully understood but likely activates receptors in the brain to decrease nausea.
Dronabinol (Marinol)
You patient is being discharged from the hospital. The physician recommends taking Bismuth Subsalicylate (Pepto Bismol) for mild cases of diarrhea. Which of the following will you teach the patient?
Select all that apply.
a)This drug may cause you to develop black stools
b)This drug may discolor your tongue
c)This drug contains aspirin, so avoid additional sources of aspirin
d)This drug may impair the absorption of other medications
e)In large enough doses, this drug may cause tinnitus
f)This drug is okay for children so you can also give it to your 3 year old if they are having diarrhea too
a)This drug may cause you to develop black stools
b)This drug may discolor your tongue
c)This drug contains aspirin, so avoid additional sources of aspirin
d)This drug may impair the absorption of other medications
e)In large enough doses, this drug may cause tinnitus
Rationale: Bismuth Subsalicylate (Pepto Bismol) contains aspiring so clients should avoid other sources of aspirin. Therefore we shouldn’t use this drug to treat children with viral, febrile illness due to the risk of Reye Syndrome and overdose can lead to Salicylate toxicity symptoms (tinnitus). Additionally, patients should know that this drug can impair the absorption of other medications and can lead to discoloration of tongue and stools.
A child has been diagnosed with attention-deficit/hyperactivity disorder. Which drug does the nurse anticipate the health care provider will prescribe?
A.Phenytoin (Dilantin)
B.Lidocaine (Xylocaine)
C.Phenobarbital (Luminal)
D.Methylphenidate (Ritalin)
D.Methylphenidate (Ritalin)
Rationale: Methylphenidate is most commonly used to treat ADHD. Phenytoin is an antiseizure medication, Lidocaine is an anesthetic and antidysrhythmic medication, and Phenobarbital is a sedative/hypnotic and antiseizure medication.