Download Cholinergic Drugs and Their Clinical Applications and more Exams Pharmacology in PDF only on Docsity!
Pharm chapter 20 Exam Practice Questions with Correct
Answers
1. What will the nurse instruct a patient who is prescribed pyridostigmine? "Do not eat solid food." "Take the medication 30 minutes after eating." "Seek medical help if you develop nausea and vomiting." "Notify your health care provider if you have a headache.": "Seek medical help if you develop nausea and vomiting." Nausea and vomiting are the symptoms of a cholinergic crisis due to an overdose of anticholinesterase therapy. The patient should report these symptoms immediately so that prompt action can be taken to reverse the crisis. The nurse instructs the patient to take the medication before eating to strengthen the muscles involved in chewing and swallowing and to help prevent aspiration or choking. There is no reason for the patient to avoid solid food, and the patient does not have to report headaches because these may be common. 2. Which patient should receive a reduced dose of memantine? The patient with migraines The patient with bradycardia The patient with hypothyroidism The patient with elevated blood urea nitrogen and creatinine: The patient with elevated blood urea nitrogen and creatinine Memantine is a N-methyl-d-aspartate receptor antagonist that is used for the treat- ment of Alzheimer's dementia. The prescribed dosage of the drug is 10 mg two times per day. However, patients with renal impairment may need the dose to be reduced to 5 mg twice daily. Hypothyroidism, bradycardia, and migraines are not contraindications to this medication and do not require a reduced dose. 3. What is the rationale behind administering ginkgo to a patient? To prevent memory loss To treat myasthenia gravis
To reverse cholinergic drug effects To treat postpartum urinary retention: To prevent memory loss Ginkgo is an herbal preparation that is used to prevent memory loss. Pyridostigmine is administered to a patient to treat myasthenia gravis. Atropine is administered to a patient to reverse cholinergic drug effects. Bethanechol is administered to a patient to treat postpartum urinary retention.
4. What is the antidote to a cholinergic overdose? Atropine Memantine Epinephrine Rivastigmine: Atropine Atropine is the antidote to a cholinergic overdose. Memantine, epinephrine, and rivastigmine are not used to treat a cholinergic overdose. 5. What should the nurse assess as a therapeutic effect of the administration of pyridostigmine to a patient who has myasthenia gravis? Patient is no longer dizzy Patient has improved memory Patient is able to walk long distances Patient has increased muscle strength: Patient has increased muscle strength Pyridostigmine is used to treat myasthenia gravis. A primary outcome is increased muscle strength. A decrease in dizziness, improved memory, and the ability to walk long distances are not expected outcomes of administration of this medication. 6. The nurse is caring for a patient diagnosed with myasthenia gravis who has been prescribed a cholinergic medication. Which nursing action is a priority when administering the medication? Administer the medication after meals. Do not administer the medication with fruit juices Administer the medication 30 minutes before
Direct-acting drugs such as carbachol are used topically to reduce intraocular pressure in patients with glaucoma or those undergoing ocular surgery. The nurse should make certain the drops are administered correctly by pulling down the lower eyelid, inserting the drop, and then having the patient close the eye.
9. Before starting a patient on memantine therapy, what is essential for the nurse to include in the assessment? Pain assessment Neurologic status Complete blood count Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies: Neurologic status
Cardiovascular status Gastrourinary (GU) status Assess for suicidal tendencies Before a drug for Alzheimer's disease, such as donepezil or memantine, is used, 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 in- tactness; 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.
10. Which assessment finding indicates an adverse reaction in a patient re- ceiving bethanechol for the treatment of urinary retention? Syncope Hair loss Mydriasis Constipation Hypertension: Syncope Hypertension Adverse effects include syncope, hypotension or hypertension, tachycardia or brady- cardia, headache, seizures, gastrointestinal upset, and asthmatic attacks. Hair loss should not occur. Miosis, not mydriasis, may result from use of bethanechol. 11. The nurse administers 10 mg bethanechol to a patient after surgery. The patient has not voided. What is the next intervention needed?
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.
12. The nurse administers physostigmine to a patient who has been exposed to pesticides. What is the expected therapeutic effect? Pupil dilation Pupil constriction Elevated heart rate Decreased heart rate: 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. 13. Which indirect-acting cholinergic drug is used to treat a patient who has both Parkinson's disease and dementia? Donepezil Memantine Galantamine Rivastigmine: Rivastigmine Rivastigmine is an indirect-acting cholinergic drug used to treat Alzheimer's disease. However, it is also effective in treating patients with Parkinson's disease who have dementia. Drugs such as donepezil and galantamine are also indirect-acting cholin- ergics, but are used for treating Alzheimer's disease only and are contraindicated in Parkinson's disease. Memantine is an N-methyl-D-aspartate receptor antagonist that is used for treating Alzheimer's disease 14. A patient is prescribed donepezil for Alzheimer's disease. What assess- ment is essential to be performed by the nurse before
administering the medication? Vital signs Bowel sounds
a headache.
16. What information is true concerning cholinergic stimulation? Nicotinic receptor stimulation causes dilation of the pupils. Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes constriction of blood vessels.
Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal mus- cle.: Nicotinic receptor stimulation causes increased blood pressure. Muscarinic receptor stimulation causes increased gastrointestinal motility. Nicotinic receptor stimulation causes increased contraction of skeletal muscle. Cholinergic drugs act by stimulating two types of cholinergic receptors, called muscarinic and nicotinic receptors. Nicotinic receptor stimulation causes increased blood pressure and increased contraction of the skeletal muscles. Muscarinic recep- tor stimulation causes increased gastrointestinal motility. Cholinergic drugs cause constriction of the pupils, called miosis. Therefore nicotinic receptor stimulation does not cause mydriasis (dilation of pupil). Muscarinic receptor stimulation does not lead to constriction of the blood vessels; instead, it results in dilation of the blood vessels.
17. A patient who has experienced an overdose of rivastigmine is having difficulty breathing. What is the primary nursing intervention? Administer epinephrine. Monitor the patient's heart rate. Assess the patient's breath sounds. Measure the patient's urinary output.: Administer epinephrine. Rivastigmine is a cholinergic drug used for the treatment of Alzheimer 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. 18. Which condition is treated with bethanechol in a postoperative patient? Urinary atony Respiratory atelectasis Postoperative hypotension Postoperative ischemic colitis: Urinary atony
19. A patient diagnosed with Alzheimer's disease has been taking donepezil for a week. The family reports no improvement in the patient's condition. What is the nurse's best response? "The medication has an onset of action of about 3 weeks." "Let me assess what other medications the patient is taking." "Sometimes family members aren't the best at assessing these things." "I will call the health care provider and ask for the medication to be changed."- : "The medication has an onset of action of about 3 weeks." Donepezil takes about 3 weeks for the onset of action. Assessment of other po- tentially interacting medications would have been completed before starting the patient on the medication. The family might be insulted by the comment that they are not the best at assessing. In actuality, information from people who are with the patient continuously may be more accurate than that from others who see the patient episodically. The medication does not have to be changed at this point. 20. What is the peak plasma concentration of donepezil? 5 hours 1 to 2 hours 3 to 4 hours 30 minutes: 3 to 4 hours Donepezil is a cholinesterase-inhibitor drug. It requires 3 to 4 hours to reach peak plasma concentration. Memantine requires 5 hours to reach peak plasma concen- tration. Pyridostigmine requires 1 to 2 hours to reach peak plasma concentration. Bethanechol requires 30 minutes to reach peak plasma concentration. 21. Which cholinergic agonist medication and dose is administered to a pa- tient undergoing maintenance therapy? Donepezil 10 mg twice a day by mouth Memantine 10 mg twice a day by mouth Bethanechol 5 mg three times a day by mouth Physostigmine 2 mg every 20 minutes by mouth: Memantine 10 mg twice
a day by mouth The dosage range for memantine is an initial dose of 5 mg/day; titrate by 5 mg/wk up to a target dose of 10 mg/bid (20 mg/day). The maximum dose in renal impairment is 10 mg/day. Donepezil 10 mg twice a day is an excessive dose. Bethanechol 5 mg
patient to void. Because it is used to initiate voiding, the nurse does not need to complete a neurologic, muscular, or gastric assessment to determine effectiveness.
25. The nurse assesses a patient and finds ptosis, diplopia, and difficulty swal- lowing. Which drug will be utilized to help confirm the diagnosis of myasthenia gravis in the patient? Memantine Bethanechol Edrophonium Physostigmine: Edrophonium Ptosis, diplopia, and difficulty swallowing and chewing are the symptoms of myas- thenia gravis. Edrophonium is a medication that helps in the diagnosis of this condition. Memantine is a noncholinergic drug prescribed for Alzheimer's disease. Bethanechol is prescribed for urinary retention. Physostigmine is a neuromuscular -locking drug, but it is not prescribed for myasthenia gravis. 26. Which condition is a contraindication to the administration of bethane- chol? Gastric atony Hyperthyroidism Urinary retention Chronic refractory heartburn: 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 parasympath- omimetic action and may exacerbate the symptoms of hyperthyroidism. Gastric atony, urinary retention, and chronic refractory heartburn are indications to admin- ister bethanechol. 27. The nurse is assessing a patient who presents with excessive salivation and abdominal cramping. The patient has been taking rivastigmine for memo- ry enhancement. What additional assessment findings support the diagnosis of a cholinergic crisis? Dyspnea Hypoglycemia Hypothyroidism
Bronchoconstriction Orthostatic hypotension Long-term use of cholinergic drugs such as rivastigmine may cause cholinergic crisis. Excessive salivation and abdominal cramps are the early symptoms of cholinergic crisis. If the patient continues to use the medication, other complications may occur, such as orthostatic hypotension because the decrease in the amount of fluids in the body. Bronchoconstriction is caused because of contraction of the bronchioles and smooth muscles. As a result, the patient has breathing difficulty and dyspnea. Cholinergic drugs do not affect insulin regulation and do not decrease the thyroid hormone levels. Therefore this drug does not cause hypoglycemia or hypothyroidism.
28. Which assessment finding in a patient receiving memantine indicates a significant side effect? Patient is unable to sleep Raised, erythematous rash Blood pressure 70/40 mm Hg Respiratory rate 30 breaths per minute: Blood pressure 70/40 mm Hg Memantine reduces blood pressure and causes hypotension as a side effect. A blood pressure of 70/40 mm Hg is a significant side effect. Insomnia, rash, and respiratory rate of 30 breaths per minute do not indicate a significant side effect. 29. Which medication is a noncholinergic drug used in the treatment of Alzheimer's disease? Atropine Memantine Donepezil Rivastigmine: Memantine Memantine is a noncholinergic drug that is used in the treatment of Alzheimer's disease. It helps by blocking the stimulation of the N- methyl-D-aspartate recep- tors. Atropine, donepezil, and rivastigmine are all cholinergic drugs. Atropine is a competitive antagonist to the acetylcholine receptor; it is used as the treatment for cholinergic
overdose. Donepezil is usually prescribed for Alzheimer's patients. It inhibits acetylcholinesterase and increases the levels of acetylcholine. Rivastigmine is also a cholinesterase inhibitor that causes an increase in acetylcholine levels.
