A patient who has myasthenia gravis will be taking neostigmine ...

[Diane]

A patient who has myasthenia gravis will be taking neostigmine (Prostigmin). What will the nurse emphasize when teaching this patient about the medication?
 
  a. Stop taking the drug if you have diarrhea.
  b. Take a supplementary dose before exercise.
  c. Use atropine if you have excessive salivation.
  d. Withhold the dose if ptosis occurs.

Question 2

Two nurses are discussing the major differences between physostigmine (Antilirium) and neostigmine (Prostigmin). One nurse correctly makes which statement about physostigmine (Antilirium)?
 
  a. It is not effective for treating poisoning by muscarinic blocking drugs.
  b. It can readily cross the blood-brain barrier.
  c. It does not cause any side effects.
  d. It can be given by all routes.

[TDubDCFL]

Answer to Question 1

ANS: B
Neostigmine doses must be adjusted continually, and patients usually need supplemental doses before exertion; therefore, patients must be taught how to modify doses as needed. Increased gastrointestinal (GI) secretions can cause loose stools; this is a known adverse effect that does not warrant stopping the drug. Atropine will help with excessive salivation but should not be used routinely, because it can mask the early signs of anticholinesterase overdose. Ptosis is one of the symptoms of myasthenia gravis and is an indication for taking neostigmine.

Answer to Question 2

ANS: B
The basic pharmacology of physostigmine is nearly identical to that of neostigmine, except that physostigmine readily crosses membranes, including the blood-brain barrier; neostigmine does not. Physostigmine and neostigmine are both effective for treating poisoning by muscarinic blocking drugs. Neither physostigmine nor neostigmine is devoid of side effects. Physostigmine can be given only intramuscularly (IM) or intravenously (IV); neostigmine is given orally (PO), IM, IV, and subcutaneously (subQ).

[Diane]

TY

[TDubDCFL]

You're welcome