A patient with 2-year history of glaucoma enters the emergency ...

[Alainaaa8]

A patient with 2-year history of glaucoma enters the emergency department with signs and symptoms consistent with those caused by irreversible cholinesterase inhibitors. The nurse understands that these findings are most likely the result of
 
  a. overdose of echothiophate.
  b. a drug-to-drug interaction.
  c. poisoning by organophosphates.
  d. a severe adverse reaction to the medication.

Question 2

A patient with myasthenia gravis has been on cholinesterase inhibitor therapy. The patient reports on occasion that she has some difficulty swallowing and periods of fatigue.
 
  The patient asks, What can be done to remedy this? The nurse's best response would be
  a. You are already on a high dosage of the drug. You will have to cope with these symptoms.
  b. This could mean that the dosage is too high and you should skip every other dose.
  c. Let's discuss some strategies to help you learn to self-adjust the dose in response to your symptoms.
  d. You are developing tolerance to the drug and will need to change to a different class of agents.

[C.mcnichol98]

Answer to Question 1

ANS: A
The limited indication for echothiophate should be no surprise, given its potential for toxicity. This scenario clearly states that a patient with glaucoma is displaying the signs and symptoms of overdose consistent with echothiophate.
There is no indication that the patient has experienced a drug-to-drug interaction.
There is no indication that the patient has been exposed to organophosphates.
The patient has a 2-year history of glaucoma; a severe adverse reaction would have occurred during initial use of the medication.

Answer to Question 2

ANS: C
To maintain optimal responses, patients occasionally must modify the dosage themselves. To do this, they must be taught to recognize signs of undermedication (difficulty swallowing, ptosis) and signs of overmedication (excessive salivation, diaphoresis).
Telling the patient that she will have to learn to cope with her symptoms without further explanation ignores the patient's need for answers.
The patient most likely is undermedicated, not overmedicated, and therefore should not be told to skip doses.
There is no indication that the patient has developed a tolerance to the drug.

[Alainaaa8]

TYSM

[Joy Chen]

Excellent