Author Question: A patient with myasthenia gravis who is taking a cholinesterase inhibitor is being admitted to the ... (Read 71 times)

dejastew · **on:** Jul 23, 2018

A patient with myasthenia gravis who is taking a cholinesterase inhibitor is being admitted to the intensive care unit and is on mechanical ventilation.

The prescriber has ordered a challenge dose of edrophonium to distinguish between a myasthenic crisis and a medication overdose. The nurse will expect to do what? a. Administer neostigmine if muscle strength decreases.
b. Be prepared to administer atropine and oxygen if muscle weakness increases.
c. Give a second dose of edrophonium if no improvement is seen.
d. Give pralidoxime Protopam if choliner-gic symptoms worsen.

Question 2

A patient who takes oral theophylline Theochron twice daily for chronic stable asthma develops an infection and will take ciprofloxacin. The nurse will contact the provider to discuss:

a. changing to a different antibiotic.
b. reducing the theophylline dose.
c. giving theophylline once daily.
d. switching from theophylline to a LABA.

snackralk · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

B
Edrophonium is an ultra-short-acting cholinesterase inhibitor used to distinguish between a myasthenic crisis and a cholinesterase inhibitor overdose, because weakness or paralysis can occur with both. If the symptoms are intensified and muscle weakness increases, the crisis is cholinergic, meaning that the patient is having toxic effects from the cholinesterase inhibitor and needs atropine as an antidote. Neostigmine would be given if the patient shows improved muscle strength, because that would indicate that the patient's symptoms are the result of a myasthenic crisis. A second dose of edrophonium would only worsen the symptoms. Pralidoxime is used to treat poisoning caused by irreversible cholinesterase inhibitors.

Answer to Question 2

B
Fluoroquinolone antibiotics increase theophylline levels, so the dose of theophylline may need to be reduced to prevent theophylline toxicity. Changing antibiotics, giving the theophylline once daily, and changing to a LABA are not indicated.