NURS 535 Module 3-Exam with Verified
Answers
Muscarinic agonist: Bethanechol
Goal:
Baseline data:
Monitoring:
High risk patients:
Evaluating therapeutic effects:
Minimizing adverse effects: - ✔✔Goal: treatment of non-obstructive urinary retention
Baseline data: v/s, urination times and amounts
Monitoring: I &O, s/s excessive muscarinic response (abnormal salivation, sweating, urinary
urgency, bradycardia, and hypotension)
High-risk patients: contraindicated in peptic ulcer disease, urinary obstruction, intestinal
obstruction, coronary insufficiency, hypotension, asthma, and hyperthyroidism
Evaluating therapeutic effects: absence of bladder distension or suprapubic discomfort,
adequate urinary output
Minimizing adverse effects: take on empty stomach to reduce N/V, treat excessive muscarinic
stimulation with atropine and supportive measures
What causes muscarinic (cholinergic) toxicity?
s/s?
SLUDGE and the Killer B's - ✔✔muscarinic agonists or cholinesterase inhibitors
Salivation
Lacrimation
Urination
Diaphoresis/ diarrhea
GI cramping
, Emesis
Bradycardia
Bronchospasm
Bronchorrhea
patient education for muscarinic agonists and cholinesterase inhibitors? - ✔✔Advise patients to
take these drugs 1 hour before meals or 2h after meals to decrease N/V
inform patients of s/s muscarinic toxicity
Cholinesterase inhibitors: pyridostigmine
Goal:
Baseline data:
Monitoring:
High risk patients:
Evaluating therapeutic effects:
Minimizing adverse effects: - ✔✔Cholinesterase inhibitors: pyridostigmine
Goal: treatment of myasthenia gravis
Baseline data: HR, BP, EC. determine the extent of neuromuscular dysfunction by assessing
muscle strength, fatigue, ptosis, and ability to swallow
Monitoring: HR, BP, ECG if bradycardia or pt reports palpitations, chest pain, SOB
monitor and record (1) times of drug administration, (2) times at which fatigue occurs, (3) state
of muscle strength, ptosis, and ability to swallow, (4) sins of excessive muscarinic stimulation.
titrate dose based on these observations
monitor for myasthenic crisis (extreme muscle weakness, paralysis of respiratory muscles)
which can occur if dosing is too low. manage with respiratory support and increased dosage
High risk patients: decreased renal function requires lower dose, use in caution in patients with
PUD, bradycardia, asthma, or hyperthyroidism, contraindicated with obstruction of intestine or
urinary tract
Evaluating therapeutic effects: increased muscle control and strength
Answers
Muscarinic agonist: Bethanechol
Goal:
Baseline data:
Monitoring:
High risk patients:
Evaluating therapeutic effects:
Minimizing adverse effects: - ✔✔Goal: treatment of non-obstructive urinary retention
Baseline data: v/s, urination times and amounts
Monitoring: I &O, s/s excessive muscarinic response (abnormal salivation, sweating, urinary
urgency, bradycardia, and hypotension)
High-risk patients: contraindicated in peptic ulcer disease, urinary obstruction, intestinal
obstruction, coronary insufficiency, hypotension, asthma, and hyperthyroidism
Evaluating therapeutic effects: absence of bladder distension or suprapubic discomfort,
adequate urinary output
Minimizing adverse effects: take on empty stomach to reduce N/V, treat excessive muscarinic
stimulation with atropine and supportive measures
What causes muscarinic (cholinergic) toxicity?
s/s?
SLUDGE and the Killer B's - ✔✔muscarinic agonists or cholinesterase inhibitors
Salivation
Lacrimation
Urination
Diaphoresis/ diarrhea
GI cramping
, Emesis
Bradycardia
Bronchospasm
Bronchorrhea
patient education for muscarinic agonists and cholinesterase inhibitors? - ✔✔Advise patients to
take these drugs 1 hour before meals or 2h after meals to decrease N/V
inform patients of s/s muscarinic toxicity
Cholinesterase inhibitors: pyridostigmine
Goal:
Baseline data:
Monitoring:
High risk patients:
Evaluating therapeutic effects:
Minimizing adverse effects: - ✔✔Cholinesterase inhibitors: pyridostigmine
Goal: treatment of myasthenia gravis
Baseline data: HR, BP, EC. determine the extent of neuromuscular dysfunction by assessing
muscle strength, fatigue, ptosis, and ability to swallow
Monitoring: HR, BP, ECG if bradycardia or pt reports palpitations, chest pain, SOB
monitor and record (1) times of drug administration, (2) times at which fatigue occurs, (3) state
of muscle strength, ptosis, and ability to swallow, (4) sins of excessive muscarinic stimulation.
titrate dose based on these observations
monitor for myasthenic crisis (extreme muscle weakness, paralysis of respiratory muscles)
which can occur if dosing is too low. manage with respiratory support and increased dosage
High risk patients: decreased renal function requires lower dose, use in caution in patients with
PUD, bradycardia, asthma, or hyperthyroidism, contraindicated with obstruction of intestine or
urinary tract
Evaluating therapeutic effects: increased muscle control and strength
