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 diarr-hea."
b. "Take a supplementary dose before exer-cise."
c. "Use atropine if you have excessive sali-vation."
d. "Withhold the dose if ptosis occurs."
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.
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