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.
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.
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