McKenna's Pharmacology for Nursing, 2e

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P A R T 4  Drugs acting on the central and peripheral nervous systems

BIBLIOGRAPHY Farrell, M. & Dempsey, J. (2014). Smeltzer & Bare’s Textbook of Medical-Surgical Nursing (3rd edn). Sydney: Lippincott Williams & Wilkins. Goodman, L. S., Brunton, L. L., Chabner, B. & Knollmann, B. C. (2011). Goodman and Gilman’s Pharmacological Basis of Therapeutics (12th edn). New York: McGraw-Hill. Hutton, D. (2011). Emergency preparedness in the OR. Malignant hyperthermia – Part 1. Plastic Surgical Nursing , 31(1) , 23–28. Jaramillo, K. S., Scruth, E. & Cheng, E. (2009). Prolonged paralysis and apnea after receiving a neuromuscular blocking agent: What nurses should know. American Journal of Critical Care , 18(6) , 588–591. McKenna, L. (2012). Pharmacology Made Incredibly Easy (1st Australian and New Zealand edn). Sydney: Lippincott Williams & Wilkins. Answers to the questions in this chapter can be found in Appendix A at the back of this book. MULTIPLE CHOICE Select the best answer to the following. 1. Non-depolarising NMJ blockers: a. antagonise acetylcholine to prevent depolarisation of muscle cells. b. act as agonists of acetylcholine, leading to depolarisation of muscle cells. c. prevent the repolarisation of muscle cells. d. are associated with painful muscle contractions on administration. 2. Curare is used as a poison on arrow tips in some cultures. Curare: a. is a depolarising NMJ blocker. b. causes muscle paralysis in the brain. c. is not affected by cooking. d. has no clinical use today. 3. Suxamethonium has a more rapid onset of action and a shorter duration of activity than the non- b. rapidly crosses the blood–brain barrier and is lost. c. is broken down by acetylcholinesterase that is found in the plasma. d. is very unstable. 4. When planning the care of a person who is to receive a NMJ blocker, the nurse or midwife would expect which of the following about the person? a. Transfer to an intensive care unit would be essential. b. Intubation would be necessary to maintain respirations. c. He would have no memory of any events. d. No adverse effects would occur after the drug is stopped. depolarising NMJ blockers because it: a. does not bind well to receptor sites.

McKenna, L. & Mirkov, S. (2014). McKenna’s Drug Handbook for Nursing and Midwifery (7th edn). Sydney: Lippincott Williams & Wilkins. Mitchell-Brown, F. (2012). Malignant hyperthermia: Turn down the heat. Nursing , 42(5) , 38–45. Porth, C. M. (2011). Essentials of Pathophysiology: Concepts of Altered Health States (3rd edn). Philadelphia: Lippincott Williams & Wilkins. Porth, C. M. (2009). Pathophysiology: Concepts of Altered Health States (8th edn). Philadelphia: Lippincott Williams & Wilkins. Wadlund, D. L. (2006). Prevention, recognition and management of nursing complications in the intraoperative and postoperative surgical patient. Nursing Clinics of North America , 41 , 219–229.

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5. Malignant hyperthermia can occur with any NMJ blocker, but it most often occurs with suxamethonium. The nurse or midwife would expect to see which drug ordered? a. phenobarbitone b. pancuronium 6. A person’s recovery from an NMJ blocker: a. is predictable, based on the drug given. b. can be affected by genetic enzyme deficiency. c. can always be ensured because of the drug half-life. d. can be shortened by administration of oxygen. 7. When preparing NMJ blockers for administration, it is important that they: a. are not mixed in with any alkaline solutions. b. are not exposed to light. c. are not mixed with any other drug. d. are not mixed with heparin. MULTIPLE RESPONSE Select all that apply. 1. The nurse or midwife would expect administration of a NMJ blocker as the drug of choice to accomplish which of the following? a. facilitate endotracheal intubation b. facilitate mechanical ventilation c. prevent injury during electroconvulsive therapy d. relieve pain during labour and birth e. treat myasthenia gravis f. treat a person with a history of malignant hyperthermia c. dantrolene d. diazepam