McKenna's Pharmacology for Nursing, 2e

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P A R T 5  Drugs acting on the autonomic nervous system

C H E C K Y O U R U N D E R S T A N D I N G

6. The nurse would expect to administer donepezil to a person with Alzheimer’s disease who: a. cannot remember family members’ names. b. is mildly inhibited and can still follow medical dosing regimens. c. is able to carry on normal activities of daily living. d. has memory problems and would benefit from once-a-day dosing. 7. Adverse effects associated with the use of cholinergic drugs include: a. constipation and insomnia.

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. Indirect-acting cholinergic agents: a. react with ACh receptor sites on the membranes of effector cells. b. react chemically with acetylcholinesterase to increase ACh concentrations. c. are used to increase bladder tone and urinary excretion. d. should be given with food to slow absorption. 2. A person is to receive pilocarpine. The nurse understands that this drug would be most likely used to treat which of the following? a. myasthenia gravis b. neurogenic bladder c. glaucoma d. Alzheimer’s disease 3. Myasthenia gravis is treated with indirect-acting cholinergic agents that: a. lead to accumulation of ACh in the synaptic cleft. b. block the GI effects of the disease, allowing for absorption. c. directly stimulate the remaining ACh receptors. d. can be given only by injection because of problems associated with swallowing. 4. A person with myasthenia gravis is no longer able to swallow. Which of the following would the health professional expect the doctor to order? a. donepezil b. memantine c. pyridostigmine d. edrophonium 5. Alzheimer’s disease is marked by a progressive loss of memory and is associated with: a. degeneration of dopamine-producing cells in the basal ganglia. b. loss of ACh-producing neurons and their target neurons in the CNS. c. loss of ACh receptor sites in the parasympathetic nervous system. d. increased levels of acetylcholinesterase in the CNS.

b. diarrhoea and urinary urgency. c. tachycardia and hypertension. d. dry mouth and tachycardia.

8. Nerve gas is an irreversible acetylcholinesterase inhibitor that can cause muscle paralysis and death. An antidote to such an agent is: a. atropine.

b. propranolol. c. pralidoxime. d. neostigmine.

MULTIPLE RESPONSE Select all that apply.

1. A nurse is explaining myasthenia gravis to a family. Which of the following points would be included in the explanation? a. It is thought to be an autoimmune disease. b. It is associated with destruction of ACh receptor sites. c. It is best treated with potent antibiotics. d. It is a chronic and progressive muscular disease. e. It is caused by demyelination of the nerve fibre. f. Once diagnosed, it has a 5-year survival rate. 2. A nurse would question an order for a cholinergic drug if the person was also taking which of the following? a. theophylline b. NSAIDs c. cephalosporin d. atropine

e. propranolol f. memantine