Unit 5 Pharm Chapter 28 Flashcards
A client develops malignant hyperthermia after receiving an NMJ blocker. What drug would be administered to the client?
A) Dantrolene
B) Naloxone
C) Calcium gluconate
D) Protamine sulfate
A) Dantrolene
Rationale:Dantrolene would be used to treat malignant hyperthermia. Naloxone would be used to treat opioid overdose. Protamine sulfate is the antidote for heparin. Calcium gluconate would be of no benefit.
The perioperative nurse ensures that a cholinesterase inhibitor is readily available for clients who are receiving an NMJ blocker. This will help the care team to:
A) treat adverse effects of NMJ blockers as they arise.
B) treat malignant hyperthermia promptly.
C) resolve the excessive sedation associated with NMJ blockers.
D) overcome excessive neuromuscular blockade, if needed.
D) overcome excessive neuromuscular blockade, if needed.
Rationale:Cholinesterase inhibitors are used to overcome excessive neuromuscular blockade by competing for ACh receptor sites. Dantrolene is used to treat malignant hyperthermia. Cholinesterase inhibitors do not treat adverse effects, and NMJ blockers do not cause sedation.
What drugs, if taken at the same time as the nondepolarizing NMJ blockers, could result in prolonged or increased neuromuscular effects? Select all that apply.
A) Barbiturates
B) Calcium channel blockers
C) Aminoglycosides
D) Salicylates
E) Xanthines
B) Calcium channel blockers
C) Aminoglycosides
Rationale:A combination of nondepolarizing NMJ blockers and aminoglycoside antibiotics (e.g., gentamicin) also leads to increased neuromuscular blockage. Calcium channel blockers may also greatly increase the paralysis caused by nondepolarizing NMJ blockers because of their effects on the calcium channels in the muscle. Combination with xanthines could result in reversal of the neuromuscular blockage. Do not mix the drug with any alkaline solutions such as barbiturates because a precipitate may form, making it inappropriate for use. Salicylates have no noted effect.
What client factors would a nurse identify as a contraindication to the use of a nondepolarizing NMJ blocking agent? Select all that apply.
A) Myasthenia gravis
B) Family history of malignant hyperthermia
C) Emphysema
D) Hyponatremia
E) Acute kidney injury
A) Myasthenia gravis
E) Acute kidney injury
Rationale:Myasthenia gravis is a contraindication because blockage of acetylcholine cholinergic receptors aggravates the neuromuscular disease. Renal dysfunction is a contraindication because it could interfere with the excretion of these drugs. Malignant hyperthermia requires cautious use of the drugs. Pulmonary dysfunction requires cautious use of the drugs. Altered fluid and electrolyte imbalance requires cautious use because the imbalance would affect membrane stability and subsequent muscular function
After teaching a group of students about NJM blockers, the instructor determines that the teaching was successful when the students identify what as an example of a nondepolarizing NMJ blocker? Select all that apply.
A) Dantrolene
B) Pancuronium
C) Vecuronium
D) Cisatracurium
E) Succinylcholine
B) Pancuronium
C) Vecuronium
D) Cisatracurium
Rationale:Pancuronium is a nondepolarizing NMJ blocker. Vecuronium is a nondepolarizing NMJ blocker. Cisatracurium is a nondepolarizing NMJ blocker. Succinylcholine is a depolarizing NMJ blocker. Dantrolene is a direct-acting skeletal muscle relaxant.
The preoperative nurse is reviewing a surgical client’s medication record. What medication would most influence the use of nondepolarizing NMJ blockers?
A) Calcium carbonate
B) Amlodipine
C) Metoprolol
D) Spironolactone
B) Amlodipine
Rationale:Calcium-channel blockers such as amlodipine may greatly increase the paralysis caused by nondepolarizing NMJ blockers because of their effects on the calcium channels in the muscle. Beta-blockers (metoprolol), potassium-sparing diuretics (spironolactone), and calcium supplements have no problematic effect.
