Question

A nurse in an emergency department is caring for a client who has myasthenia gravis and is in a cholinergic crisis. Which of the following medications should the nurse plan to administer?

Option 1:
a) Atropine

Option 2:
b) Acetaminophen

Option 3:
c) Epinephrine

Option 4:
d) Neostigmine

Answer 1

In a cholinergic crisis due to myasthenia gravis, a nurse should plan to administer atropine, an anticholinergic drug that blocks muscarinic acetylcholine receptors to reduce the overactivity of acetylcholine.

Step-by-step explanation:

A nurse caring for a patient with myasthenia gravis who is in a cholinergic crisis should plan to administer atropine. This medication is an anticholinergic drug that works as an antagonist to muscarinic acetylcholine receptors, thereby blocking the effects of excess acetylcholine which is responsible for the symptoms of a cholinergic crisis. Cholinergic crisis is characterized by excessive activation of acetylcholine receptors, and atropine's antimuscarinic effects are critical in reversing these symptoms. Other medications like neostigmine are used to block the breakdown of acetylcholine but are not used during a cholinergic crisis as they would exacerbate the condition.

Myasthenia gravis is an autoimmune disorder where circulating antibodies block nicotinic acetylcholine receptors at the neuromuscular junction, leading to muscle weakness. Treatments for myasthenia gravis typically include drugs that either suppress the immune system or counter the actions of these antibodies to improve muscle contraction. However, in a cholinergic crisis, caused by overmedication with anticholinesterase drugs such as neostigmine, the accumulation of acetylcholine needs to be managed with an anticholinergic agent such as atropine. Atropine administration's endpoint is the clearing of bronchial secretions, which are a common symptom of cholinergic crisis.