Pharmacology

STUDENT ACTIVITY SHEET BS NURSING / SECOND YEAR

Session 12

LESSON TITLE: DRUGS FOR NEUROMUSCULAR

DISORDERS (MYESTHENIA GRAVIS & MUSCLE SPASM)/
Materials:
DRUGS FOR NEUROLOGIC DISORDER: PARKINSONISM
& ALZHEIMER’S DISEASE Student: Notebook, Pharmacology book, Drug
handbook, pens & paper
LEARNING OUTCOMES:
At the end of the lesson, the nursing student can: Teacher: Projector and SAS

1. Define myasthenia gravis and muscle spasm;

2. Identify the drug group used in myasthenia gravis; References:
3. Differentiate between the muscle relaxants used for
Hayes, Evelyn R. Pharmacology: A Nursing
spasticity and those used for muscle spasm; and,
Process Approach: 6 th Edition. Singapore:
4. Describe the nursing interventions including client
Elsevier Saunders Company.
teaching, for drugs used in the treatment of Karch, Amy M. Focus on Nursing Pharmacology
myasthenia gravis and muscle spasm. 5th edition. Philedelphia: Lippincott William
5. Define Parkinsonism and Alzheimer’s disease; and Wilkins
6. Identify the drugs used for Parkinsonism and
Alzheimer’s disease; and, .
7. Identify the nursing interventions including client
teaching, for drug used in the treatment of
Parkinsonism and Alzheimer’s disease.

LESSON REVIEW/ PREVIEW OR HOOK ACTIVITY (5 minutes)

DIAGRAM
Make a diagram of what you have understood about your assigned work. Choose between myasthenia gravis and muscle
spasm.

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MAIN LESSON (50 minutes)

MYASTHENIA GRAVIS

Myasthenia Gravis (MG) : is characterized by weakness and rapid fatigue of any of the muscles under your voluntary
control. The cause of myasthenia gravis is a breakdown in the normal communication between nerves and muscles.
 There is no cure for myasthenia gravis, but treatment can help relieve signs and symptoms — such as weakness
of arm or leg muscles, double vision, drooping eyelids, and difficulties with speech, chewing, swallowing and
breathing.
 Nursing management: Provide rest in-between nursing care interventions.
o Admin. Meds on time and evenly spaced intervals to prevent relapse.
o Make the most of energy peaks.
o Plan diet and food intake around ability to swallow.
o Stress need for frequent rest periods.
o Establish resp. and neuro. Baseline.
 Medical Management
o Mestinon: Orally active cholinesterase inhibitor. Increases the amount of acetylcholine at the neuromuscular
junction. Enhances Communication between nerves and muscles.
o Corticosteroids- these inhibit the immune system
o Immunosuppressant’s- to alter immune system. ( these can increase risk for infection)
cyclosporine/mycophenolate
o Atropine: for bradycardia. This med will pick up the heart rate.
o Tensilon: trade name for Edrophonium chloride. The tensilon test is an injection used to diagnose MG.
Prolongs the muscle stimulation and temporarily improves strengths, increased strength following an
injection of tensilon suggests a diagnosis of MG.
 Muscle Spasm : A disturbance to the normal flow of information in the CNS caused by diseases, infections,
toxins, and injuries can lead to disturbances ranging from spasms to paralysis.
 results from violent and painful involuntary muscle contraction usually caused by muscle overstretching, joint
wrenching, and tendon or ligament tearing. When this happens, the injured area floods sensory impulses to
the spinal cord and it responds by eliciting intense muscle contraction. Pain from muscle spasms is due to
lactic acid accumulation that occurs when blood flow is cut off during contractions. Sensory impulses continue
to flood and a vicious cycle of contraction develops.
 What causes muscle spasms?
a. Insufficient stretching before physical activity.
b. Muscle fatigue.
c. Exercising in heated temperatures.
d. Dehydration.
e. Electrolyte imbalances in potassium, magnesium and calcium
 Muscle spasticity occurs when damaged neurons are within the CNS rather than the peripheral areas. The site of
damage makes this abnormality permanent. There is an interruption in the balance of excitatory and inhibitory
influences within the CNS which can lead to hypertonia (excessive muscle stimulation) and consequent
contractures and structural changes. There is now loss of coordinated muscle activity.
 Centrally acting muscle relaxants work in the CNS to interfere with reflexes that cause muscle spasms. They
essentially destroy or lyse spasms and are often referred to as spasmolytics.
 Other modalities of spasm and pain relief like rest, heat application, and physical therapy are used in addition
to these drugs.
 Therapeutic Action : The exact mechanism of action of skeletal muscle relaxants is not fully understood but it is
thought that it involves the participation of upper or spinal interneurons. It inhibits monosynaptic and polysynaptic
spinal reflexes. Other than that, it is a CNS depressant.
 Indications : Primary indication is relief of discomfort associated with acute, painful musculoskeletal conditions as
adjunct to rest, physical therapy, and other measures. Alleviation of signs and symptoms of spasticity, may be of
use in spinal cord injuries or spinal cord diseases.
 Contraindications and Cautions
o Allergy to centrally acting skeletal muscle relaxants. Prevent hypersensitivity reactions.
o Skeletal muscle spasms caused by rheumatic disorders. Do not benefit from these drugs.
o History of epilepsy. CNS depression and imbalance caused by drugs may exacerbate seizure disorder.
o Cardiac dysfunction. Muscle function may be depressed.
o Condition marked by muscle weakness. Can be exacerbated by drugs.
o Hepatic, renal dysfunction. Interfere with drug metabolism and excretion.

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 o Baclofen is not indicated for treatment of spasticity that contributes to locomotion, upright function, or
increased function. Blocking this spasticity results in loss of these functions.
 Adverse Effects
o CNS: depression, drowsiness, fatigue, weakness, confusion, headache, insomnia.
o CV: hypotension, arrhythmias
o GI: nausea, dry mouth, anorexia, constipation.
o GU: urinary frequency, enuresis, urinary urgency
o Chlorzoxazone may turn urine into purple-red color.
o Tizanidine has been associated with liver toxicity and hypotension in some patients.
o Baclofen is tapered over 1-2 weeks to prevent development of psychoses and hallucinations.
 Interactions : Other CNS depressants, alcohol: increased CNS depression
 Implementation with Rationale
o Provide additional spasm and pain relief like rest periods, heat application, NSAIDs as ordered,
and positioning to augment the effects of the drug at relieving the musculoskeletal discomfort.
o Discontinue drug at any sign of liver and renal dysfunction to prevent severe toxicity.
o Monitor respiratory status to evaluate adverse effects and arrange for appropriate dose adjustment or
discontinuation of the drug.
o Provide comfort measures to help patient tolerate drug effects.
o Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
o Educate client on drug therapy to promote understanding and compliance.

MUSCLE SPASM
 Spasms of skeletal muscles are most common and are often due to overuse and muscle fatigue, dehydration,
and electrolyte abnormalities. The spasm occurs abruptly, is painful, and is usually short-lived. It may be relieved
by gently stretching the muscle.

Direct-Acting Skeletal Muscle Relaxants: enter the muscle to prevent muscle contraction directly.
 Therapeutic Action : Dantrolene acts within skeletal muscle fibers and interfere with calcium ion release from the
muscle tubules. Therefore, the fibers are prevented from contracting. It does not interfere with neuromuscular
transmission and does not affect skeletal muscle surface membrane.
 Indications
Children
 Safety and effectiveness not established in children.
 Dantrolene is used to treat upper motor neuron spasticity in children.
 Dose should be accurately calculated based on body weight and it increases over time.
 Children are at increased risk of CNS and GI toxicity.
Adult

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  They should be cautioned to avoid activities that require alertness (e.g. driving) because drugs can
cause confusion and drowsiness.
 Pregnant and lactating women should be advised to use contraception and alternative method of
feeding, respectively.
 Premenopausal women are at increased risk for hepatotoxicity in association with use of dantrolene.
Older adults
 They are more likely to experience adverse effects associated with these drugs.
 Older women who are receiving hormone replacement therapy have the same risk for hepatotoxicity
with premenopausal women in association with use of dantrolene.
 Contraindications and Cautions
o Allergy to direct-acting skeletal muscle relaxants. Prevent hypersensitivity reactions
o Spasticity that contributes to locomotion, upright position, increased function. These functions will be lost if
spasticity were blocked
o Active hepatic disease. Interfere with metabolism of drug
o Pregnancy. Potential adverse effects to the fetus
o Lactation. May cross breast milk and may cause adverse effects in the infant
o Women and patients older than age 35. Caution is applied because of increased risk of potentially fatal
hepatocellular disease
o History of liver disease or previous dysfunction. Increases liver’s susceptibility to cellular toxicity
o Respiratory depression. Exacerbated by muscular weakness
o Cardiac disease. Cardiac muscle depression may be a risk

 Adverse Effects
o CNS: drowsiness, fatigue, weakness, confusion, headache, insomnia, visual disturbances
o GI: GI irritation, diarrhea, constipation, abdominal cramps
o GU: urinary frequency, enuresis, urinary urgency , crystalline urine with pain or burning on urination
o Others: acne, abnormal hair growth, rashes, photosensitivity, abnormal sweating, chills, nyalgia
o Dantrolene can cause direct hepatocellular damage and potentially fatal hepatitis
o Botulinom toxins are associated with anaphylactic reactions characterized by headache, dizziness, muscle
pain, paralysis
 Interactions
o Estrogens: increased incidence of hepatocellular toxicity if used with dantrolene
o Neuromuscular junction blockers, lincosamides, quinidine, magnesium sulphate, anticholinesterase,
succinylcholine, polymyxin, aminoglycosides: increased risk of additive effects
 Implementation with Rationale
o Assess area before administering botulinum toxins because area with active infection will be exacerbated by
injection.
o Monitor intravenous access sites of dantrolene for potential extravasation because drug is alkaline and very
irritating to tissues.
o Periodically discontinue dantrolene for 2-4 days as ordered to monitor therapeutic effectiveness.
o Discontinue drug at any sign of liver dysfunction to prevent adverse effects.
o Provide comfort measures to help patient tolerate drug effects.
o Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
o Educate client on drug therapy to promote understanding and compliance.

PARKINSON’S DISEASE
 Parkinson’s Disease is a chronic, progressive neurological disorder with rhythmic tremors as its initial
manifestation. These tremors lead to rigidity and weakness which interfere with the ability to maintain posture.
 Other manifestations include bradykinesia (extremely slowed movements), shuffling gait, drooling, and slow
and slurred speech. Cranial nerve affectations lead to a mask-like expression.
 It is important to note that Parkinson’s does not affect the higher levels of cerebral cortex so intelligence and
other brain functions at the same level are intact.
 The actual cause of Parkinson’s is not known but the manifestations are directly related to the damaged neurons
in the basal ganglia of the brain. Neuronal damage is thought to be caused by viral infections, head trauma,
brain infections, atherosclerosis, and drug and environmental exposures.
Parkinsonism
 Parkinsonism is referred to as the Parkinson’s disease-like extrapyramidal symptoms which are associated to
particular drugs or brain injuries’ adverse effects.

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Antiparkinsonism agents are drugs used for management of signs and symptoms of Parkinson’s disease, a progressive,
chronic neurological disorder primarily characterized by lack of coordination. Over time, individuals with Parkinson’s develop
rigidity and weakness.
 There is no known treatment for Parkinson’s as of present and drug therapy remains to be the primary treatment.
 The goal of the therapy is to restore the balance between decreasing dopamine levels (has inhibitory effect on
the neurons of the basal ganglia) and increasing cholinergic neurons (excitatory).

Dopaminergic Agents : Drugs that increase the effects of dopamine at receptor sites.
Therapeutic Action
 Dopamine does not cross the blood-brain barrier so other drugs with actions similar to dopamine and those that
increase its concentration in the substantia nigra (area responsible for muscle tone) must be used. This is one
way of restoring the balance between stimulatory and inhibitory neurotransmitters.
 Levodopa, the precursor of dopamine is the mainstay of treatment for Parkinson’s. It crosses the blood-brain
barrier and is converted into dopamine. When combined with carbidopa, the enzyme dopa decarboxylase is
inhibited from metabolizing levodopa, leading to higher levels that can cross the barrier.
Indications
 Dopaminergics are indicated for the relief of the signs and symptopms of idiopathic Parkinson’s disease.
 Levodopa is the drug of choice and acts as a replacement therapy.
 Amantadine is an antiviral drug that increases release of dopamine.
 Apomorphine directly binds with postsynaptic dopamine receptors.
Contraindications and Cautions
 Allergy to dopaminergics. Prevent hypersensitivity reactions
 Angle-closure glaucoma. Can be exacerbated by drug effects
 Lactation. Can enter breast milk and cause adverse effects to the baby
 Pregnancy. Can enter
 Suspicious skin lesions. Levodopa is associated with development of melanoma
 CV disease, bronchial asthma, psychiatric disorders. Can be exacerbated by dopamine receptor stimulation
 Hepatorenal diseases. Can interfere with metabolism and excretion of drug
 Apomorphine can increase risk of hypotension and prolonged QT interval.
Adverse Effects
 CNS: anxiety, nervousness, headache, malaise, fatigue, confusion, mental changes, blurred vision, muscle
twitching, and ataxia
 CV: arrhythmias, hypotension, palpitation
 Respiratory: bizarre breathing patterns
 GI: anorexia, nausea, vomiting, dysphagia, constipation or diarrhea
 GU: urinary retention
 Others: flushing, increased sweating, hot flashes
Interactions
 MAOI: Increased therapeutic effects and risk of hypertensive crisis. MAOI should be stopped 14 days before
beginning dopaminergic therapy.
 Vitamin B6, phenytoin: decreased levodopa efficacy
 Over-the-counter vitamins: decreased dopaminergic effectiveness
Implementation with Rationale
These are vital nursing interventions done in patients who are taking dopaminergics:
 Decrease dose of drug as ordered if therapy has been interrupted to prevent systemic dopaminergic effects.
 Evaluate disease progress and signs and symptoms periodically for reference of disease progress and drug
response.
 Give drug with meals to alleviate GI irritation if present.
 Monitor bowel function and institute bowel program if constipation is severe.
 Have patient void before taking the drugs to decrease risk of urinary retention.
 Monitor laboratory test results (renal and liver function, CBC) to detect early signs of dysfunction.
 Provide comfort measures to help patient tolerate drug effects.
 Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
 Educate client on drug therapy to promote understanding and compliance.

Anticholinergic Agents : are synthetic drugs which have been developed to achieve a greater affinity for cholinergic
receptor sites in the CNS.Drugs that inhibit the effects of acetylcholine at receptor sites of substantia nigra and corpus
striatum.

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Therapeutic Action
 Returns the balance to the basal ganglia and reduces the severity of rigidity, akinesia, and tremors.
 Peripheral anticholinergics reduce drooling and other secondary effects of parkinsonism.
Indications
 Adjunctive therapy for Parkinson’s disease (idiopathic, atherosclerotic, and postencephalitic)
 Indicated for patients who no longer respond to levodopa.
Contraindications and Cautions
 Allergy to dopaminergics. Prevent hypersensitivity reactions
 Angle-closure glaucoma, GI and GU obstruction, prostatic hypertrophy. Can be exacerbated by drug effects
 Myasthenia gravis. Exacerbated by acetylcholine receptor sites blocking effect of the drug
 Tachycardia, dysrhythmia, hyper or hypotension. Blocking the parasympathetic system may cause a dominance
of sympathetic stimulatory activity
 Hepatic dysfunction. Interfere with the metabolism of drugs increasing risk of toxicity
 Lactation. Can enter breast milk and cause adverse effects to the baby
 Pregnancy. Can enter
Adverse Effects
 CNS: disorientation, confusion, memory loss, agitation, nervousness, delirium, dizziness, light-headedness,
weakness
 CV: tachycardia, palpitations, hypotension
 EENT: blurred vision, photophobia, pupil dilation, blocking of lens accommodation
 GI: dry mouth, nausea, vomiting, paralytic ileus, constipation
 GU: urinary retention and hesitancy
 Others: flushing, reduced sweating
Interactions
 TCAs, phenothiazines: increased risk of potentially fatal paralytic ileus and toxic psychoses
 Antipsychotics: decreased antipsychotic therapeutic effectiveness because of central antagonism of two agents

Implementation with Rationale

 Administer drug with caution for patients exposed in hot weather or environments because patients are at
increased risk for heat prostration due to decreased ability to sweat.
 Give drug with meals to alleviate GI irritation if present.
 Monitor bowel function and institute bowel program if constipation is severe.
 Have patient void before taking the drugs to decrease risk of urinary retention.
 Monitor laboratory test results (renal and liver function) to detect early signs of dysfunction.
 Provide comfort measures to help patient tolerate drug effects.
 Provide safety measures (e.g. adequate lighting, raised side rails, etc.) to prevent injuries.
 Educate client on drug therapy to promote understanding and compliance.
 Evaluate disease progress and signs and symptoms periodically for reference of disease progress and drug
response.

AHLZEIMER’S DISEASE
Alzheimer’s disease (AD) is a progressive and irreversible, degenerative, fatal disease and is the most common form of
dementia among older people.

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Dementia is a brain disorder that seriously affects a person’s ability to carry out daily activities. It usually begins after age
60 and the risk goes up as you get older. Risk is also higher if a family member has the disease.
Clinical Manifestations
 Memory impairment. Impaired ability to learn new information or to recall previously learned information.
 Impairment in abstract thinking, judgment, and impulse control.
 Impairment in language ability, such as difficulty naming objects. In some instances, the individual may not
speak at all (aphasia).
 Personality changes are common.
 Impaired ability to perform motor activities despite intact motor abilities (apraxia).
 Disorientation. Patient may feel disoriented regarding current place, time, o names of persons they are close
with.
 Wandering. Because of disorientation, patient with dementia may often wander from one place to another.
 Delusions are common (particularly delusions of persecution).

Nursing Interventions
The nursing interventions for a dementia client are:
 Orient client. Frequently orient client to reality and surroundings. Allow client to have familiar objects around him
or her; use other items, such as a clock, a calendar, and daily schedules, to assist in maintaining reality
orientation.
 Encourage caregivers about patient reorientation. Teach prospective caregivers how to orient client to time,
person, place, and circumstances, as required. These caregivers will be responsible for client safety after
discharge from the hospital.
 Enforce with positive feedback. Give positive feedback when thinking and behavior are appropriate, or when
client verbalizes that certain ideas expressed are not based in reality. Positive feedback increases self-esteem
and enhances desire to repeat appropriate behavior.
 Explain simply. Use simple explanations and face-to-face interaction when communicating with client. Do not
shout message into client’s ear. Speaking slowly and in a face-to-face position is most effective when
communicating with an elderly individual experiencing a hearing loss.
 Discourage suspiciousness of others. Express reasonable doubt if client relays suspicious beliefs in response
to delusional thinking. Discuss with the client the potential personal negative effects of continued suspiciousness
of others.
 Avoid cultivation of false ideas. Do not permit rumination of false ideas. When this begins, talk to client about
real people and real events.
o Observe client closely. Close observation of client’s behavior is indicated if delusional thinking reveals an
intention for violence. Client safety is a nursing priority.

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CHECK FOR UNDERSTANDING (30 minutes)
You will answer and rationalize this by yourself. This will be recorded as your quiz. One (1) point will be given to correct
answer and another one (1) point for the correct rationalization. Superimpositions or erasures in you answer/ratio is not
allowed. You are given 25 minutes for this activity:

Multiple Choice

1. A client with myasthenia gravis has become frequently complaining of weakness and fatigue. The physician plans to
identify whether the client is responding to an overdose of the medication or a worsening of the disease. A tensilon test
is performed. Which of the following would indicate that the client is experiencing an overdose of the medication?
A. Temporarily worsening of the condition.
B. Improvement of the weakness and fatigue.
C. No change in the condition.
D. Complaints of muscle spasms.
ANSWER: ________
RATIO:___________________________________________________________________________________________
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2. The diagnostic work-up of a client hospitalized with complaints of progressive weakness and fatigue confirms a
diagnosis of myasthenia gravis. The medication used to treat myasthenia gravis is:
A. Prostigmine (neostigmine)
B. Atropine (atropine sulfate)
C. Didronel (etidronate)
D. Tensilon (edrophonium)
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

3. Karina a client with myasthenia gravis is to receive immunosuppressive therapy. The nurse understands that this
therapy is effective because it:
A. Promotes the removal of antibodies that impair the transmission of impulses
B. Stimulates the production of acetylcholine at the neuromuscular junction.
C. Decreases the production of autoantibodies that attack the acetylcholine receptors.
D. Inhibits the breakdown of acetylcholine at the neuromuscular junction.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

4. Myasthenia gravis is due to ____ receptors being blocked and destroyed by antibodies.
A. Epinephrine
B. Nicotinic
C. Acetylcholine
D. Transient
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

5. A client with myasthenia gravis has been receiving Neostigmine (Prostigmin). This drug acts by:
A. Stimulating the cerebral cortex
B. Blocking the action of cholinesterase
C. Replacing deficient neurotransmitters
D. Accelerating transmission along neural swaths
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

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6. The most significant initial nursing observations that need to be made about a client with myasthenia include:
A. Ability to chew and speak distinctly
B. Degree of anxiety about her diagnosis
C. Ability to smile an to close her eyelids
D. Respiratory exchange and ability to swallow
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

7. In making a diagnosis of myasthenia gravis Edrophonium HCI (Tensilon) is used. The nurse knows that this drug will
cause a temporary increase in:
A. Muscle strength
B. Symptoms
C. Blood pressure
D. Consciousness
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
_________________________________________________________________________________________________

8. A nurse is instructing a client regarding Carbidopa-levodopa (Sinemet) for the treatment of Parkinson’s disease. The
nurse tells the client that which of the following is a side effect of the medication?
A. Difficulty performing a voluntary movement.
B. Increased blood pressure.
C. Increased heart rate.
D. Itchiness of the skin.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

9. A nurse is giving dietary instructions to a client receiving levodopa. Which of the following food items should be avoided
by the client?
A. Goat yogurt.
B. Whole grain cereal.
C. Asparagus.
D. Apples
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

10. Biperiden hydrochloride (Akineton) is added to a list of antiparkinsonian medications that an elderly client is taking.
Which of the following instructions made by the nurse that needs further learning?
A. To avoid smoking, alcohol and caffeine.
B. To use ice chips, candy or gum for dry mouth.
C. Walking in the morning to have a daily source of direct sunlight.
D. Eating foods rich in fiber and increase fluid intake.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

11. What is the goal of therapy for Parkinson’s disease?

A. To decrease dopamine and to increase cholinergic neurons
B. To balance dopamine and cholinergic neurons
C. To excite neurons more
D. To inhibit neurons more
ANSWER: ________

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RATIO:___________________________________________________________________________________________
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______________________________________________________________________________________________

12. What is the mainstay of treatment for Parkinson’s?

A. Symmetrel
B. Levodopa
C. Cogentin
D. Parlodel
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

13. The drug of choice in children with parkinsonian symptom.

A. Levodopa
B. Artane
C. Benadryl
D. Benztropine
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

14. Which can decrease efficacy of levodopa?

A. Phenytoin
B. Pyridoxine
C. Niacin
D. Both A and B
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

15. A construction worker for 10 years is about to receive anticholinergics. What should the nurse consider in handling this
patient?
A. Do not give the drug to the patient.
B. Administer it with caution.
C. Discuss it with the doctor and have the order changed.
D. Arrange for a possible increase in the dose.
ANSWER: ________
RATIO:___________________________________________________________________________________________
_________________________________________________________________________________________________
______________________________________________________________________________________________

RATIONALIZATION ACTIVITY (THIS WILL BE DONE DURING THE FACE TO FACE INTERACTION)
The instructor will now rationalize the answers to the students. You can now ask questions and debate among yourselves.
Write the correct answer and correct/additional ratio in the space provided.

1. ANSWER: ________
RATIO:_______________________________________________________________________________________
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2. ANSWER: ________
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3. ANSWER: ________

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 RATIO:_______________________________________________________________________________________
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LESSON WRAP-UP (5 minutes)

You will now mark (encircle) the session you have finished today in the tracker below. This is simply a visual to help you
track how much work you have accomplished and how much work there is left to do.

You are done with the session! Let’s track your progress.

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THREE W’s

1. What did we learn today?

2. So What ?(relevancy, importance, usefulness)
3. Now What? (how does this fit into what we are learning, does it affect our thinking, can we predict where we are
going)

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For next session, review Adrenergic & Adrenergic Blocker

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