Pharmacological and Parenteral Therapies Q 44

Correct Answer: D. Nausea

Nausea and gastrointestinal upset are very common in clients taking acetylcholinesterase inhibitors such as Exelon. Other side effects include liver toxicity, dizziness, unsteadiness, and clumsiness. The main adverse effects associated with the use of rivastigmine are gastrointestinal. The primary symptoms are nausea and vomiting. These acute effects primarily occur during the initial dose-escalation phase of therapy upward dose titration of the drug to achieve a therapeutic dose. These events can be minimized by using a slow titration schedule and taking the medication with food if prescribing an oral formulation.

Option A: Toxicity to the drug, while rare, should be carefully monitored. Common manifestations of toxicity include the presence of severe gastrointestinal reactions, allergic cutaneous reactions, as well as central nervous system effects. Classic manifestations of a patient in crisis can be remembered by the mnemonic DUMBELS – diarrhea, urination, miosis, bradycardia, excitability, lacrimation, salivation/excessive sweating prior to treatment.

Option B: The client might already be experiencing urinary incontinence or headaches, but they are not necessarily associated. Patients that are experiencing a cholinergic crisis should have atropine followed by pralidoxime to reverse the anticholinergic effects of rivastigmine. While the usual treatment of the crisis involves giving atropine before pralidoxime, a case study done in 2009 showed a successful reversal of cholinergic crisis with just pralidoxime without atropine pretreatment.

Option C: The client with Alzheimer’s disease is already confused. With its approval by the FDA, rivastigmine is indicated to treat mild to moderate dementia of the Alzheimer’s type. Its indications also include the treatment of mild to moderate dementia that is associated with Parkinson’s disease.