Page 2065 - Saunders Comprehensive Review For NCLEX-RN

6. Instruct the client to wear a MedicAlert bracelet.
7. Note that antimyasthenic therapy is lifelong therapy.
8. Evaluate for medication effectiveness, which is based
on the improvement of neuromuscular symptoms or
strength without cholinergic signs and symptoms.
9. When administering edrophonium, have emergency
resuscitation equipment on hand and atropine sulfate
available for cholinergic crisis.

E. Edrophonium test (may be known as the Tensilon test)

1. Edrophonium is injected intravenously.
2. The edrophonium test can cause bronchospasm,
laryngospasm, hypotension, bradycardia, and cardiac
arrest.
3. Atropine sulfate is the antidote for overdose.
4. Diagnosis of myasthenia gravis: Most myasthenic
clients will show a significant improvement in muscle
tone within 30 to 60 seconds after injection, and the
muscle improvement lasts 4 to 5 minutes.
5. The edrophonium test is also used to diagnose
cholinergic crisis (overdose with anticholinesterase)
or myasthenic crisis (undermedication).
a. In cholinergic crisis, muscle tone does
not improve after the administration of
edrophonium, and muscle twitching
may be noted around the eyes and
face.
b. An edrophonium injection temporarily
worsens the condition when a client is
in cholinergic crisis (negative
edrophonium test).
c. An edrophonium injection temporarily
improves the condition when the client
is in myasthenic crisis (positive
edrophonium test).
II. Multiple Sclerosis Medications
A. Description
1. Medication therapy is aimed at modifying the disease,
treating acute episodes or relapses, and treating
symptoms.
2. Disease-modifying medications decrease the
frequency and severity of relapses, reduce brain
lesions, increase future functional capability, and
increase overall quality of life.
3. The 2 main groups of disease-modifying medications
are immunomodulators and immunosuppressants
(Box 59-3).
4. Treating acute episodes usually consists of giving a

2065