A client on galantamine 16 mg/day for Alzheimer disease is b… | MyMerci
Medical EmergenciesPA
Question
A client on galantamine 16 mg/day for Alzheimer disease is brought to the ED with profuse drooling, bradycardia (HR 42), abdominal cramping, diarrhea, and miosis. Which is the priority nursing action?
1Administer an additional dose of galantamine to ensure consistent therapeutic levels
2Administer naloxone IV to reverse the effects of a possible opioid overdose
3Encourage oral fluid intake to manage the diarrhea and reassess the client in 2 hours
4Prepare to administer atropine IV — the client is experiencing cholinergic crisis✓ Correct answer
Explanation
Correct (2): SLUDGE symptoms with bradycardia and miosis after a galantamine overdose are classic cholinergic crisis. Treatment: atropine (anticholinergic antidote), supportive airway/respiratory care, ECG monitoring. (1) More drug worsens crisis. (3) Naloxone reverses opioids, not cholinergic excess. (4) Delay is dangerous.
In-depth explanation
Memory Tip Cholinergic crisis = SLUDGE + DUMBELS. Antidote = Atropine. Caution Differentiate from myasthenic crisis (improves WITH ChEi); use edrophonium test if uncertain.
Clinical scenario
Scenario 75-year-old male on galantamine 16 mg/day; daughter doubled the dose by mistake yesterday. Presents with drooling, HR 42, miosis, cramping, diarrhea, sweating.