A client taking galantamine is brought to the emergency department with profuse salivation, vomiting, diarrhea, muscle weakness, a heart rate of 42/min, and shallow respirations. Which action should the nurse anticipate?
1Give another galantamine dose to improve the muscle weakness and respiratory effort.
2Hold galantamine, support ventilation, and prepare prescribed atropine for cholinergic toxicity.✓ Correct answer
3Administer naloxone because the secretions and bradycardia indicate opioid toxicity.
4Encourage oral fluids and reassess after the gastrointestinal symptoms resolve.
Explanation
Severe salivation, vomiting, diarrhea, bradycardia, muscle weakness, and respiratory depression during galantamine therapy indicate cholinergic toxicity. The nurse should hold galantamine, support the airway and ventilation, notify the emergency treatment team or poison center, and prepare a prescribed tertiary anticholinergic such as atropine. Additional galantamine can worsen the crisis, while naloxone does not reverse cholinergic excess and oral fluids are unsafe with respiratory compromise.
Clinical reasoning Galantamine inhibits acetylcholinesterase. Excess exposure can overstimulate muscarinic and nicotinic receptors, producing secretions, gastrointestinal hyperactivity, bradycardia, muscle weakness, and respiratory failure.
Decision rule Treat suspected galantamine overdose as a cholinergic emergency: stop exposure, support ventilation, obtain poison-control guidance, and administer atropine according to the prescribed response-based plan.
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.
Cholinergic crisis — Severe acetylcholine excess causing secretions, vomiting, diarrhea, bradycardia, weakness, hypotension, and respiratory depression.
Atropine — A tertiary anticholinergic that may be used as an antidote for the muscarinic manifestations of galantamine overdose.