# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=391759&lang=en  
> language: en  
> subject: Medical Emergencies  
> category: PA

## 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?

## Option

1. Administer an additional dose of galantamine to ensure consistent therapeutic levels
2. Administer naloxone IV to reverse the effects of a possible opioid overdose
3. Encourage oral fluid intake to manage the diarrhea and reassess the client in 2 hours
4. Prepare to administer atropine IV — the client is experiencing cholinergic crisis **✔ Correct answer**

**Correct answer: 4**

## 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.

## Key concepts

- **Cholinergic crisis** — Acetylcholinesterase inhibitor toxicity causing SLUDGE, bradycardia, miosis, weakness, respiratory failure.
- **Atropine** — Anticholinergic antidote for cholinergic crisis; given IV in titrated doses.
- **DUMBELS** — Mnemonic: Diarrhea, Urination, Miosis, Bronchospasm/Bradycardia, Emesis, Lacrimation, Salivation/Sweating.

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