A nurse is explaining myasthenia gravis to a family. Which of the following points would be included in the explanation? (Select All that Apply.)

Answer: A. “Syncope episodes may occur when taking this medication.”

Rationale:

A) “Syncope episodes may occur when taking this medication.”
Syncope (fainting) is a possible side effect of donepezil, a cholinesterase inhibitor used to treat Alzheimer’s disease. Donepezil can cause bradycardia, which may lead to a decrease in blood pressure and reduced blood flow to the brain, resulting in syncope. It's important for family members to monitor for episodes of dizziness, fainting, or lightheadedness, particularly when the client changes positions (orthostatic hypotension).

B) “You will need to monitor for constipation.”
Constipation is not commonly associated with donepezil use. In fact, donepezil may cause diarrhea or gastrointestinal upset due to its cholinergic effects. Family members should be more concerned about potential gastrointestinal disturbances such as nausea, vomiting, or diarrhea rather than constipation.

C) “This medication may cause tachycardia.”
Donepezil is more likely to cause bradycardia (a slower-than-normal heart rate) rather than tachycardia (a fast heart rate). Bradycardia is a known side effect because the medication increases acetylcholine, which enhances parasympathetic activity, leading to a slower heart rate.

D) “You should administer the medication each morning.”
Donepezil is typically administered in the evening before bed. This schedule helps reduce the risk of daytime gastrointestinal side effects, like nausea and vomiting, which can interfere with daily activities. Administering the medication at night can also reduce the impact of potential dizziness or syncope during the day.

This is the correct response. ACE inhibitors are known to cause a persistent, dry, and irritating cough in some individuals. This adverse effect occurs due to the accumulation of bradykinin and other substances in the lungs, leading to increased sensitivity of the cough reflex. The cough typically resolves upon discontinuation of the ACE inhibitor.

B) Respiratory depression:
Respiratory depression is not a common side effect of ACE inhibitors. ACE inhibitors do not directly affect respiratory drive or function in the central nervous system. Therefore, this option is incorrect.

C) Spontaneous pneumothorax:
Spontaneous pneumothorax is not a typical adverse effect associated with ACE inhibitor use. ACE inhibitors do not directly cause the development of pneumothorax, which is characterized by the presence of air in the pleural space. Therefore, this option is incorrect.

D) Pneumonia:
While ACE inhibitors can increase the risk of respiratory infections due to their effect on the immune system, pneumonia is not a specific adverse effect associated with ACE inhibitor use. Pneumonia is typically caused by infectious agents such as bacteria, viruses, or fungi, rather than being a direct effect of ACE inhibitors. Therefore, this option is incorrect.”