Medical Surgical Dementia vs Delirium #1

Question

The nurse is going over the drug list for a dementia client newly admitted to the Memory Unit. Which medication order will the nurse question?

Answers

  1. Donepezil 5 mg po at bedtime.
    • Rationale:

      This answer is not correct because donepezil is used to treat memory loss and enhance cognitive functioning. It works by preventing the breakdown of acetylcholine, which aids in memory.

  2. Lorazepam 0.5 mg po q 6h PRN anxiety.
    • Rationale:

      This answer is not correct because although lorazepam is known to increase confusion, it is frequently used to calm behaviors associated with dementia. Also, this medication is PRN and is not taken on a regular basis to affect the client negatively.

  3. Citalopram 10 mg po q day.
    • Rationale:

      This answer is not correct because citalopram is a common medication used for depression in dementia clients. It has fewer side effects and drug interactions than other classes of antidepressants.

  4. Oxybutynin 5 mg po tid.
    • Rationale:

      This answer is correct since oxybutynin is an anticholinergic drug that blocks the action of acetylcholine, which is involved in learning and memory. It is not recommended in clients with dementia due to the ability to cross the blood brain barrier, thus exacerbating dementia. Because donepezil prevents the breakdown of acetylcholine and oxybutynin blocks acetylcholine, these meds will counteract one another. So in conclusion taking oxybutynin will worsen the client’s dementia due to its effect on cognitive status and its decreasing effect on donepezil.

Overview

Dementia is a set of symptoms that include memory loss and cognitive difficulties. It is treated with cholinesterase inhibitors which boost acetylcholine. Oxybutynin is an anticholinergic drug that blocks the action of acetylcholine and should be questioned.

Explanation

Learning Outcomes

Dementia is a set of symptoms that include memory loss and cognitive difficulties. It is treated with cholinesterase inhibitors which boost acetylcholine. Acetylcholine relieves the cognitive and memory loss symptoms of dementia. Donepezil is used to treat memory loss and enhance cognitive functioning. It works by preventing the breakdown of acetylcholine. Oxybutynin is an anticholinergic drug that blocks the action of acetylcholine. Oxybutynin is prescribed for overactive bladder since it inhibits spasms of smooth muscles by blocking acetylcholine. Because donepezil prevents the breakdown of acetylcholine and oxybutynin blocks acetylcholine, these meds will counteract one another.

Test Taking Tip

Understand the role of acetylcholine in the nervous system.

Video Rationale