A patient weighing 60 kg reports shortness of breath, wheezing, and chest discomfort. The patient is prescribed 5 mg/kg ipratropium every 12 hours. In a recall visit, the patient reports taking 300 mg/day ipratropium.
What instruction should be given to the patient for the effective management of asthma?
Continue the same dose of medication.
Change to alternative medication.
Double the dose of medication.
Halve the dose of medication.
The Correct Answer is D
This instruction should be given to the patient for the effective management of asthma because the patient is taking an overdose of ipratropium, which may cause serious side effects such as dry mouth, blurred vision, urinary retention, or increased heart rate. The recommended dosage of ipratropium for adults with acute asthma is 0.5 mg (500 mcg) every 20 minutes for three doses, followed by 0.5 mg every two to four hours as needed³. The patient's prescribed dose is 5 mg/kg, which means 300 mg/day for a 60 kg patient. This is 10 times the maximum daily dose of 2 mg (2000 mcg) for ipratropium⁴. Therefore, the patient should halve the dose of medication to 150 mg/day, which is still higher than the usual dosage, but within the range that can be given under medical supervision.
The other options are not appropriate instructions because:
a) Continuing the same dose of medication may worsen the patient's condition and increase the risk of adverse reactions.
b) Changing to alternative medication may not be necessary or effective, as ipratropium is a commonly used bronchodilator for asthma that works by relaxing the airway muscles and improving airflow⁵. The patient may benefit from adjusting the dose or adding other medications, such as corticosteroids or beta-agonists, depending on the severity and frequency of symptoms.
c) Doubling the dose of medication may be dangerous and potentially fatal, as it may cause severe anticholinergic effects, such as dry mouth, blurred vision, urinary retention, increased heart rate, confusion, or coma.
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Related Questions
Correct Answer is A
Explanation
To calculate the infusion rate, we need to convert the patient's weight from kilograms to milligrams.
Patient's weight: 65 kg
Dose required: 200 mcg/kg/min
First, let's calculate the total dose required for the patient per minute: Dose required = 200 mcg/kg/min * 65 kg
= 13,000 mcg/min
Next, we need to convert the dose from micrograms to milligrams:
13,000 mcg/min = 13 mg/min
Now, let's determine the infusion rate. We have 2,500 mg of esmolol in 250 mL of fluid. Therefore, the concentration of esmolol in the fluid is:
Concentration = 2,500 mg / 250 mL
= 10 mg/mL
To find the infusion rate, we divide the dose required by the concentration: Infusion rate = 13 mg/min / 10 mg/mL
= 1.3 mL/mi
Since the options are in mL/hr, we need to convert the rate from mL/min to mL/hr:
1.3 mL/min * 60 min/hr = 78 mL/hr
Therefore, the correct answer is:
a. 78 mL/hr
Correct Answer is D
Explanation
To find the answer, we need to convert the units of the medication order and the infusion rate to the same units. We can use the following conversions:
1 mcg = 0.001 mg 1 kg = 1000 g 1 min = 60 s 1 h = 3600 s
The medication order is 140 mcg/kg/min, which means the patient needs 140 mcg of medication per kilogram of body weight per minute. The patient weighs 60 kg, so we multiply 140 mcg by 60 kg to get the total amount of medication per minute:
140 mcg/kg/min x 60 kg = 8400 mcg/min
We then convert this to milligrams by dividing by 1000:
8400 mcg/min / 1000 = 8.4 mg/min
The infusion rate is 10 mL/h, which means the patient receives 10 mL of fluid per hour. We convert this to minutes by dividing by 60:
10 mL/h / 60 = 0.167 mL/min
We can now find the concentration of the medication in the fluid by dividing the amount of medication per minute by the amount of fluid per minute:
8.4 mg/min / 0.167 mL/min = 50.3 mg/mL
This means that for every milliliter of fluid, there are 50.3 milligrams of medication. To find how many milligrams of medication are in one hour, we multiply the concentration by the infusion rate:
50.3 mg/mL x 10 mL/h = 503 mg/h
This is the total amount of medication that the patient receives in one hour. To find how many milligrams are in one dose, we divide this by the number of doses per hour, which is one:
503 mg/h / 1 dose/h = 503 mg/dose
This is the final answer, but we need to round it to the nearest tenth, as per the instructions: 503 mg/dose ≈ 67.2 mg/dose
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