Endocrine Flashcards
(8 cards)
Name 8 common medications that can exacerbate myasthenia gravis
New medications: ABCDF - aminoglycosides, BB, CCB, dilantin, fluroquinolones
- Magnesium
- Antibiotics
- floroquinolones
-macrobids
-amino-glycosides - Statins
- Steroids
- BB
- CCB
7.lidocaine - procainamide
- phenytoin
- neuromuscular blockers
What is the pathophysiology of myasthenia gravis?
Weakness and fatigue result from circulating autoantibodies against nicotinic ACh receptors on postsynaptic membrane
Define myasthenia crisis
Defined as diagnosis of MG with respiratory failure requiring mechanical ventilation
What are the treatments for myasthenia crisis
- Intubate
- Steroids- Prednisone 60mg daily
-(give with IVIG or PLEX, but not alone as can worsen weakness)
3.PLEX = first line - IVIG 2g/kg in divided doses over several days
How is MG managed in the outpatient setting
- Pyridostigmine - acetylcholinesterase inhibitor
Dose: 60-120mg PO q4-6h
Prolongs the presence and activity of ACh in synaptic cleft
Side effect: excessive cholinergic stimulation - Thymectomy
- Steroids
- Rituximab
- Eculizumab
What is forced vital capacity?
What is normal?
What FVC is a consideration for intubation for
a. MG
b. GBS
FVC is the total amount of air a person can forcefully exhale from their lungs after a deep breath
Normal is 60 ml/kg or 3-5L
MG <15 ml/kg –> intubate
GBS <15 ml/kg –>intubate
What is MIPS?
What is normal?
What MIP is a consideration for intubation in neuromuscular disease
Mean Inspiratory Pressure
Normal 60-100 mmH2O
MIP <30 –> intubate
Name 5 clinical features of MG
- Ocular muscle weakness (1st sign of MG in up to 40% of patients
- Ptosis (worse towards the end of the day)
- New-onset diplopia
- Bulbar weakness - dysarthria, dysphagia
- Facial/extremity muscle weakness
- Difficulty combing hair, brushing teeth
- Weakness of muscles of head –> “dropped head appearance”
