Lecture 5: Myasthenia Gravis, MS, Guillain-Barre, Brain Tumor Flashcards
Do pts with myasthenia gravis have increased or decreased sensitivity to NDMRs?
Increased
Do myasthenia gravis pts have increased or decreased sensitivity to depolarizer muscle relaxants?
Could either be very sensitive or resistant to Succs. If possible, avoid all muscle relaxants in MG
What type of muscle relaxant is preferred (short, intermediate, or long-acting) if skeletal muscle paralysis in a pt being treated for myasthenia gravis is necessary?
Valley says short or Intermediate (Cisatracurium or Mivacurium).
Prodigy says short acting only (Cisatricurium)
Why are myasthenia gravis pt’s likely to develop a cholinergic crisis?
because they take anticholinesterase medications.
An excessive dose of neostigmine is accidentally infused. In addition to profound parasympathometic effects (bradycardia, etc) what else could conceivably happen?
Depolarizing neuromuscular blockade due to the accumulation of acetylcholine at the neuromuscular junction.
What med can be given to a pt to determine if they have a cholinergic crisis vs problems from Myasthenia Gravis.
Edrophonium 10mg. If they improve, their problem is related to myasthenia gravis.
Bilateral damage to the hypoglossal nerve may be found in pts with which two diseases?
Amyotrophic Lateral Sclerosis and myasthenia gravis - increased risk for aspiration
What are some of the classic symptoms of myasthenia gravis?
weakness, easy fatigability of skeletal muscles. Can be assymemtric, confined to one group of muscles or generalized.
What is the cause of symptoms associated with myasthenia gravis?
caused by autoimmune destruction of nicotinic acetylcholine receptors at the neuromuscular junction.
Onset of Myasthenia gravis is slow or quick?
Slow, insidious onset
Which muscle groups are most commonly affected by the ONSET of myasthenia gravis?
Any muscle group can be affected but the most common for onset is OCULAR.
- Ptosis
- Diplopia
What meds are used to treat myasthenia gravis?
Neostigmine and Pyridostigmine
What med is used to treat a cholinergic crisis?
Physostigmine
What kind of lung problem can be associated with myasthenia gravis?
Restrictive lung disease
What heart problem is associated with Myasthenia gravis?
myocarditis with a-fib
What are some other diseases associated with Myasthenia gravis?
hypothyroidism (Valley)
From Courtney's notes Hyperthyroid Rheumatoid Arthritis Systemic Lupus Pernicious Anemia
What surgery is performed to alleviate the symptoms of myasthenia gravis?
Thymectomy
When speaking with a pt preoperatively, what should you inform the pt could happen postoperatively?
They might need to remain intubated due to poor lung mechanics and muscle weakness.
Multiple sclerosis is an autoimmune disease that is characterized by the loss of the _______ _______ _____.
Axonal myelin sheath
In Multiple sclerosis affects the central or peripheral nerves?
Central nervous system
Is there a genetic or environmental link to getting multiple sclerosis?
Neither, but there is a stronger chance of getting MS if you have a first degree relative with it.
What drugs are used to slow the progression and severity of multiple sclerosis?
corticosteroids
What drugs are the treatment of choice for exacerbation/remission forms of Multiple sclerosis?
Interferon-B
What can bring about an exacerbation of symptoms of multiple sclerosis?
any forms of stress and even any increase in temperature, by as little as one degree Celsius
**Treat fever aggressively and early
