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myasthenia gravis
pn 141 test 3 book burke: pg 956
| Question | Answer |
|---|---|
| what is it | a chronic, autoimmune disorder |
| who does it affect | wm, ages 20-30 |
| what do they have periods of | exacerbations and remissions |
| what can trigger an acute onset | stress, pregnancy, secondary infection |
| cause | unknown |
| what gland is involved | the thymus gland |
| what does the thymus gland produce | antibodies |
| what do the antibodies do | they block or reduce the # acetylcholine receptors at each neuromuscular junction |
| what happens to nerve impulses | they cannot be sent to the cranial nerves that control the face, lips, tongue, neck and throat |
| what does this cause weakness of | the facial, speech, and chewing muscles |
| charecteristic s/s | eyelid ptosis, diplopia, slurred speech, nasal voice, difficulty chewing and swallowin, faituge |
| s/s : what may a smile look like | as a snarl or grimace |
| s/s: what tasks are difficult to perform | fine motor tasks (writing) |
| s/s: what other muscles are weak | respiratory |
| s/s: since the respiratory msucles are weak, what does this increase the risk for | aspiration and respiratory insufficiency |
| s/s: what is the onset | gradual |
| what are the two life threatening emergencies that can arise | myasthenic crisis, cholinergic crisis |
| myasthenic crisis: what is the cause | missed doses of meds ot infection |
| myasthenic crisis: what happens | pt suddenly develops increased muscle weakness, an inability to speak or swallow and respiratory distress |
| cholinergic crisis: what is the cause | overmedication with anticholinesterase (cholinergic) meds |
| cholinergic crisis: what are the s/s similar to | myasthenic crisis |
| cholinergic crisis: s/s | severe muscle weakness, N/V, abdominal cramps, increased salivation, sweating and bradycardia |
| physical exam: of what | the facial, oculomotor, laryngeal andrespiratory muscle |
| how is dx confirmed | by injectiing edrophonium chloride (tensilon) |
| med: edrophonium chloride (tensilon- what is the class | a short acting acnticholinersterase |
| edrophonium chloride (tensilon)- when this is injected what does pt show a drmatic improvemetn in; how long does the improvement last | muscle strength, only 5 min |
| diagnostic tests: what will an EMG show | increased muscle fatigue |
| diagnostic tests: what will a CT show | a tumor of the thymus gland |
| what is the Tx of choice | pyridostigmine (mestinon) and anticholinesterase |
| meds: pyridostigmine (mestinon)- why is dosage adjusted | until the pt s/s decrease |
| meds: pyridostigmine (mestinon)- dosage too late may cuase what | myasthenic crisis: |
| meds: pyridostigmine (mestinon)- dosage too early may cuase what | cholinergic crisis |
| surgery: that is a thymectomy | surgical removal of the thymus gland |
| surgery: why is a thymectomy done | to remove the source of the antibodies |
| what is a short term Tx option | plasmapheresis |
| plasmapheresis: what does it do | it removes the antiacetylcholine receptor antibodies so that muscle weakness and fatigue decrease |
| what is the number one way to dx | the tensilen test |
| meds: pyridostigmine (mestinon)- class | anticholinesterase |
| meds: pyridostigmine (mestinon)- action | it prolongs the action of acetylcholine to improve muscle contractions, it inhibits the release of aChe |
| meds: pyridostigmine (mestinon)- adverse reactions | increased bronchosectretions, cardiac arrhythmias, muscle weakness |
| meds: pyridostigmine (mestinon)- long or short acting | short |
| meds: pyridostigmine (mestinon)- why does it have to be taken at night | bc of breathing issues |
| meds: pyridostigmine (mestinon)- doseing | 1-2times a day |
| meds: why is prednisone give n | if pt is not responding well to pyridostigmine (mestinon), it suppresses immune activity antibody productions |
| plasmapheresis: how often does it takes place | daily exchange for 3-4 hors, for 5-7 days |
| what is done when one of the crisises occur | secure airway, rensilon test is performed |
| if a crisis occurs and a tensilon test is given what one will show improvemnt to test what one won't show improvement | myasthenic, cholinergic |
Created by:
jmkettel
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