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ch 24

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myasthenia gravis (MG)   ☺lack of nerve impulses and muscle responses at myneuronal junction ☻weakness in resp system, facial muscles, and extremities ♥cranial nerve involvement causes ptosis, difficulty chewing and swallowing, respiratory arrest from resp muscle paralysis ♦caused by autoimmune destruction of ACh  
MS   ☺dx by MRI shows sclerotic plaques ☻s/s of MS: dipolpia, weakness of extremities or spasticity ♥lab tests: ↑IgG in CSF and ↑ratio to albumin in serum  
myasthenic crisis   ☺triggers: inadequate dosing of AChE inhibitors, infxn, pregnancy, emotional stress, menses, surgery, trauma, hypoK, temperature extremes, etoh intake ☻crisis can occur 3-4 hrs after taking aminoglycoside and fluoroquinolines, calcium channel blockers, dilantin, psychotropics ♥death can result from paralyis of resp muscles  
OD with AChE inhibitors   ☺may cause cholinergic crisis which is an acute exacerbation of symptoms ☻occurs 30-60 min after taking anticholinergics - due to continuous depolarization of postsynaptic membranes that create neuromuscular blockade s/s: severe muscle weakness, miosis (pupil constriction), pallor, sweating, vertigo, excess salivation, n/v/d, abd cramps, bradycardia, and fasciculations (invol muscles twitching)  
neostigmine   ☺treats MG ☻short acting AChE inhibitor ♥given q3-4 hr - must give on time  
pyridostigmine bromide (mestinon) prototype drug chart   ☺immediate action ☻given every 3-6 hrs ♥CI: GI and GU mechanical obstruction, severe renal disease, ileus ♦caution: asthma, HoTN, bradycardia, hyperthyroidism, renal dx, pregnancy and BF ♣used to treat MG, anti-nerve gas agent used to tx Soman, muscle relaxant,  
pyridostigmine bromide (mestinon) prototype drug chart continued   ☺s/e: n/v/d, HA, blurred vision, dizziness, abd cramps, excess saliva and sweating, rash, miosis ☻a/e: HoTN, bradycardia, dyspnea, bronchospasm, dysrhythmias, seizures  
NC pyridostigmine bromide (mestinon)   ☺pt should avoid atropine and muscle relaxants ☻assess for s/s of MG crisis ♥effectiveness of tx should be ↑muscle strength ♦rate and depth of resp should be monitored ♣give med IV undiluted at rate of 0.5 mg/min, DO NOT ADD TO IV FLUIDS ♠atropine sulfate is antidote for cholinergic crisis ☺teach: wear medical alert ID ☻take before meals for best absorption  
ambenonium (mytelase)   ☺long acting ☻given when a pt does not respond to neostigmine or pyridostigmine b/c of bromide component ♥can be taken with glucocorticoids  
derophonium (tensilon)   ☺used to dx MG, if muscle strength is ↑ immediately or if ptosis is immediately corrected the dx is most likely MG  
tx of MS   ☺acute attack: fatigue, motor weakness, optic neuritis - glucocorticoids ☻recurrent: spasticity - BRMs, interferon, glatiramer acetate (Copaxone) - antineoplastic, give IV q3mo with accumulative life time dose of no more than 140 mg/m2 ♦fingolimod (gilenya) ♣chronic: progressive s/s such as using wheelchair - immunosuppressant cyclophosphamide (cytoxan)  
cyclobenzaprine (flexeril) prototype drug chart   ☺muscle relaxant ☻CI: acute MI, av blocks, bundle branch blocks, arrhythmias, HF, hyperthyroidism, paralytic ileus, concurrent use of MAOIs or within 14 days after d/c ♥caution: seizures, etoh, CNS depressants, glaucoma, BPH, urinary retention, liver dx, BF  
cyclobenzaprine (flexeril) prototype drug chart continued   ☺s/e: anticholinergic effects - blurred vision, constipation, dry mouth, tachycardia, urinary retention, drowsiness, dizziness, HA, fever, abd pain, v/d, flatulence, ED ☻a/e: allergic reaction, angioedema, MI, seizures, ileus  
NC cyclobenzaprine (flexeril)   ☺determine if spasm is acute or chronic ☻CI in narrow angle glaucoma or MG ♥monitor liver functions - ALP, ALT and GGT ♦report abnormal VS ♣teach: do not stop abruptly, taper over 1 wk to avoid rebound spasms, take no more than for 3 wks, avoid etoh and CNS depressants s/e: n/v, dizziness, fainting, HA, diplopia ♠take with food  
diazepam (valium)   ☺relieve muscle spasms assoc with paraplegia and CP ☻CI in narrow angle glaucoma  
baclofen (lioresal)   ☺muscle spasms caused by MS and spinal cord injury ☻OD may cause CNS depression, drowsiness, dizziness, nausea, HoTN  
dantrolene sodium (dantrium)   ☺for spasms from spinal cord injury, stroke, MS ☻start dose low and ↑q4-7 days, ♥avoid etoh or CNS depressants  
arisoprodol (soma)   ☺skeletal muscle relaxant ☻has CNS depressant effects ♥avoid etoh or CNS depressants ♦should be used short term only  
methocarbamol (robaxin)   ☺acute muscle spasms and the tx of tetanus ☻CNS effects ♥avoid etoh or CNS depressants ♦urine may be green, brown, or black  
metaxalone (skelaxin)   ☺acute muscle spasms ☻can be toxic with mild OD ♥used in combo with asa and caffeine (norgesic)  
succinylcholine (anectine)   ☺for surgical skeletal muscle relaxation and used for endoscopy and intubation ☻0.3-1.1 mg/kg  


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Created by: nursingTSJC2013