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
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| 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
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| 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
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| 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)
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| neostigmine | ☺treats MG
☻short acting AChE inhibitor
♥given q3-4 hr - must give on time
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| 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,
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| 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
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| 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
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| 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
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| derophonium (tensilon) | ☺used to dx MG, if muscle strength is ↑ immediately or if ptosis is immediately corrected the dx is most likely MG
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| 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)
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| 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
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| 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
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| 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
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| diazepam (valium) | ☺relieve muscle spasms assoc with paraplegia and CP
☻CI in narrow angle glaucoma
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| baclofen (lioresal) | ☺muscle spasms caused by MS and spinal cord injury
☻OD may cause CNS depression, drowsiness, dizziness, nausea, HoTN
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| dantrolene sodium (dantrium) | ☺for spasms from spinal cord injury, stroke, MS
☻start dose low and ↑q4-7 days,
♥avoid etoh or CNS depressants
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| arisoprodol (soma) | ☺skeletal muscle relaxant
☻has CNS depressant effects
♥avoid etoh or CNS depressants
♦should be used short term only
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| methocarbamol (robaxin) | ☺acute muscle spasms and the tx of tetanus
☻CNS effects
♥avoid etoh or CNS depressants
♦urine may be green, brown, or black
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| metaxalone (skelaxin) | ☺acute muscle spasms
☻can be toxic with mild OD
♥used in combo with asa and caffeine (norgesic)
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| succinylcholine (anectine) | ☺for surgical skeletal muscle relaxation and used for endoscopy and intubation
☻0.3-1.1 mg/kg
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nursingTSJC2013
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