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Krista: Neuro > Lecture 5: Myasthenia Gravis, MS, Guillain-Barre, Brain Tumor > Flashcards

Lecture 5: Myasthenia Gravis, MS, Guillain-Barre, Brain Tumor Flashcards

1
Q

Do pts with myasthenia gravis have increased or decreased sensitivity to NDMRs?

A

Increased

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2
Q

Do myasthenia gravis pts have increased or decreased sensitivity to depolarizer muscle relaxants?

A

Could either be very sensitive or resistant to Succs. If possible, avoid all muscle relaxants in MG

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3
Q

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?

A

Valley says short or Intermediate (Cisatracurium or Mivacurium).
Prodigy says short acting only (Cisatricurium)

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4
Q

Why are myasthenia gravis pt’s likely to develop a cholinergic crisis?

A

because they take anticholinesterase medications.

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5
Q

An excessive dose of neostigmine is accidentally infused. In addition to profound parasympathometic effects (bradycardia, etc) what else could conceivably happen?

A

Depolarizing neuromuscular blockade due to the accumulation of acetylcholine at the neuromuscular junction.

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6
Q

What med can be given to a pt to determine if they have a cholinergic crisis vs problems from Myasthenia Gravis.

A

Edrophonium 10mg. If they improve, their problem is related to myasthenia gravis.

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7
Q

Bilateral damage to the hypoglossal nerve may be found in pts with which two diseases?

A

Amyotrophic Lateral Sclerosis and myasthenia gravis - increased risk for aspiration

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8
Q

What are some of the classic symptoms of myasthenia gravis?

A

weakness, easy fatigability of skeletal muscles. Can be assymemtric, confined to one group of muscles or generalized.

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9
Q

What is the cause of symptoms associated with myasthenia gravis?

A

caused by autoimmune destruction of nicotinic acetylcholine receptors at the neuromuscular junction.

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10
Q

Onset of Myasthenia gravis is slow or quick?

A

Slow, insidious onset

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11
Q

Which muscle groups are most commonly affected by the ONSET of myasthenia gravis?

A

Any muscle group can be affected but the most common for onset is OCULAR.

  • Ptosis
  • Diplopia
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12
Q

What meds are used to treat myasthenia gravis?

A

Neostigmine and Pyridostigmine

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13
Q

What med is used to treat a cholinergic crisis?

A

Physostigmine

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14
Q

What kind of lung problem can be associated with myasthenia gravis?

A

Restrictive lung disease

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15
Q

What heart problem is associated with Myasthenia gravis?

A

myocarditis with a-fib

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16
Q

What are some other diseases associated with Myasthenia gravis?

A

hypothyroidism (Valley)

From Courtney's notes
Hyperthyroid
Rheumatoid Arthritis
Systemic Lupus
Pernicious Anemia
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17
Q

What surgery is performed to alleviate the symptoms of myasthenia gravis?

A

Thymectomy

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18
Q

When speaking with a pt preoperatively, what should you inform the pt could happen postoperatively?

A

They might need to remain intubated due to poor lung mechanics and muscle weakness.

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19
Q

Multiple sclerosis is an autoimmune disease that is characterized by the loss of the _______ _______ _____.

A

Axonal myelin sheath

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20
Q

In Multiple sclerosis affects the central or peripheral nerves?

A

Central nervous system

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21
Q

Is there a genetic or environmental link to getting multiple sclerosis?

A

Neither, but there is a stronger chance of getting MS if you have a first degree relative with it.

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22
Q

What drugs are used to slow the progression and severity of multiple sclerosis?

A

corticosteroids

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23
Q

What drugs are the treatment of choice for exacerbation/remission forms of Multiple sclerosis?

A

Interferon-B

24
Q

What can bring about an exacerbation of symptoms of multiple sclerosis?

A

any forms of stress and even any increase in temperature, by as little as one degree Celsius
**Treat fever aggressively and early

25
Q

Should spinal anesthesia be considered in the pt with multiple sclerosis?

A

Spinal anesthesia is typically avoided - Epidural anesthesia is considered less risky

26
Q

Why is spinal anesthesia avoided in the pt with multiple sclerosis?

A

The lack of myelin predisposes the neurons to the effects of local anesthetic toxicity.
- Epidural is considered less risky

27
Q

What kind of paralytic should be avoided in the pt with multiple sclerosis?

A

Succs - can result in hyperkalemic response

NMDRs may have a prolonged duration

28
Q

Should you plan on giving supplemental corticosteroids to the pt with multiple sclerosis on induction?

A

YES - may be necessary

29
Q

Is Guillain-Barre an autoimmune disorder?

A

Yes, but it is a response to a bacterial or viral infection

30
Q

What is the hallmark sign of Guillain-Barre?

A

Symmetrical lower extremity parasthesias and weakness

31
Q

Is there an exact cause of Guillain-Barre?

A

No, 60% of cases start as an infection of the lungs or digestive tract - some cases have no apparent triggers

32
Q

What are some common triggers for Guillain-Barre?

A
  • Campylobacter (found in poultry)
  • Surgery
  • Epstein-Barr Virus
  • Hodgkin’s disease
  • Mononucleosis
  • HIV
  • RARELY rabies vax or Flu vax
33
Q

Are corticosteroids useful in the treatment of Guillain-Barre?

A

No

34
Q

T/F - Plasma exchange or infusion of y-globulin may be beneficial to Guillain-Barre sufferers?

A

True

35
Q

What is a possible side effect of Guillain-Barre?

A

SIADH with sodium depletion

36
Q

What muscle groups are affected by Guillain-Barre?

A

The syndrome can be limited to only the legs or can

progress to complete paralysis with autonomic dysfunction.

37
Q

Will pts with Guillain-Barre have lasting effects from the disease?

A

No, the disease is self limiting and pts typically make a full recovery

38
Q

What type of anesthesia is preferred for pts with Guillain-Barre?

A

General Anesthesia

  • No succs due to K+ release
  • May need postop vent support
  • A-Line if autonomic dysfunction present
39
Q

Is it OK to use regional anesthesia on pts with Guillain-Barre?

A

Controversial - has been used successfully in OB pts.

40
Q

Which of the following factors is associated with an increased risk for postoperative ventilation following general anesthesia in patients with myasthenia gravis? (select two)

A
  • Disease duration greater than 6 years

- A negative inspiratory pressure less than -25cm H20

41
Q

Which of the following is consistent with a diagnosis of myasthenia gravis?

A

-Decreased numbers of functional acetylcholine receptors

42
Q

A patient with myasthenia gravis is taking the medication pyridostigmine for control of symptoms. What would you see:

A
  • Expect a potentially exaggerated response to nondepolarizing muscle relaxants
  • Expect a potentially exaggerated response to succinylcholine
  • Monitor neuromuscular blockade at the orbicularis oris muscle
43
Q

Which antibiotic class is associated with aggravation of muscle weakness in patients with myasthenia gravis?

A

-Aminoglycosides

44
Q

Which of the following is most likely to result in an exacerbation of the symptoms of multiple sclerosis following general anesthesia?

A

-An increase in body temperature of 1 degree celsius

45
Q

Which of the Multiple sclerosis is associated with:

A

-Prolonged latency of evoked poetentials

46
Q

T/F: The rate of relapse decreases during pregnancy for Multiple sclerosis.

A

True

47
Q

T/F: Idiopathic polyneuritis is also Guillain-Barre syndrome.

A

TRUE

48
Q

Name the three S/S of Cushing Triad.

A
  • HTN
  • Bradycardia
  • Respiratory disturbances
49
Q

What is the equation for cerebral perfusion pressure?

A

CPP = MAP - ICP

50
Q

What is the first effect of an increase in the volume of the brain?

A

-Decrease in cerebral blood flow

51
Q

What is the normal ICP:

A

10 mmHg

52
Q

What is the definition of intracranial hypertension:

A

SUSTAINED pressure above 15 mmHG

53
Q

What are the areas the brain can herniate through if the ICP is great enough:

A
  • cingulate gyrus
  • uncinate gyrus
  • the LEVEL of the cerebellar tonsils through the foramen magnum
  • opening in the skull
54
Q

_____ edema is the result of a breakdown in the blood brain barrier which allows protein to move into the extracellular tissue of the brain.

A

Vasogenic

55
Q

_______ edema is the result of neuronal damage which increases the amount of sodium and water in the brain cells leading to increased brain cell volume.

A

-Cytoxic

Krista: Neuro (7 decks)

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