Myasthenia Gravis - 405

Question 1

Myasthenia Gravis

Answer 1

an acquired, autoimmune, progressive disease characterized by muscle weakness
-has remissions & exacerbations
-usually peaks within 2 yrs
-results from a reduction of acetylcholine receptors

Question 2

MG triggers

Answer 2

-emotional stress
-pregnancy
-illness
-heat

Question 3

two types of MG

Answer 3

-ocular & generalazied
-1/2 patients present w/ reports about vision problems

Question 4

where does MG typically originates in the

Answer 4

face, neck & jaw
-arm & leg muscles are affected later

Question 5

MG presenting symptoms

Answer 5

-ptosis: fluctuates throughout any given day (uni&bi)
-sneer
-diplopia (blurred vision)
-bulbar sx: dysarthria, dysphagia, & fatigable chewing
-proximal limb weakness

Question 6

MG dx

Answer 6

based on ocular or general sx
-tensilon test (for pt w/ ptosis): acetylcholinesterase inhibitor is given, onset set is 30sec, duration of action is 5-10mins -> will have improvement in eyelids if MG is cause
-ice pack test: ice eyelid for 2 mins and assess ptosis for improvement
-serologic test: autoantibodies
-nerve conduction tests

Question 7

drug therapy for MG

Answer 7

-acetylcholinesterase inhibitors: provides relief in mins
-pyridostigmine bromide (mestinon)
-immunotherapeutics (prednisone, azathioprine, cyclosporine)

Question 8

MG short term treatment as we wait for drugs to set in

Answer 8

1) IVIG: an injection of nonspecific antibodies that work by dialing down the immune system’s production of its own antibodies
2) plasmapheresis: IV line used to remove antibodies from plasma to decrease sx (6 exchanges over 2wk period w/ follow ups)

Question 9

MG surgical mgt

Answer 9

-thymectomy: bc thymus gland seems to enhance AChR antibodies

Question 10

comps of MG

Answer 10

hospitalization d/t respiratory tract infection or acute myasthenic crisis

Question 11

care for MG

Answer 11

-focus on care on neurologic deficits & their impact on ADLs
-teach balanced diet that can be easily chewed/swallowed (semi solid is best)
-schedule meds around meal times
-arrange diversional activities that require minimal exertion

Question 12

teaching for MG

Answer 12

-what causes flares
-med regimen + SE
-comps of disease
-comps of therapy
-support groups

Question 13

myastehnic crisis & cholinergic crisis features

Answer 13

apprehension
restlessness
dsypnea
dysphagia
generalized weakness
resp distress

Question 14

myathenic crisis is caused by + unique features

Answer 14

not enough antichol drugs
-inc in VS
-bowel & bladder incontinence
-absence of cough/swallow reflex
-improvement of sx w/ tensilon test

Question 15

cholinergic crisis + unique features

Answer 15

too many antichol drugs
-flaccid paralysis
-hypersecretions
-N/V/D
-abdominal cramps
-worsening sx w/ tensilon test