Myasthenia Gravis Flashcards
Explain pathophys of MG:
Autoimmune disease in which nictoninic ACH receptors are attacked by IgG antibodies.
What does bulbar mean?
Generalized-weakness of face, limbs, and respiratory muscles in addition to the ocular muscles. (weakness wiht chewing, head drop, respiratory insufficiency)
Symptoms of MG: Explain them and when they’re worse?
Symptoms are usually worse later in the day or after exercise and are often transient early in the disease process
DDX for MG:
Generalized fatigue, botulism, statin med effects
Explain the edrophonium test for MG: What is edrophonium and how is the test done?
Edrophonium: achetylcholinesterase inhibitor
this will increase the Ach in the NM junction and should improve muscle weakness in pts wiht MG (10 mg dose)
Tx for MG:
Usually starts with acetylcholinesterase therapy
Steroids and immunosuppressants
Plasmapheresis
IV IG
How does rocuronium work?
It is a competitive antagonist at the ACh receptor
How does succinylcholine work?
It is an agonist at the ACh receptor
pts wiht MG are sensitive to ____ and resistant to ____
Sensitive to NDMB
Resistant to Sux
What are you thinking as far as reversal of NDMB in pts wiht MG?
Have to be careful because you could trigger a cholinergic crisis-especially in pts who are already on anticholinesterase therapy
Which NM blockers could you give in MG if they had to have NDMB?
cisatracurium (Hoffman elimination)
Atracurium (Hoffman elimination)
Regional Anesthesia in MG:
Caution must be taken in pts wiht resp insufficiency, but it does prevent you from having to use Neuormuscular blockers. -USE LOWER DOSES
Aspiration and MG:
If pts have bulbar symptoms, they are at an increased risk of aspiration due to an inability to protect their airway
What talk do you need to have wiht all MG patients?
In depth discussion about possibly of remaining intubated after surgery.
Predictors for post-op mechanical ventilation
MG for greater than 6 years
COPD
Daily pyridostigmine 750 mg or ore
Vital capacity less than 40 mL/kg
