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7262 MS Block 2 > Myasthenia Gravis/Rhabdomyolysis > Flashcards

Myasthenia Gravis/Rhabdomyolysis Flashcards

1
Q

__ is muscular pain and/or weakness in the absence of elevations of creatine kinase (CK)

A

myalgia

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2
Q

___ is muscular pain and/or weakness with elevations of CK > 2x ULN

A

myositis

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3
Q

__ is muscular pain and/or weakness with elevations of CK > 10x ULN with evidence of acute kidney injury

A

rhabdomyolysis

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4
Q

Testing CK for skeletal muscle, brain, or cardiac damage is a highly __, lowly __ test

a. specific, sensitive
b. sensitive, specific

A

b. sensitive, specific

cell membrane damage causes a release of CK from the cell into circulation

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5
Q

Normal CK levels for males?

A

55-170IU/L

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6
Q

Normal CK levels for females?

A

30-135IU/L

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7
Q

Generally CK levels < __ IU/L in adults are acceptable

A

300

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8
Q

4 reasons for CK elevation:

A

thyroid disorders
muscular dystrophy
dehydration
myocardial infarction

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9
Q

__ is the oxygen binding protein that is found in the cardiac and skeletal muscles

A

myoglobin

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10
Q

__ can change urine color to dark brown or red

A

myoglobin

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11
Q

Normal myoglobin serum level is < __ ng/mL

A

85

> 85 suggests muscle injury

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12
Q

Drug induced myopathy usually occurs within __ months of initiating therapy

A

6

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13
Q

CK > __ is a severe Sx of drug induced myopathy

A

400

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14
Q

8 differential diagnoses for drug induced myopathy:

A 
thyroid disorders
myocardial injury
infections
heart failure
muscle injury
muscular dystrophy
myasthenia gravis
systemic lupus erythematosus
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15
Q

Age > __ is a common risk factor for drug-induced myopathy

A

75

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16
Q

Other causes of drug induced myopathy:

A

autoimmune disease
thyroid disorder
hepatic impairment
hypoalbuminemia

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17
Q

5 common drug classes that cause drug-induced myopathy:

CADSF

A 
C - corticosteroids
A - antiretrovirals
D - daptomycin
S - statins
F - fibrates
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18
Q

Two things that cause painless drug-induced myopathies:

A 
electrolyte disturbances (diuretics, laxatives)
corticosteroids
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19
Q

Painful neuropathies:

Three drugs/classes that cause necrotizing neuropathies?

A

statins
fibrates
alcohol

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20
Q

Two drugs that cause mitochondrial painful neuropathies?

A

zidovudine

ipecac

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21
Q

Two drugs/classes that cause inflammatory painful neuropathies?

A

D-penicillamine

PPIs

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22
Q

3 Drugs that cause lysosomal painful neuropathies?

A

amiodarone
chloroquine
hydroxychloroquine

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23
Q

Which statins cause more risk for muscular adverse events?

lipophilic or hydrophilic?

A

lipophilic

simvastatin, atorvastatin, lovastatin

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24
Q

Which vibrate has less risk of causing necrotizing myopathy?

gemfibrozil or fenofibrate

A

fenofibrate

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25
Q

Necrotizing myopathies:

Statin doses should be limited to __mg with ticagrelor

A

40

26
Q

Necrotizing myopathies:

Statin doses should be limited to __mg with amiodarone and amlodipine

A

20

27
Q

Necrotizing myopathies:

Statin doses should be limited to __mg with diltiazem and verapamil

A

10

28
Q

What is used for management of statin necrotizing myopathy?

A

source control

switch from lipophilic to hydrophilic

29
Q

__ causes mitochondrial dysfunction by inhibiting DNA polymerase

A

zidovudine

interferes with replication of mitochondrial DNA

30
Q

Two types of inflammatory myopathy?

A

polymyositis

dermatomyositis

31
Q

Inflammatory myopathy:

__ reduces IgM rheumatoid factor serum concentrations and depresses T cell activity

A

D-penicilliamine

leads to loss of tolerance to muscle antigens

32
Q

Painless myopathies:

__ inhibits the release of ACh causing decreased neuromuscular transmission

A

hypermagnesemia

33
Q

CK is always elevated with corticosteroid painless myopathy

a. true
b. false

A

b. false

may or may not be elevated

34
Q

Corticosteroid painless myopathy may cause atrophy of what type muscle fibers?

A

type II

35
Q

Corticosteroid painless myopathy is most common at higher doses of > __ mg/day for > __ weeks

A

40, 4

36
Q

Prednisone __ to __ mg for 7 days with slow taper over a few months is used for severe drug induced myopathy

A

50, 100

37
Q

How often is CK monitored for drug induced myopathy?

A

baseline and weekly

38
Q

How often are TSH and T3/T4 monitored for drug induced myopathy?

A

once

39
Q

How often is BMP monitored for drug induced myopathy ?

A

once

daily if inpatient

40
Q

How often is vitamin d monitored for drug induced myopathy ?

A

once

41
Q

3 parts of the rhabdomyolysis triad?

A
  • tea colored urine
  • weakness
  • muscle pain
42
Q

CK > __ ULN indicates rhabdomyolysis

A

10

43
Q

CK __ U/L indicates renal failure

A

5000

44
Q

Rhabdo:

Urine will be tea colored when myoglobin exceeds __ mg/dL

A

1.5

45
Q

Rhabdo:

CK rises within __ hours of injury onset and peaks at 1-3 days

A

12

46
Q

Rhabdo:

Myoglobin returns to normal within __ to __ hours

A

1, 6

47
Q

Rhabdo:

There is a __ ratio of BUN to creatinine

a. increased
b. decreased

A

b. decreased

rise in both levels and decreased ratio of BUN to creatinine

large amounts of creatinine released from damaged muscle

48
Q

__ occurs with rhabdomyolysis

a. hyperkalemia
b. hypokalemia

A

a. hyperkalemia

due to release of intracellular K into circulation and renal failure

49
Q

__ occurs with rhabdomyolysis

a. hypercalcemia
b. hypocalcemia

A

b. hypocalcemia

due to deposition on necrotic muscle tissue

may become HYPERcalcamic when disease resolves

50
Q

What syndrome causes trauma rhabdo?

A

Crush syndrome

caused by prolonged crushing force on muscle (ex. car accident)

51
Q

Compartment syndrome:

__ phenomenon is a rebound elevation in CK levels after 48-72 hours

A

second wave

52
Q

Rhabdo AKI represents __ % of all AKIs

A

10

53
Q

What should be started as soon as possible with rhabdo?

A

aggressive fluid resuscitation

before admission or right after

54
Q

Rhabdo:

Fluids should be titrated to urine output goal of __ to __ mL/kg/hr

A

2, 3

initiate rate of 400mL/hr

avoid diuretics

55
Q

Consider __ therapy with rhabdo if hyperkalemia persists

A

renal replacement

56
Q

Hypocalcemia should always be corrected with rhabdo.

a. true
b. false

A

b. false

correct only if symptomatic (tetany or seizures)

57
Q

Rhabdo:

If urine pH is < __ alternate each liter of NS with 1 liter of 5% dextrose plus 100mmol of bicarb (controversial)

A

6.5

may worsen hypocalcemia

58
Q

How often are BMP and ins/outs monitored with rhabdo?

A

daily

59
Q

How often is CK monitored with rhabdo?

A

baseline and dialy

60
Q

How often is myoglobin monitored with rhabdo?

A

at baseline

watch urine color

7262 MS Block 2 (10 decks)

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