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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
Necrotizing myopathies: Statin doses should be limited to __mg with ticagrelor
40
26
Necrotizing myopathies: Statin doses should be limited to __mg with amiodarone and amlodipine
20
27
Necrotizing myopathies: Statin doses should be limited to __mg with diltiazem and verapamil
10
28
What is used for management of statin necrotizing myopathy?
source control | switch from lipophilic to hydrophilic
29
__ causes mitochondrial dysfunction by inhibiting DNA polymerase
zidovudine interferes with replication of mitochondrial DNA
30
Two types of inflammatory myopathy?
polymyositis | dermatomyositis
31
Inflammatory myopathy: __ reduces IgM rheumatoid factor serum concentrations and depresses T cell activity
D-penicilliamine leads to loss of tolerance to muscle antigens
32
Painless myopathies: __ inhibits the release of ACh causing decreased neuromuscular transmission
hypermagnesemia
33
CK is always elevated with corticosteroid painless myopathy a. true b. false
b. false may or may not be elevated
34
Corticosteroid painless myopathy may cause atrophy of what type muscle fibers?
type II
35
Corticosteroid painless myopathy is most common at higher doses of > __ mg/day for > __ weeks
40, 4
36
Prednisone __ to __ mg for 7 days with slow taper over a few months is used for severe drug induced myopathy
50, 100
37
How often is CK monitored for drug induced myopathy?
baseline and weekly
38
How often are TSH and T3/T4 monitored for drug induced myopathy?
once
39
How often is BMP monitored for drug induced myopathy ?
once daily if inpatient
40
How often is vitamin d monitored for drug induced myopathy ?
once
41
3 parts of the rhabdomyolysis triad?
- tea colored urine - weakness - muscle pain
42
CK > __ ULN indicates rhabdomyolysis
10
43
CK __ U/L indicates renal failure
5000
44
Rhabdo: Urine will be tea colored when myoglobin exceeds __ mg/dL
1.5
45
Rhabdo: CK rises within __ hours of injury onset and peaks at 1-3 days
12
46
Rhabdo: Myoglobin returns to normal within __ to __ hours
1, 6
47
Rhabdo: There is a __ ratio of BUN to creatinine a. increased b. decreased
b. decreased rise in both levels and decreased ratio of BUN to creatinine large amounts of creatinine released from damaged muscle
48
__ occurs with rhabdomyolysis a. hyperkalemia b. hypokalemia
a. hyperkalemia due to release of intracellular K into circulation and renal failure
49
__ occurs with rhabdomyolysis a. hypercalcemia b. hypocalcemia
b. hypocalcemia due to deposition on necrotic muscle tissue may become HYPERcalcamic when disease resolves
50
What syndrome causes trauma rhabdo?
Crush syndrome caused by prolonged crushing force on muscle (ex. car accident)
51
Compartment syndrome: __ phenomenon is a rebound elevation in CK levels after 48-72 hours
second wave
52
Rhabdo AKI represents __ % of all AKIs
10
53
What should be started as soon as possible with rhabdo?
aggressive fluid resuscitation before admission or right after
54
Rhabdo: Fluids should be titrated to urine output goal of __ to __ mL/kg/hr
2, 3 initiate rate of 400mL/hr avoid diuretics
55
Consider __ therapy with rhabdo if hyperkalemia persists
renal replacement
56
Hypocalcemia should always be corrected with rhabdo. a. true b. false
b. false correct only if symptomatic (tetany or seizures)
57
Rhabdo: If urine pH is < __ alternate each liter of NS with 1 liter of 5% dextrose plus 100mmol of bicarb (controversial)
6.5 may worsen hypocalcemia
58
How often are BMP and ins/outs monitored with rhabdo?
daily
59
How often is CK monitored with rhabdo?
baseline and dialy
60
How often is myoglobin monitored with rhabdo?
at baseline watch urine color

7262 MS Block 2 (10 decks)

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