Neuro Zebras

Question 1

Myasthenia Gravis

- ACh thing

Answer 1

• Acute exacerbations: IVIg; High dose IV steroids

- Long term sx relied: AChE inhibitors (pyridostigmine); Immunosuppressants

Question 2

Acetylcholinesterase inhibitors (AChE inhibitors)

Answer 2

Pyridostigmine (Mestinon)
- ACh: SNS/PSNS neurons (smooth muscle/ skeletal muscle/ heart/ sweat glands); Neuromuscular junction (motor nerve/skeletal muscle)

Question 3

Pyridostigmine (Mestinon)

• For myasthenia gravis
• ADR Cholinergic things (bunch of fluids/ muscle stuff)

Answer 3

• MOA: prevents destruction of ACh by AChE; Allows transmission of nerve impulses across neuromuscular junction
• USE: counteract effects of nerve poisoning
• ADR: skin rash (bromide); muscarinic (N/V/D/abd cramps/increased peristalsis/increased salvation; miosis; diaphoresis); Nicotinic (muscle cramps/ fasciculation/ weakness)
• CONTRAINDICATION: urinary/bowel obstruction; caution in asthma/COPD
• OVERDOSE: Cholinergic crisis (increase muscle weakness)- do Tensilon test (Cholinergic crisis vs worsening MG)/ treat with atropine

Question 4

Neostigmine (Prostigmin)

Answer 4

• IV or PO

- Faster than pyridostigmine (shorter duration/ more GI side effects)

Question 5

Riluzole (Rilutek)

- For ALS (does not cure, increase 3 months of life expectancy)

Answer 5

• MOA: inhibits glutamate release; inactivates Na channels
• ELEVATES LFTs
• ADR: asthenia; N/V/D/abd pain/anorexia; dizziness/vertigo; decrease lung function/pneumonia; paresthesia; somnolence

Question 6

Tetrabenazine (Xenazine)

- For Chorea (involuntary dance like movements; fatal)

Answer 6

• MOA: related to monoamine depletion (dopamine, serotonin, NE, histamine)
• USE: reduces involuntary movements
• ADR: depression/ suicidal ideation; fatigue/ insomnia/dizziness/akathisia
• CONTRAINDICATION: liver dz; MAOI