Neuro Zebras

Question 1

Name 2 treatments for acute exacerbations of MG (Myasthenia Gravis)

Answer 1

• IV IgG

- High-dose steroids

Question 2

Name 2 long-term symptom relief treatments for MG

Answer 2

• Acetylcholinesterase (AChE) Inhibitors (allows more AChE to bind): pyridostigmine
• Immunosuppressants

Question 3

List 7 thing Acetylcholine effects

Answer 3

• sympathetic neurons
• parasympathetic neurons
• skeletal muscle (& motor nerve)
• smooth muscle
• heart
• sweat glands
• NM junction

Question 4

name the indication for Pyridostigmine

Answer 4

myasthenia gravis (MG)

Question 5

contraindication of pyridostigmine

Answer 5

urinary/bowel obstruction

Question 6

why should an asthmatic or COPD pt taking pyridostigmine be cautious?

Answer 6

ipratropium & tiotropium are inhaled cholinergics (this could lead to an overdose)

Question 7

what med:

• prevents destruction of ACh by AChE
• allows transmission of nerve impulses across NMJ

Answer 7

Pyridostigmine

Question 8

What another use of pyridostigmine (other than treating MG)?

Answer 8

counteract effects of nerve poisoning

Question 9

Sx of pyridostigmine OD

Answer 9

increasing muscle weakness

Question 10

what is the Tensilon test used for?

Answer 10

to differentiate worsening MG from Pyridostigmine OD

Question 11

What is administered in a Tensilon test?

Answer 11

edrophonium

Question 12

If muscle weakness worsens in a Tensilon test, pt is suffering from ___ crisis

Answer 12

cholinergic

Question 13

If muscle weakness improves in a Tensilon test, pt is suffering from ___ crisis

Answer 13

myasthenic

Question 14

ADRs of Pyridostigmine

Answer 14

skin rash
muscarinic effects
nicotinic effects

Question 15

muscarinic ADRs of Pyriodstigmine

Answer 15

N/V/D, abd cramps, increased peristalsis & salivation & bronchial secreations, miosis, diaphoresis

Question 16

nicotinic ADRs of Pyridostigmine

Answer 16

muscle cramps, fasciculation, weakness

Question 17

2 administration methods of Neostigmine

Answer 17

IV

PO

Question 18

What medication has a shorter duration & more GI side effects than Pyridostigmine

Answer 18

Neostigmine

Question 19

What is Neostigmine used for?

Answer 19

MG

Question 20

What is Riluzole used for

Answer 20

ALS

Question 21

What medication:

• inhibits glutamate release
• inactivates voltage-gated sodium channels

Answer 21

Riluzole

Question 22

What is the warning for Riluzole?

Answer 22

liver impairment (elevated LFTs)

Question 23

ADRs of Riluzole

Answer 23

N/V/D, abd pain, dizziness, vertigo, somnolence, paresthesia, asthenia, decreased lung fxn, pneumonia, anorexia

Question 24

how long does Riluzole extend life?

Answer 24

3 months

may have a greater benefit if started at diagnosis

Question 25

what is Edaravone used for?

Answer 25

ALS

Question 26

What effect does Edaravone have on ALS?

Answer 26

delays dz progession

Question 27

how is Edaravone administered?

Answer 27

IV

28 day cycles: 14 on, 14 off

Question 28

ADRs of Edaravone (3)

Answer 28

anaphylaxis, brusing, gait disturbance

Question 29

What does Tetrabenazine tx?

Answer 29

Chorea (Huntington’s)

Question 30

What is Tetrabenazine’s MOA?

Answer 30

unknown

possibly something w/ neurotransmitters - reduces involuntary movements

Question 31

Tetrabenazine’s ADRs

Answer 31

depression, suicidal ideation, fatigue, insomnia, dizziness, akathisia (restlessness)

Question 32

what is a contraindication of Tetrabenazine?

Answer 32

liver disease

Question 33

what type of drug should you NOT take w/ Tetrabenazine?

Answer 33

MAOIs