Neuro Zebras Flashcards
Name 2 treatments for acute exacerbations of MG (Myasthenia Gravis)
- IV IgG
- High-dose steroids
Name 2 long-term symptom relief treatments for MG
- Acetylcholinesterase (AChE) Inhibitors (allows more AChE to bind): pyridostigmine
- Immunosuppressants
List 7 thing Acetylcholine effects
- sympathetic neurons
- parasympathetic neurons
- skeletal muscle (& motor nerve)
- smooth muscle
- heart
- sweat glands
- NM junction
name the indication for Pyridostigmine
myasthenia gravis (MG)
contraindication of pyridostigmine
urinary/bowel obstruction
why should an asthmatic or COPD pt taking pyridostigmine be cautious?
ipratropium & tiotropium are inhaled cholinergics (this could lead to an overdose)
what med:
- prevents destruction of ACh by AChE
- allows transmission of nerve impulses across NMJ
Pyridostigmine
What another use of pyridostigmine (other than treating MG)?
counteract effects of nerve poisoning
Sx of pyridostigmine OD
increasing muscle weakness
what is the Tensilon test used for?
to differentiate worsening MG from Pyridostigmine OD
What is administered in a Tensilon test?
edrophonium
If muscle weakness worsens in a Tensilon test, pt is suffering from ___ crisis
cholinergic
If muscle weakness improves in a Tensilon test, pt is suffering from ___ crisis
myasthenic
ADRs of Pyridostigmine
skin rash
muscarinic effects
nicotinic effects
muscarinic ADRs of Pyriodstigmine
N/V/D, abd cramps, increased peristalsis & salivation & bronchial secreations, miosis, diaphoresis
nicotinic ADRs of Pyridostigmine
muscle cramps, fasciculation, weakness
2 administration methods of Neostigmine
IV
PO
What medication has a shorter duration & more GI side effects than Pyridostigmine
Neostigmine
What is Neostigmine used for?
MG
What is Riluzole used for
ALS
What medication:
- inhibits glutamate release
- inactivates voltage-gated sodium channels
Riluzole
What is the warning for Riluzole?
liver impairment (elevated LFTs)
ADRs of Riluzole
N/V/D, abd pain, dizziness, vertigo, somnolence, paresthesia, asthenia, decreased lung fxn, pneumonia, anorexia
how long does Riluzole extend life?
3 months
may have a greater benefit if started at diagnosis
what is Edaravone used for?
ALS
What effect does Edaravone have on ALS?
delays dz progession
how is Edaravone administered?
IV
28 day cycles: 14 on, 14 off
ADRs of Edaravone (3)
anaphylaxis, brusing, gait disturbance
What does Tetrabenazine tx?
Chorea (Huntington’s)
What is Tetrabenazine’s MOA?
unknown
possibly something w/ neurotransmitters - reduces involuntary movements
Tetrabenazine’s ADRs
depression, suicidal ideation, fatigue, insomnia, dizziness, akathisia (restlessness)
what is a contraindication of Tetrabenazine?
liver disease
what type of drug should you NOT take w/ Tetrabenazine?
MAOIs
