Neuromuscular Disorders and Muscle Spasms

Question 1

What is the pathophysiology of Myasthenia Gravis?

Answer 1

Autoimmune Disorder

Antibodies attach to acetylcholine receptor sites and destroy receptor sites.

Lack of acetylcholine impairs transmission of messages at neuromuscular junctions

This leads to ineffective muscle contraction and muscle weakness. Also leads to weakness of respiratory, facial and extremity muscles.

Question 2

What are the characteristics of Myasthenia Gravis?

Answer 2

Skeletal muscle weakness

Fatigue, Ptosis (drooping upper eye lids)

Dysphagia, dysarthria

Respiratory muscle weakness, paralysis and arrest.

Question 3

What can trigger Myasthenic Crisis?

Answer 3

Inadequate/Not enough medication dosing

Emotional stress, menses, pregnancy

Infection, surgery, trauma

Hypokalemia, alcohol intake

Temperature extremes

Medication interactions

Question 4

What is the reversal agent for Myasthenic Crisis?

Answer 4

Neostigmine

Question 5

What is Myasthenic Crisis?

Answer 5

Severe generalized muscle weakness.

Involves diaphragm and intercostal muscles

Question 6

What is Cholinergic Crisis?

Answer 6

Usually occurs within 30-60 minutes after taking Anticholinergic medications.

IT IS TRIGGERED BY OVERDOSING.

Question 7

What are the symptoms of Cholinergic Crisis?

Answer 7

Severe muscle weakness

Possible respiratory
paralysis and arrest

Abnormal pupil constriction

Pallor, sweating, vertigo

Excess salivation, GI distress

Bradycardia, fasciculations

Question 8

True or false? Edrophonium can cause Cholinergic crisis to worsen?

Answer 8

True

Question 9

What does SLUD stand for in Cholinergic Crisis?

Answer 9

Salivation

Lacrimation

Urination

Defection

Question 10

What acetylcholinesterase inhibitor would be used to help differentiate between Myasthenic and cholinergic crisis?

Answer 10

Edrophonium

Question 11

What do acetylcholinesterase inhibitors generally do for Myasthenia gravis patients?

Answer 11

Increases muscle strength

Question 12

What is Pyridostigmine classified as?

Answer 12

Intermediate acting Acetylcholinesterase Inhibitor

Question 13

What is the MOA of Pyridostigmine?

Answer 13

Promotes transmission of neuromuscular impulses across the myoneural junctions by preventing destruction of acetylcholine

Question 14

What is Pyridostigmine used for?

Answer 14

Myasthenia gravis

Neuromuscular blockade

Nerve Gase exposure prophylaxis

Question 15

What are the SE/ASE of Pyridostigmine?

Answer 15

Hypotension

Bradycardia

Bronchospasm

Respiratory Distress

Seizure

Excess salivation

Blurred vision

Miosis

GI distress (N/V/D)

Sweating

Rash

Question 16

What interventions can be used if the patient is unresponsive to Acetylcholinesterase Inhibitor?

Answer 16

Prednisone (choice drug)

Plasma exchange

IV immune globulin

Immunosuppressive drugs (Azathioprine)

Question 17

What should be monitored when a patient is taking Azathioprine because they are not responsive to Acetylcholinesterase Inhibitor?

Answer 17

Need to monitor for Leukopenia and Hepatoxicity

Question 18

What should be assessed for a patient on Acetylcholinesterase Inhibitor?

Answer 18

S&S of Myasthenic Crisis like muscle weakness with difficulty breathing and swallowing

Question 19

What is the nursing plan for a patient on Acetylcholinesterase inhibitor?

Answer 19

Symptoms of muscle weakness will be eliminated or reduced in 2 - 3 days

Question 20

What are the nursing interventions for a patient on ACHE inhibitors?

Answer 20

Administer doses on time.

Take drug before meals if possible.

Monitor drug effectiveness.

Have antidote available for cholinergic crisis.

Encourage patient to wear medical identification.

Question 21

What is the reversal agent for Cholinergic Crisis?

Answer 21

Atropine

Question 22

How should a nurse evaluate a patient on ACHE inhibitors?

Answer 22

Evaluate drug effectiveness

Evaluate muscle strength

Absence of respiratory distress

Is the patient able to drug properly?

Question 23

What is the Pathophysiology of Multiple Sclerosis?

Answer 23

Autoimmune Disorder

Attacks myelin sheath of nerve fibers in brain and spinal cord

Causes formation of plaques

Question 24

Is there a cause for Multiple Sclerosis?

Answer 24

No.

Question 25

What are the characteristics of Multiple Sclerosis?

Answer 25

Remissions and exacerbations

Weakness or paralysis of extremities, fatigue

Muscle spasticity,
paresthesia

Dysarthria, dysphagia, ataxia

Diplopia, blurred vision, vertigo, tinnitus

Question 26

How can Multiple Sclerosis be diagnosed?

Answer 26

There is no specific test.

It is only diagnosed by having several indicators such as

Medical history
Neurologic exam
Multiple lesions observable through MRI
Visual evoked potential 
Elevated immunoglobulin G in the cerebrospinal fluid

Question 27

What are the Classifications of Multiple Sclerosis?

Answer 27

Relapsing Remitting = Relapse with full recovery and residual deficit

Primary progressive = Slowly worsening neurologic function with relapses or remissions

Secondary progressive = Initially relapsing remitting. Then progression with or without occasional relapses, minor remissions and plateaus

Progressive relapsing = Progressive from onset wtih acute relapses with or without full recovery.

Question 28

What drug can be used to help treat M.S?

Answer 28

Immunomodulators

These drugs are first-line treatment and they slow the disease progression and prevents relapses.

Question 29

What drug is classified as Immune Modulator?

Answer 29

Beta-Interferon

Question 30

What is the MOA of Beta-Interferon?

Answer 30

antiviral and immune-regulatory properties are produced by interacting with specific receptor sites on cell surfaces.

Question 31

What is Beta-Interferon used for?

Answer 31

decrease number and severity of MS attacks

slows progression of disability.

Question 32

What are the SE/ASE of using Beta-Interferon?

Answer 32

myelosuppression, hepatitis, neutropenia, myalgia, anaphylaxis, flulike symptoms