Other

Question 1

Myasthenia gravis

Answer 1

Muscle weakness

Question 2

Myasthenia gravis - treatment

Answer 2

Immunosuppressants = corticosteroid, azathioprine, methotrexate

Anticholinesterases = neostigmine, pyridostigmine

Question 3

Lambert-Eaton myasthenic syndrome

Answer 3

Rare disorder of neuromuscular transmission

Question 4

Lambert-Eaton myasthenic syndrome - Management

Answer 4

Acetylcholine-release enhancers = Amifampridine, Fampridine

Question 5

Nocturnal cramps - management

Answer 5

Quinine
- Restricted use

Question 6

When can quinine be used?

Answer 6

• Sleep is regularly disturbed
• Cramps are very painful or frequent
• Treatable causes of cramps are excluded
• Non-pharmacological treatments have not worked e.g. passive stretch exercises

Question 7

Quinine - SE

Answer 7

QT prolongation
Convulsions
Arrhythmias
Toxin in overdose

Question 8

Quinine - MHRA

Answer 8

Dose dependent QT prolonging effects.
Caution in patients with risk factor for QT prolongation or atrioventricular block

Question 9

Quinine - monitoring

Answer 9

Interrupt treatment every 3 months to assess further need.

Question 10

Spasticity

Answer 10

Baclofen
- Chronic severe spasticity
- GABA analogue (works at spinal level + depresses CNS

Question 11

Baclofen - SE

Answer 11

Drowsiness
Muscular hypotonia

Question 12

Baclofen - cautions

Answer 12

Drowsiness
- May affect driving
Withdrawal reactions
- Avoid abrupt withdrawal
- Gradually reduce dose over 1-2 weeks
Intrathecal use

Question 13

Withdrawal reactions

Answer 13

• Hyperactive states
• Exacerbates muscle spasticity + precipitates autonomic dysfunction
• Hyperthermia
• Convulsions
• Psychiatric reactions

Question 14

Intrathecal use

Answer 14

Test dose
Monitor
Have resuscitation available
Initiate within 3 months of test dose