Drugs
Treatment of a cholinergic crisis
Atropine
O2 & suction
What is the main difference between a myasthenic and cholinergic crisis?
Excessive secretions
+ extreme weakness, muscle stimulation, & frank paralysis
How are MG & GB classified?
Neuromuscular disorders
What kind of receptors do autoantibodies attack in MG?
nicotinic M on skeletal muscle
When are the acute, plateau, and recovery periods in GB?
Acute: 1-3 wks
Plateau: days-2 wks
Recovery: up to 2 yrs (80-90% recover)
Inhibits and suppresses autoantibodies in GB
IV IgG
In which direction does weakness appear in MG?
Proximal to distal
Flaccid paralysis/hyporeflexia/areflexia
When do pts with MG experience max weakness?
within the first 3 yrs of dx
What is the result of a tensilon test that reveals alleviated symptoms? How long does it last?
Myasthenic crisis; ~5 mins
Are cholinesterase inhibitors selective or nonselective?
Nonselective b/c they can cause other symptoms
What are the mild symptoms of early MG?
Vision abnormalities, ptosis, dysphagia
What are the main effects of upper motor neuron problems?
Hemiparalysis/hemiplegia, diplegia, paraplegia, quadriplegia
Explain what happens during a myasthenic crisis
Insufficient ACh at neuromuscular junctions creates extreme weakness, paralysis, and risks death
Which disorder experiences fluctuating muscle weakness and predisposition to rapid fatigue?
MG
What drug is used in a tensilon test?
Endrophonium
What are the main symptoms of GB?
"glove & stocking" ascending paralysis, dec DTRs, inc HR, dec BP
How do lower motor neurons differ from upper motor neurons?
LMNs have a direct influence on muscles, UMNs relay info only in the CNS
Lymphocytes/macrophages strip/attack myelin and inflammation causes axonal injury- which results in a loss of nerve transmission
What are the similarities between GB and MG?
What are some examples of cholinesterase inhibitors?
Neostigmine
Pyridostimine
Endrophonium
Ambenonium
Explain the functional return of symptoms in GB
Proximal to distal (opposite of how s/s first develop)
Are reflexes diminished or spastic in UMN disorders?
spastic-- inc DTRs
Explain plasmapheresis
Wiping out all antibodies to get rid of autoantibodies that attack myelin, pt is put on crazy precautions to prevent risk of infection b/c their immune sys is at it's lowest
What is the purpose of administering cholinesterase inhibitors in MG?
Drugs delay destruction of ACh at synapses & produce skeletal muscle stimulation