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21 Cards in this Set
- Front
- Back
What is the cause of myasthenia gravis? |
decreased available acetylcholine receptors on the postsynaptic site on the NMJ due to destruction by circulating antibodies |
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What are some of the hallmark findings in myasthenia gravis? |
muscle weakness w/ |
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How is muscle weakness manifested in myasthenia gravis? |
1. ptosis, |
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What are the types of myasthenia gravis? |
-type 1: limited to extraocular muscles |
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what conditions are consistent with cholinergic crisis? |
SLUDE + BBC |
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How is cholinergic crisis treated? |
maintain oxygenation and ventilation, and atropine 2mg should be given |
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How is myasthenic crisis treated? |
maintain oxygenation and ventilation and give neostigmine |
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What is the tensilon test used for? |
distinguish myasthenic from cholinergic crisis |
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What tests should you get preop in a patient with suspected myasthenia? |
ABG and PFTs, |
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What preop sedation should you give a patient with myasthenia gravis? |
typically no preop sedation is required |
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What should you inform patients with myasthenia gravis about prior to general anesthesia? |
possible need for prolonged mechanical ventilation postop |
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How should you change your doses of neuromuscular blockers in myasthenia gravis patients? |
-possible resistance to SCh (less receptors to cause muscle stimulation), |
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When do patients with myasthenia gravis get a thymectomy? |
drug resistant disease |
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What different should you do in pregnant patients with myasthenia gravis in labor? |
continue anticholinesterase medications during labor, use great caution when giving sedatives |
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How are neonates of mothers with myasthenia gravis affected? |
-neonatal myasthenia gravis is present in 20-30% of newborns, |
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What is the mechanism of myasthenia syndrome (lambert-eaton) |
decreased acetylcholine release following nerve stimulation |
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How are patients with myasthenic syndrome affected by NMBDs |
-marked sensitivity to both depolarizers (decreased ACh leads to increased sites for SCh to bind) and nondepolarizers (decreased ACh leads to more competitive inhibition from nondepolarizers) |
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How is myasthenic syndrome affected by removal of bronchial cancer? |
temporary but not permanent improvement |
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What are the manifestations of myasthenic syndrome? |
1. muscular weakness, associated with bronchial carcinomas, |
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In the myasthenic pt, what can precipitate a crisis? |
1. inadequate pyridostigmine |
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What are the anticholinesterase drugs used in myasthenia gravis? What is the difference between the 2? |
1. pyridostigmine - lasts longer and produces fewer muscarinic side effects; PO = 60 mg, IM or IV = 2 mg |