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– Neuromuscular disease: weakness and fatigue of the voluntary muscles.

– Is usually due to insufficient amount of Acetycholine.

CAUSES:

– An autoimmune response

– Inadequate release of Ach.

ASSESSMENT

  • WEAKNESS AND FATIGUE
  • DIFFICULTY CHEWING
  • DYSPHAGIA, PTOSIS
  • DIFFICULTY BREATHING (RESPIRATORY)

Diagnostics:

Tensilon Test

– used for diagnosing Myasthenia Gravis.

– used to defferntiate cholinergic crisis from myasthenic crisis.

How the test is done:

An IV injection of edrophonium or neostigmine causes some quick relief of muscle weakness.

Cholinesterase Inhibitor is used for Myasthenia Gravis

– Cholinesterase Inhibitor can intensify transmission at muscarinic and neuromuscular junctions.

Atropine- antidote for cholinergic crisis.

TREATMENT:

Cholinergic Medications (Anticholinesterase.

  • Neostigmine (Prostigmin)
  • Pyridostigmine (Mestinon)

Side effects of Medications:

  • – increase GI motilioty
  • – bradycardia
  • –  increased salivation

* Pay attention to the patient and monitor for

  1. Cholinergic Crisis (Drug Overdose)
  2. Myasthenic Crisis (Undermedication)

Differentiation between the two:

  1. Cholinergic Crisis– usually develops about an hour before the administration of the drug.

       * Atropine is the antidote.

Symptoms can include:

  • dysphagia
  • dyspnea
  • respiratory and muscle weakness2

    2. Myasthenic Crisis= Increase the anticholinesterase dose.

 

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