22 Questions
What is believed to be the mechanism by which plasmapheresis treats Myasthenia Gravis?
It rids plasma of certain antibodies that contribute to the immune system attack on the nerves
What is the primary cause of Myasthenia Gravis?
An autoimmune disorder that destroys acetylcholine receptor sites
What is the significance of electromyography (EMG) in diagnosing Myasthenia Gravis?
It shows a rapid decrease in the amplitude of evoked potentials
Which of the following is a characteristic of the neuromuscular transmission in Myasthenia Gravis?
Decreased transmission of impulses from nerve to muscle cells
What is the role of acetylcholine receptor sites in Myasthenia Gravis?
They are destroyed by the antibodies in the autoimmune disorder
What is the primary site of muscle weakness in Myasthenia Gravis?
Muscles innervated by the cranial nerves
What is the purpose of Carbidopa in the treatment of Parkinson's disease?
To prevent the breakdown of dopamine in the periphery
What is the primary characteristic of Relapsing-Remitting Multiple Sclerosis (RRMS)?
Relapses develop over 1-2 weeks and resolve over 4-8 months
What is the mechanism of action of Anticholinergic medications in the treatment of Parkinson's disease?
Inhibiting the action of acetylcholine
What is the primary use of Bromocriptine mesylate in the treatment of Parkinson's disease?
To stimulate the release of dopamine in the substantia nigra
What is the prevalence of Relapsing-Remitting Multiple Sclerosis (RRMS) among all cases of Multiple Sclerosis?
85% of cases
What is the primary difference between Primary Progressive Multiple Sclerosis (PPMS) and Secondary Progressive Multiple Sclerosis (SPMS)?
Presence of remission
What is the purpose of Antiviral medications, such as Amantadine, in the treatment of Parkinson's disease?
To reduce rigidity, tremor, and bradykinesia
What is the common side effect of Anticholinergic medications, such as Benztropine mesylate and procyclidine?
Dry mouth, blurred vision, constipation, and urinary retention
What is the primary mechanism of action of neostigmine bromide and pyridostigmine bromide?
Blocking the action of cholinesterase at the neuromuscular junction
Which of the following is a common side effect of anticholinesterase drugs?
Fasciculations (muscle twitching)
What is the primary indication for corticosteroids, such as prednisone, in the management of autoimmune disorders?
Suppressing the autoimmune response
Why should anticholinesterase drugs be administered with milk and crackers?
To decrease gastrointestinal upset
What is the importance of assessing muscle strength and vital capacity before and after medication?
To monitor the effectiveness of the medication
Why is it important to check the gag reflex and swallowing ability before feeding?
To assess the risk of aspiration
What is the purpose of providing a mechanical soft diet?
To promote optimal nutrition
Why should mealtimes coincide with the peak effects of the medication?
To promote optimal nutrition
Study Notes
Myasthenia Gravis (MG)
- A neuromuscular disorder characterized by a disturbance in the transmission of impulses from nerve to muscle cells at the neuromuscular junction.
- Causes extreme muscle weakness, especially in voluntary muscles innervated by cranial nerves.
- Highest prevalence is between ages 15-35 for women and over 40 for men.
- Affects women more than men.
- Thought to be an autoimmune disorder where antibodies destroy acetylcholine receptor sites on the postsynaptic membrane.
Symptoms of Myasthenia Gravis
- Weakness of eye muscles, difficulty in swallowing, or slurred speech.
- Decreased amplitude of evoked potentials in electromyography (EMG).
Medical Management
- Anticholinesterase drugs: neostigmine bromide (Prostigmin), pyridostigmine bromide (Mestinon), and edrophonium chloride (Tensilon).
- Block action of cholinesterase and increase levels of acetylcholine at the neuromuscular junction.
- Side effects: excessive salivation and sweating, abdominal cramps, nausea and vomiting, diarrhea, and fasciculations (muscle twitching).
- Corticosteroids: prednisone, used if other drugs are not effective, suppress autoimmune response.
Nursing Management
- Administer anticholinesterase drugs as ordered.
- Give medication exactly on time.
- Give with milk and crackers to decrease GI upset.
- Monitor effectiveness of drugs: assess muscle strength and vital capacity before and after medication.
- Observe for side effects.
- Promote optimal nutrition.
- Mealtimes should coincide with the peak effects of the drugs: give medications 30 minutes before meals.
- Check gag reflex and swallowing ability before feeding.
- Provide a mechanical soft diet.
Multiple Sclerosis (MS)
- A chronic, progressive, and often disabling disease that affects the central nervous system (CNS).
Types of Multiple Sclerosis
- Relapsing-remitting MS (RRMS): 85% of cases, relapses develop over 1-2 weeks and resolve over 4-8 months.
- Progressive-relapsing MS (PRMS): 5% of cases, absence of remission and client's condition does not return to baseline.
- Primary progressive MS (PPMS): 10% of cases, steady, gradual neurologic deterioration without remission.
- Secondary progressive MS (SPMS): begins with RRMS course that later becomes steadily progressive.
Medications for Multiple Sclerosis
- Carbidopa (Sinemet): prevents breakdown of dopamine in the periphery and causes fewer side effects.
- Antiviral: Amantadine (Symmetrel), used in early/mild cases to reduce rigidity, tremor, and bradykinesia.
- Anticholinergic: Benztropine mesylate (Cogentin), procyclidine (Kemadrin), relieve tremor and rigidity.
- Dopamine agonist: Bromocriptine mesylate (Parlodel), stimulates release of dopamine in the substantia nigra.
- Tricyclic antidepressants: given to treat depression.
- Antihistamines: have mild central anticholinergic and sedative effects, and may reduce tremors.
Test your knowledge of Myasthenia Gravis, a neuromuscular disorder causing muscle weakness, its diagnosis, and treatment options.
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