Myasthenia Gravis

  1. What is Myasthenia Gravis?
    • autoimmune disorder affecting the myoneural juction 
    • characterized by varying degrees of weakness of the voluntary muscles
  2. How many people have MG in the US and who does it affect?
    • Approx 60,000
    • affects women for than men
    • women age 20 to 40
    • men age 50-60
  3. The problem with MG
    antibodies directe at the acetylcholine receptors sites impaire transmissionof impulses accross the myoneural junction. The re for fewer receptors are avalible for stimulation resulting in volunatry muscle weakness
  4. 80% of MG PTs have?
    • thymic hyperplasia or
    • thymic tumor and the thymus gland is belive to be the site for antibody production
  5. Intial manifestation?
    • 2/3's involves teh ocular muscles.
    • Diplopia (double vision)
    • ptosis (drooping of the eyelids)
    • may also have muscle weakness in face and throat (bulbar symptoms)
  6. Weakness in the facial muscles result in
    in bland facial expressions 
  7. Laryngeal involvment produces?
    • Dysphonia (voice impairment)
    • and increase risk of choking and aspiraton 
  8. Generalixed weakness affects?
    All the extremities and the intercostal muscles resulting in decreasing vital capacityand resp failure.
  9. Does MG effect sensation or coordiantion?
    No it is purley a motor disorder
  10. Assesment and Diagnostic findings?
    Acetylcholinesterase inhibitor test is use to DX MG
  11. Tensilon test?
    • Edrophonium cholrid (Tensilon) is admin via IV.
    • 30 secs after injection facial muscle weakness and ptosis resolve for about 5 min.
    • Immediate improvement in  muscle strength after admin ofthis agent represent a positive test.
  12. Atropoine
    should be avalible to contro side effects of Tensilon which include bradycardia, sweating, and cramping
  13. The ______gland is enlarged in MG
    Thymus gland
  14. Medical mangament 
    • improve function 
    • reducing and removing circulating antibodies
  15. Is there a cure for MG?
    • NOOOO Cure!!!
    • treatments do not stop teh production of acetylcholine receptor antibodies.
  16. Pyridostigmine bromide (Mestinon) 
    • the first line of therapy, 
    • provides symptom relief by inhibiting breakdown of actyl and increasind the relative concentration of actyl at the neuromusculalr junction
    • side effect-
    • Fasciculations
    • abd pain diarrhea 
    • increased oropharyngeal secreations
  17. Mestionon does not?
    improve muscle strength and control fatigue
  18. the goal of Immunosuppreson meds is
    to reduce production of the antibody
  19. Corticosteroids 
    suppress the PT;s immune response decreasing the production of the antibody
  20. Cytotoxic meds are used if 
    there is and inaduquate respone to corticosteriod meds 
  21. What does Imuran do?
    • inhibits T lymphocytes and reduces actly receptor antibody levels but take 3-12 months
    • side effects-
    • leukopenia and hepatotoxicity
    • evaluate liver enzymes and WBC monthly
  22. Intravenous immunce globulin is used?
    to treat exacerbation and n selected patients use in long term.
  23. Plasmapheresis is?
    Plasma exchange and is used to treat exacerbations. The plasma and componants are removed through a centrally place large-bore double lumen cath  the blood cells and antibodies are seperated then a substite is infused.  which reduces antibodies. imporves symptoms in 75% but only lasts a few weeks
  24. Novocain should be? 
  25. Thymectomy
    • removal of the thymus gland.
    • results in partial or complete remission
    • Use transternal surgical approach
    • placed in ICU to watch Resp function
    • after thymus is remove it may take 3 years for improvement 
  26. Respiratory failure is a complication
    a myastenic crisis is and exacerbation, characterized by sever generalized muslce weakness and resp and bulbar weakness may result in Resp Failure
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Myasthenia Gravis
SPC nursing Myasthenia Gravis