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Chapter 24 Neuromuscular
Chapter 24: Neuromuscular Disorders Myasthenia Gravis, Multiple Sclerosis, Muscle Spasms
14
Pharmacology
Undergraduate 2
04/10/2014

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Term
Myasthenia Gravis
Definition

-lack of nerve impulses at myoneural junction

-fatigue, muscle weakness (eye, swallowing, breathing, extremities)

-symptoms: drooling, speech problems, ptosis (drooping eyelid, 1st symptom)

-can affect diaphragm

-acetylcholine deficit or increased acetylcholinesterase at myoneural junction--> destroys acetylcholine receptor sites

Term
Myasthenia Crisis
Definition

-underdosing of med w/ extreme muscle weakness

-difficulty breathing & swallowing

-give Tensilon to see what happens

Term
Cholinergic crisis
Definition

-overdose of med w/ extreme muscle weakness

-sweating, salivation, bradycardia, miosis, may require ventilation

 

-antidote is Atropine IV

Term
Cholinesterase Inhibitors
Definition

-inhibits action of acetylcholinesterase enzyme

 

ex: Mestinon, Tensilon, Prostigmine

Term
*pyridostigmine (Mestinon)
Definition

-cholinesterase inhibitor, prevents destrucion of acetylcholine

-longer-acting

-60-120 mg TID (every 8 hrs)

SE: excess saliva, sweating, abd cramps

-Adverse: hypotension, bradycardia, urticaria, seizure, resp. depression, dysrhythmias

Term
edrophonium (Tensilon)
Definition

-cholinesterase inhibitor, for diagnosing MG

-temporary, only lasts minutes

-2 mg IV

Term
neostigmine (Prostigmine)
Definition

-cholinesterase inhibitor, controls MG

-long-acting

-must be given timely

-oral, IM, IV

Term
Multiple Sclerosis
Definition

-attack of myelin sheath in brain & spinal cord, causing plaques

-typically in women in 30's-40's, 50's

-acute=remission/exacerbation

-chronic=progressive

-avoid beta blockers, NSAIDs, H2 blockers

-treat w/ steroids, ACTH, Interferon B, immune modifiers

Term
Skeletal Muscle Relaxants
Definition

-for sprain, strain, spasticity; cerebral palsy, MS, CVA, SCI, muscle spasm

-central-acting, suppress hyperactive reflex muscle spasms (relax muscles in spasm)

-act on spinal cord

 

ex: Soma, Flexeril, Parafon Forte, Skelaxin, Lioresal

Term
*carisoprodol (Soma)
Definition

-skeletal muscle relaxant for MS

-350 mg TID & HS

-SE: dizziness, weakness, insomnia

-Adverse: tachycardia, hypotension, asthma

CI: liver/renal disease

Term
Drugs for acute muscle spasms
Definition

-Flexeril

-Parafon Forte

-Skelaxin

Term
Drug for central muscle spasm
Definition

-Lioresal

-5-20 mg TID

-for spasticity from MS & SCI

Term
Nursing Measures
Definition

-avoid alcohol & CNS depressants

-take with food to decrease GI distress

-monitor VS

-avoid heat

-monitor LFT's

-do not drive

-don't stop abruptly

-do not take > 3 weeks if for spasms

Term
Depolarizing Muscle Relaxants
Definition

-Pavulon - relax abd wall muscles

-Anectine - relax skeletal muscles

-tubocurarine - anesthesia intubation

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