(^242) Medical-Surgical Nursing Demystified
- Twitching of facial muscles
- Small pupils (miosis)
- Low blood pressure
INTERPRETING TEST RESULTS
Symptoms are relieved temporarily after administering endrophonium (Tensilon)
or neostigmine bromide (Prostigmin) because the drug will allow the acetylcholine to
bind at the post-synaptic receptor site on the muscle at which it should normally bind.- Acetylcholine receptor antibodies are present in greater than 80 percent of
patients with myasthenia gravis. - Electromyography (EMG) shows reduced muscle response to repeated
stimulations. - CT scan to rule out thymoma.
TREATMENT
- Administer immunosuppressants to induce remission and help control
symptoms:- prednisone or dexamethasone initially to improve symptoms
- azathioprine and cyclophosphamide in the long term to help control
symptoms
- Administer cholinesterase inhibitors for long-term control of symptoms. These
drugs have short duration of action, therefore have to be dosed several times
during the day:- neostigmine
- pyridostigmine
- ambenonium
- Administer natural tears or other lubricant to keep eyes moist:
- patch eyes if unable to close
- High-calorie diet of appropriate food type—patient may have difficulty
swallowing. - Removing antibodies from plasma (plasmapheresis) may be beneficial.
- BiPAP or CPAP for enhanced air movement and oxygenation.
- Thymectomy (surgical removal of thymus gland) for patients with thymoma.
- Avoid aminoglycoside antibiotics which may exacerbate symptoms.