Question

Ms. A, a 42-year-old patient who lives alone, recently was diagnosed with myasthenia gravis. She tells you that she will be going home soon and that she is very worried about having to manage her disease. She asks you the following questions. What are your best responses to these questions?

1. “What medications will I have to take?”

2. “When will I be able to stop taking all these pills?”

3. “I’m concerned that they don’t know how much medication to give me. How will they know when I have enough medication?”

Answer 1

Myasthenia gravis categorized under neuromuscular disease causing weakening of the skeletal muscles. It occurs as result of impairment in communication between the nerve cella and the muscles. It is a autoimmune disease that mistakenly attacks the neuromuscular junction.

The medications used are Anticholinesterase inhibitors that interferes with the ACh availability at the neuromuscular junction. The mechanism of action starts from 30-60 minutes and it effcts lasts for 3-6 hours. AchE inhibitors neostigmine inhibits the breakdown of the ACh.

Corticosteroids acts as anti inflammatory drugs. Prednisolone most common steroids used to treaet MG. It suppresses the autoantibodies. Methylprednisolone decreases the inflammatory process by supressing leukocytes.

Immunomodulators like azathioprine inhibits the DNA,RNA and the protein synthesis. Cyclosporine depresses the cell mediated immunoresponses. The drug cyclophospamide inhibits purine synthesis.

Immuneglobulins are used in crisis situation. Monoclonal antibodies rituximab, eculizumab reduces the deposition of terminal complement complex deposition in the neuromuscular junction.