Acetylcholinesterase inhibitors for myasthenia gravis: Nursing pharmacology

00:00 / 00:00
Notes
ACE INHIBITORS TO TREAT MYASTHENIA GRAVIS | ||
DRUG NAME | neostigmine (Bloxiverz), pyridostigmine (Mestinon, Regonol) | |
CLASS | Acetylcholinesterase inhibitors | |
MECHANISM OF ACTION | Inhibit acetylcholinesterase, resulting in a buildup of acetylcholine in the synaptic cleft | |
INDICATIONS | Myasthenia gravis | |
ROUTE(S) OF ADMINISTRATION |
| |
SIDE EFFECTS |
| |
CONTRAINDICATIONS AND CAUTIONS |
|
NURSING CONSIDERATIONS: ACE INHIBITORS TO TREAT MYASTHENIA GRAVIS | ||
ASSESSMENT AND MONITORING | Assessment
Monitoring
| |
CLIENT EDUCATION |
|
Transcript
Myasthenia gravis is an autoimmune disorder caused by antibodies that bind to and destroy acetylcholine receptors on the surface of skeletal muscle cells, resulting in fatigue and muscle weakness due to impaired muscle contractions.
Although there’s no cure, certain medications, called acetylcholinesterase inhibitors, can be used to help mitigate some of the symptoms and improve the client’s quality of life.
Now, the most commonly used acetylcholinesterase inhibitors for myasthenia gravis are neostigmine and pyridostigmine. These medications can be administered orally, intravenously, or intramuscularly, while neostigmine can be also given subcutaneously to children.
Once absorbed into the bloodstream, acetylcholinesterase inhibitors travel to the skeletal muscles and inhibit the enzyme acetylcholinesterase, which normally breaks down the neurotransmitter acetylcholine.
As a result, these medications cause acetylcholine to build up in the synaptic cleft, causing its cholinergic effects to be increased and prolonged.
This helps counteract the effect of acetylcholine receptor antibodies, and ultimately results in improved muscle strength and contraction.
However, increased acetylcholine levels can also cause cholinergic side effects, such as miosis, blurred vision, headaches, dizziness, and drowsiness.
At the same time, in the airways, acetylcholine triggers bronchoconstriction and increases bronchial secretions, which can lead to dyspnea and a persistent cough.
In the cardiovascular system, acetylcholine reduces blood pressure and slows down the heart rate, which can result in hypotension, bradycardia, heart block, and even cardiac arrest.
Summary
Acetylcholinesterase inhibitors are a class of drugs that are used to treat myasthenia gravis. These drugs work by inhibiting the action of acetylcholinesterase, an enzyme that breaks down the neurotransmitter acetylcholine. Acetylcholine is responsible for mediating muscle contraction. By inhibiting its breakdown, acetylcholinesterase inhibitors increase the amount of acetylcholine available for muscle contraction, which leads to improved muscle strength.
Sources
- "Focus on Nursing Pharmacology" LWW (2019)
- "Pharmacology" Elsevier Health Sciences (2014)
- "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
- "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)
- "Goodman and Gilman's The Pharmacological Basis of Therapeutics, 13th Edition" McGraw-Hill Education / Medical (2017)