What patient teaching is recommended for myasthenia gravis management?

Patient Teaching for Myasthenia Gravis Management

Patients with myasthenia gravis should be educated about medication management, symptom monitoring, and lifestyle modifications to prevent exacerbations and improve quality of life. 1

Medication Management

• Instruct patients about pyridostigmine (Mestinon), the most common symptomatic treatment:

  • Take medication exactly as prescribed, typically starting at 30 mg three times daily and potentially increasing to a maximum of 120 mg four times daily based on symptoms 1
  • Be aware that sustained-release formulations may reduce the number of daily doses and improve quality of life 2
  • Monitor for common side effects including flatulence, urinary urgency, muscle cramps, blurred vision, hyperhidrosis, and gastrointestinal issues such as diarrhea and abdominal cramps 3

• Teach patients to recognize signs of medication overdose (cholinergic crisis):

  • Increasing muscle weakness, especially affecting respiratory muscles
  • Excessive salivation, lacrimation, urination, and defecation
  • This condition requires immediate medical attention and withdrawal of cholinesterase inhibitors 4

• Educate patients to distinguish between myasthenic crisis (disease worsening) and cholinergic crisis (medication overdose):

  • Myasthenic crisis requires more intensive anticholinesterase therapy
  • Cholinergic crisis requires prompt withdrawal of these medications 4

Medications to Avoid

• Advise patients to avoid medications that can worsen myasthenia symptoms, including:

  • Beta-blockers
  • Intravenous magnesium
  • Fluoroquinolone antibiotics
  • Aminoglycoside antibiotics
  • Macrolide antibiotics 1
  • Barbiturate-containing medications like Firocet (butalbital and acetaminophen) 5

• Instruct patients to inform all healthcare providers about their myasthenia gravis diagnosis before receiving any new medication 5

Symptom Monitoring

• Teach patients to monitor for and report worsening symptoms:

  • Increasing muscle weakness
  • Changes in speech or swallowing (bulbar symptoms)
  • Respiratory difficulties
  • Drooping eyelids (ptosis)
  • Double vision (diplopia) 1, 6

• Educate patients about the importance of regular pulmonary function assessment, especially for those with more severe disease 1

Crisis Recognition and Management

• Instruct patients to seek immediate medical attention for:

  • Difficulty breathing or shortness of breath
  • Inability to swallow
  • Significant increase in muscle weakness 1

• Teach patients that crises may require hospitalization, possibly in an intensive care unit, and treatments such as IVIG or plasmapheresis 1

Lifestyle Modifications

• Advise patients to:
  • Plan activities around medication timing for optimal strength
  • Rest between activities to prevent fatigue
  • Avoid extreme temperatures and stress, which can worsen symptoms 6
  • Implement respiratory physiotherapy techniques if experiencing dyspnea 6

Treatment Options Education

• Inform patients about potential treatments beyond symptomatic management:

  • Corticosteroids (like prednisone) for immunosuppression
  • Steroid-sparing agents (azathioprine, mycophenolate mofetil)
  • Thymectomy for AChR antibody-positive patients
  • Rituximab for refractory cases
  • Plasmapheresis or IVIG for crisis management 6

• Discuss the importance of regular neurological follow-up to adjust treatment as needed 1

Special Considerations

• For women of childbearing age, discuss potential teratogenicity of certain therapies and pregnancy planning 6

• For elderly patients, explain the need for careful medication management due to increased risk of side effects, including rare but serious complications like myocardial infarction with pyridostigmine 7

• Address fatigue management through a combination of physical therapy and psychological support 6