Cholinergic Crisis vs Myasthenic Crisis Nursing | Symptoms, Treatment, Tensilon Test (Edrophonium)

Myasthenic crisis vs. cholinergic crisis nursing NCLEX review lecture that will cover the symptoms, treatment, pathophysiology, testing (Tensilon test Edrophonium). UPDATE: Tensilon test is no longer used in the US. The FDA discontinued edrophonium in 2018 due to a high rate of false positives.

CORRECTION: At 8:28, when I discuss Edrophonium it should say that Edrophonium = acetylcholinesterase inhibitor (which is a cholinesterase inhibitor) NOT ANTIcholinesterase.

Cholinergic crisis and myasthenic crisis are two complications that can happen with the neuro disease myasthenia gravis. The causes of each condition are different along with some of the signs and symptoms. However, both conditions will share the sign and symptoms of respiratory failure and severe muscle weakness.

A tensilon test (administration of Edrophonium: which is an cholinesterase medication) can help differentiate between the two conditions. If a patient is experiencing a cholinergic crisis, the tensilon test will show a negative result in that the patient’s signs and symptoms will worsen. However, if the patient is experiencing a myasthenic crisis the test will show a positive test result in that the patient's signs and symptoms will improve temporarily.

The cause of myasthenic crisis is NOT receiving enough of an anticholinesterase medication (example Pyridostigmine) or an acute exacerbation of the disease myasthenia gravis due to stress or respiratory infection.

The cause of a cholinergic crisis is receiving TOO MUCH of an anticholinesterase medication.

How do anticholinesterase medications work? They stop the breakdown of acetylcholine at the neuromuscular junction, which allows more ACh to be available at the junction. This is great for treatment of myasthenia gravis. However, if too much of this medication is given it will cause a cholinergic crisis, but if not enough is given it will cause a myasthenic crisis.

Cholinergic crisis vs Myasthenic Crisis Quiz: http://www.registerednursern.com/chol...

Notes: http://www.registerednursern.com/chol...

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