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He recently took early retirement from his job as an Office Clerk as he was getting extreme fatigue in all his muscles, especially after a long day at work. The fatigue improved after having a rest.

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He had spoken to you a He bought some multivitamins with ginseng, but his tiredness did not improve except when he had a few days holiday. Mr Jones had been referred to a neurologist at the local hospital who ran some tests and has asked his GP to write him a prescription for pyridostigmine bromide 60 mg tablets with half a tablet to be taken four times daily initially then increased up to six tablets a day if the muscle weakness does not improve.

The GP also prescribed hyoscine butylbromide 10 mg tablets, two of which were to be taken up to four times daily.

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Q 1 What is myasthenia gravis? In myasthenia gravis antibodies block, alter or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle contraction from occurring.

life cycle of enterobius vermicularis with diagram

Hence with fewer receptor sites available the muscles receive fewer nerve signals. The patient has muscle weakness which increases after a period of activity and improves with rest.

He has drooping of the eyelids ptosis with blurred vision due to weakness of the muscles that control eye movement.

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What are the risk factors? Myasthenia gravis most commonly affects young adult women under 40 and older men over 60 and is not inherited. Risk factors include fatigue, life cycle of enterobius vermicularis with diagram, stress, extreme heat and other medication including beta-blockers, calcium channel blockers, quinine and quinolones.

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Why choose pyridostigmine as the anticholinesterase consider the duration of action, side-effects and the formulations available? It is less powerful and slower in action than neostigmine but it has a longer duration of action.

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It has relatively mild gastrointestinal effect but an antimuscarinic drug may still be required for the stomach cramps. A total daily dose of mg should not be exceeded in order to avoid acetylcholine receptor downregulation.

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Immunosupressant therapy is usually added if the dose of pyridostigmine exceeds mg daily. It is only available as a tablet, unlike neostigmine which comes as a tablet and injection.