Medical Interventions

Medications
Cholinesterase inhibitors. Medications such as pyridostigmine (Mestinon) enhance communication between nerves and muscles. These medications don't cure the underlying condition, but they may improve muscle contraction and muscle strength. Possible side effects may include gastrointestinal upset, nausea, and excessive salivation and sweating.

 Corticosteroids. Corticosteroids such as prednisone inhibit the immune system, limiting antibody production. Prolonged use of corticosteroids, however, can lead to serious side effects, such as bone thinning, weight gain, diabetes and increased risk of some infections.

 Immunosuppressants. Your doctor may also prescribe other medications that alter your immune system, such as azathioprine (Imuran), mycophenolate mofetil (CellCept), cyclosporine (Sandimmune, Neoral) or tacrolimus (Prograf). Side effects of immunosuppressants can be serious and may include nausea, vomiting, gastrointestinal upset, increased risk of infection, liver damage and kidney damage.

Therapy
Plasmapheresis This procedure uses a filtering process similar to dialysis. Your blood is routed through a machine that removes the antibodies that block transmission of signals from your nerve endings to your muscles' receptor sites. However, the beneficial effects usually last only a few weeks.

 Intravenous immunoglobulin (IVIg). This therapy provides your body with normal antibodies, which alters your immune system response. IVIg has a lower risk of side effects than do plasmapheresis and immune-suppressing therapy. However, it may take about a week to start working, and the benefits usually last no more than three to six weeks. Side effects, which usually are mild, may include chills, dizziness, headaches and fluid retention.

 Surgery to remove the thymus (thymectomy) may result in permanent remission or less need for medicines, especially when there is a tumor present.

Nursing Interventions

 Listen to the patients concerns and answer the questions honestly. Administer medications on time and at evenly spaced intervals, as ordered, to prevent relapses. Plan exercise, meals, patient care, and activities to make the most of energy peaks. When swallowing is difficult, give semi-solid foods instead of liquids to lessen the risk of choking.

 After severe exacerbations, try to increase social activity as soon as possible. Establish accurate neurologic and respiratory baseline. Stay alert for signs of impending myesthenic crisis such as increased muscle weakness and difficulty talking or chewing. Help the patient plan daily activities to coincide with energy peaks. Stress the need for frequent rest periods. If surgery is scheduled, provide perioperative teaching.