ADVERSE EFFECTS OF CHOLINESTERASE INHIBITORS IN THE ELDERLY PATIENT WITH MYASTHENIA GRAVIS. CASE REPORTS

  • Adina Carmen ILIE “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ramona STEFANIU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Mihaela HANDARIC “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Silvia DASCALESCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ioana IVASCU “Grigore T. Popa” University of Medicine and Pharmacy Iasi
  • Ioana Dana ALEXA “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Abstract

Myasthenia gravis (MG) is an autoimmune neuromuscular disease caused by the blockade of acetylcholine receptors at the post-synaptic neuromuscular junction. The clinical signs of MG are obvious in the young patient, but they may be misinterpreted in an elderly person with comorbidities either as manifestations of sarcopenia, as the onset of a minor stroke or “equivalents” of acute coronary syndrome or heart failure. Anticholinesterases (Pyridostigmine, Neostigmine) increase acetylcholine concentration at the neuromuscular junction and are the standard agents for symptomatic treatment; in elderly patients, their side-effects can easily be attributed to other age-related problems, such as bradycardia, arrhythmia or epigastric pain and nausea. We present two cases that illustrate the particularities of diagnosing and treating elderly patients with comorbidities and MG. We conclude that it is necessary to periodically monitor the elderly patient with MG for the early identification of adverse effects. It is also useful to remember that in the elderly patient with comorbidities and MG the risk of cholinesterase inhibitor overdose is increased, partly due to numerous concomitant drugs and partly due to low therapy adherence. Both statins and associated metabolic diseases are possible causes of disease progression, therefore caution is required in prescribing medication to the patient with myasthenia gravis.

Author Biographies

Adina Carmen ILIE, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)
“Dr. C. I. Parhon” Clinical Hospital Iasi

Ramona STEFANIU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Faculty of Medicine
Department of Medical Specialties (II)

Mihaela HANDARIC, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

Cardiovascular Disease Institute “George I. M. Georgescu” Iasi

Silvia DASCALESCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Dr. C. I. Parhon” Clinical Hospital Iasi

Ioana IVASCU, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Dr. C. I. Parhon” Clinical Hospital Iasi

Ioana Dana ALEXA, “Grigore T. Popa” University of Medicine and Pharmacy Iasi

“Grigore T. Popa” University of Medicine and Pharmacy Iasi
Faculty of Medicine
Department of Medical Specialties (II)
“Dr. C. I. Parhon” Clinical Hospital Iasi

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Published
2018-06-30
Section
INTERNAL MEDICINE - PEDIATRICS