Paper I
2022 July (Supplementary) (2019 Scheme) · 100 marks · 180 min

Question

Pharmacological management of Myasthenia gravis.

Q94 marksShort Answers

Answer

  • Anticholinesterases (Pyridostigmine, preferred for longer action, or Neostigmine) — first-line symptomatic therapy, allowing acetylcholine to interact repeatedly with the reduced pool of available receptors.
  • Corticosteroids and immunosuppressants (Azathioprine, Cyclosporine) — suppress antibody production directly, used for induction and maintenance of remission.
  • IV immunoglobulin or plasmapheresis — for acute exacerbations/myasthenic crisis, providing rapid but temporary improvement.
  • Thymectomy (surgical, not pharmacological, but part of overall management) — advised particularly with a thymoma or in younger patients, can produce gradual improvement or remission.

Diagnostic confirmation: the edrophonium (Tensilon) test — IV edrophonium produces dramatic, brief improvement in muscle power specifically in myasthenia gravis.

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