Question

14. How would antibodies against ACh receptors affect the neuromuscular junction?

15. How would antibodies against the ACh receptors affect the influx of Na+ into the cell?

16. How would antibodies against the ACh receptors affect the levels of Ca2+ inside the sarcoplasmic reticulum? What effect does this have on the actin and myosin filaments?

17. What disorder does Samson have? How do we treat/manage this diagnosis?

18. Use a graphing program to create two line graphs. Each graph should compare the lab values between Joyce and Samson for time points 1-4. Graph #1 should compare Joyce and Samson’s acetylcholinesterase activity and hematocrit; Graph #2 should compare their Na+ and K+. Place time points 1-4 on the x-axis and the lab values on the y-axis.

19. Fill out Table 3 below, compare the lab values that accompanied the muscle contraction problems faced by Joyce and Samson at time point #3 to that of a normal person. Use the terms normal, increased, or decreased to complete the table.

Table 3. Comparison of Lab Values for Joyce Snyder, Samson Taylor, and a normal patient. (Serum)

ACh

AChE

ACh Receptors

Na+ influx

SR Ca2+ release

Cross bridge formation

Frequency of muscle contraction

Healthy person

Joyce

Samson

Part IV

Assume the role of a medical practitioner and communicate your findings and prognosis to the patients and their families.

Note: As you assume the role of the practitioner, be mindful of what expectations you would have of the medical professionals if you were the patient or the caregiver. Be thorough in your explanation of the findings, the prognosis, and the treatment regimens. Remember, these family members are scared, anxious, and confused. Throwing complex medical jargon at them with no explanation as to what it means will terrify them even more. On the other hand, if you use too simple or a minimal explanation, they will get angry and lose all faith in you!

Questions [Critical Thinking and Communication]

20. Write two paragraphs, one for each patient, that communicates your findings and prognosis to the patients and their families.

Part V

21. Write an alphabetized list of all sources referenced in your answers in proper APA format.

Answer 1

14) The binding of antibodies reduces synaptic transmission at the neuromuscular junction by preventing receptors from binding acetylcholine or causing the cell to endocytose the receptor. The net effect is that there are fewer available receptors to bind acetylcholine.

15) It would decrease and the cell would be unable to depolarize.

16) The levels would be lowered because the calcium is being released from the sarcoplasmic reticulum.

They stay contracted because they are being overstimulated.

17) The diagnosis is Myasthenia gravis.

Treatment :-

Since the crisis is caused by under-medication, usually the patient is given neostigmine and pyridostigmine (Mestinon), both are AchE inhibitors, thus they increase the available acetylcholine to stimulate muscle contractions. If needed, an endotracheal (ET) tube to keep your airway open, and ventilated.

Plasmapheresis can be used to remove the antibodies from the circulation. (The machine takes out your blood plasma, removes the antibodies, then gives you back your cleaned plasma.)