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The antibodies are produced by the patients own immune system resulting in an autoimmune reaction, which causes structural changes at the synapse. The disease is characterized by fluctuating weakness and easy fatigability of certain skeletal muscles. Patients may present with double vision or a drooping eyelid at the end of the day. Other facial muscles may be affected, resulting in difficulty in chewing, an abnormal smile, or nasal speech. In severe cases there may be difficulty in swallowing with the risk of aspirating food into the lungs and difficulty in breathing, due to weakness of the respiratory muscles, which can be life threatening if untreated. Not all muscle groups are affected in all patients, and the disease has a variable progression.
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Mefenamic acid, and piroxicam and tenoxicam have a spectrum of side effects between that of aspirin and the ibuprofen type.
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In response to this, the cardiovascular centre reduces heart rate and force of contraction by decreasing sympathetic stimulation and increasing parasympathetic stimulation of the heart.
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General factors affecting diffusion across cell membranes, considered above, apply in addition to the pH of gastrointestinal contents: surface area of the gastrointestinal tract; gastric emptying and intestinal transit time; blood flow from the gastrointestinal tract; plasma protein binding; active transport mechanisms and drug formulation.
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