3 - Botulinum Toxin Flashcards
C. botulinum neurotoxins inhibit acetylcholine neurotransmitter release from the neuromuscular junction
True
Inhibition of acetylcholine release from the neuromuscular junction leads to flaccid muscle paralysis
True
There are 7 serotypes of C. Botulinum neurotoxins (A, B, C, D, E, F, G)
True
C. Botulinum neurotoxin serotype A (Botox) is the most potent used in humans
True
SNARE proteins are believed to mediate the mechanism of action of Botulinum neurotoxin
True
SNARE proteins mediate all types of intracellular membrane fusion
True
Botulinum toxin impairs neuromuscular function resulting in post synaptic cellular paralysis via the SNARE proteins
True
It takes approximately 3 months to recover the neuromuscular function post botulinum toxin treatment
True
Muscular atrophy may be seen with each botulinum toxin injection
True
Each vial of Botox contains 100 units of neurotoxin
True
Antibody formation may occur against botulinum toxin
True
Botox (botulinum toxin A) vials are heat sensitive and may be stored in the fridge or freezer
True
Injection pain may be reduced if Botox was reconstituted with saline preserved with benzyl alcohol
True
Reconstitution of Botox with preservative-free saline may be associated with injection pain
True
Reconstitution of Botox with Saline preserved with benzyl alcohol does not affect the safety and efficacy of the drug
True
There is potential loss of efficacy of Botox if the vial was shaken
True
Botox is used for treatment of dynamic rhytides (wrinkles) caused by muscle pull
True
Botox is used for axillary hyperhidrosis
True
Infection at the injection site is an absolute contraindication for botulinum toxin injection
True
Botulinum toxin may exacerbate neuromuscular disease
True (relative contraindication)
Inflammation at the injection site is relatively contraindicated in botulinum toxin injection
True
Calcium channel blockers are relatively contraindicated with botulinum toxin
True (although calcium channel blockers are acceptable for doses of botulinum toxin used in dermatology)
Aminoglycosides are relatively contraindicated with botulinum toxin
True
Cholinesterase inhibitors are relatively contraindicated with botulinum toxin
True
Succinylcholine are relatively contraindicated with botulinum toxin
True
Quinidine is relatively contraindicated with botulinum toxin
True
Lincosamides are relatively contraindicated with botulinum toxin
True
Pregnancy and lactation is relatively contraindicated with botulinum toxin
True (although pregnant and nursing women have been inadvertently treated without I’ll effects but no studies have been done)
The cosmetic use of Botox at the approved dose has not been associated with botulism
True
There is no evidence that use of botulinum toxin leads to permanent nerve or muscle injury
True
Antibody production against botulinum toxin is serotype specific
True
Another serotype of botulinum toxin may be used if resistance is encountered due to antibody production against one serotype
True
Botulinum toxin resistance is associated with repetitive treatment with doses greater than 300 units, resulting in reduced efficacy
True
Botulinum toxin resistance is associated with repetitive treatment with doses greater than 300 units, resulting in reduced efficacy
True
Most reports on antibody production involve patients treated with the original more antigenic formulation of botulinum toxin
True
Most adverse events of botulinum toxin relate to injection technique
True
Pain is a common adverse event related to needle injection of botulinum toxin
True
Swelling is a common adverse event related to needle injection of botulinum toxin
True
Erythema is a common adverse event related to needle injection of botulinum toxin
True
Bruising is a common adverse event related to needle injection of botulinum toxin
True
Ptosis is an uncommon adverse event related to local diffusion of botulinum toxin
True
Hand weakness is an uncommon adverse event related to local diffusion of botulinum toxin for palmar hyperhidrosis treatment
True
Dysphagia is an uncommon adverse event related to local diffusion of botulinum toxin in neck injections
True
Headache is an uncommon idiosyncratic adverse event related to botulinum toxin
True
Distant inflammation is an rare idiosyncratic adverse event related to botulinum toxin
True
Anaphylaxis is an rare idiosyncratic adverse event related to botulinum toxin
True
Flu like symptoms is an rare idiosyncratic adverse event related to botulinum toxin
True
Metallic taste is an rare idiosyncratic adverse event related to botulinum toxin
True
In non-dermatologic use, dysphagia is common when treating cervical dystonia with botulinum toxin
True
In non-dermatologic use, xerophthalmia (abnormal dryness of conjunctiva and cornea) is common when treating blepharospasm or strabismus with botulinum toxin
True
In non-dermatologic use, transient headache can occur when treating cervical dystonia with botulinum toxin
True
Keep botulinum toxin injections at least 1cm above the orbital rim to avoid ptosis
True
Keep botulinum toxin injections at least 3cm above the brow to lessen the risk of diminished expressiveness
True
Applying digital pressure with the non-injecting thumb along the orbital rim between the injection sites and the eye may reduce eyelid ptosis from botulinum toxin
True
Muscular denervation occurs wherever the botulinum toxin spreads
True
Botulinum toxin Injection > 1cm lateral to the orbital rim will avoid diplopia and lid ptosis
True
Injections close to the inferior margin of the zygomatic arch risk weakening of the lip legato muscles causing lip ptosis
True
Botulinum toxin injections for hyperhidrosis are spaced 1-1.5cm apart
True
Approximately 0.1 mL of Botulinum toxin is injected per hyperhidrosis injection site (spaced 1-1.5cm apart)
True
Botulinum toxin can be injected into superficial fat to target the dermal eccrine glands in axillary hyperhidrosis with no adverse effects
True
Botulinum toxin is injected into dermis to target the eccrine glands in palmoplantar hyperhidrosis and to avoid dispersion of the toxin to underlying intrinsic hand muscles
True
