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Neuromuscular I - PnT - CVA/Muscular Spasms > Anti-spasticity Agents > Flashcards

Anti-spasticity Agents Flashcards

1
Q

What are the names of some common centrally-acting anti-spasticity agents?

A

Baclofen (Lioresal)
Diazepam (Valium)
Tizanidine (Zanaflex)

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2
Q

What are the names of some common peripherally-acting anti-spasticity agents?

A

Dantrolene (Dantrium)

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3
Q

What is a positive of centrally-acting anti-spasticity agents?

A

No ceiling effects

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4
Q

Baclofen (Lioresal) - site of action

A

GABA-b receptors

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5
Q

Baclofen (Lioresal) - side effects:

A 
Sedation
Ataxia
Hypotension
Slurred speech
Respiratory depression
Hallucinations
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6
Q

Baclofen (Lioresal) - drug interactions:

A 
Drugs that also cause sedation
Methadone
Mirtazapine
Zolpidem
Azelastine
Buprenorphine
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7
Q

Baclofen (Lioresal) - clinical considerations:

A

Effectiveness limited by systemic SEs
Limited ability to cross the BBB (where spasticity comes from)
May lower the seizure threshold
Withdrawal sx

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8
Q

What is one way to combat Baclofen’s limited ability to cross the BBB?

A

It is also available intrathecally or via a pump (usually placed between T12/L1)

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9
Q

Indications for intrathecal Baclofen (Lioresal):

A

Severe spasticity unresponsive to oral agents

Intolerable SEs at effective oral doses (systemic reactions)

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10
Q

What is a positive of Baclofen (Lioresal)

A

Fewer systemic SEs because it is injected directly into the SC

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11
Q

When can intrathecal Baclofen (Lioresal) be prescribed?

A

After an initial screening hospital admission trial of 1-3 days

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12
Q

Is there a black box warning associated with intrathecal Baclofen (Lioresal)?

A

YES - abrupt discontinuation may lead to organ failure or death

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13
Q

Intrathecal Baclofen (Lioresal) - complications:

A 
Infection
Dislodged pump
Blocked or twisted catheter
Pump failure
OD
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14
Q

Diazepam (Valium) - site of action:

A

Brainstem reticular formation

Spinal polysynaptic pathways

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15
Q

Diazepam (Valium) - side effects:

A 
Sedation
Decreased gait speed
Muscle weakness
Hypotension
Ataxia
Constipation
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16
Q

Diazepam (Valium) - half-life:

A

20-80 hours

17
Q

How is the half-life of Diazepam (Valium) determined?

A

Age

18
Q

Diazepam (Valium) - side effects:

A 
Antifungal agents
Azelastine 
CCBs
Azithromycin 
Methadone
19
Q

Diazepam (Valium) - clinical considerations:

A

Class IV controlled substance
Long half-life - not recommended in elderly (Beers)
Avoid alcohol - potentiates CNS depression

20
Q

What are common anticholinergic effects caused by antihistamines?

A

Flushing
Dry mouth
Difficulty urinating
Cognitive effects

21
Q

Tizanidine (Zanaflex) - site of action:

A

Alpha-2 adrenergic receptors

22
Q

Tizanidine (Zanaflex) - side effects:

A 
Sedation
Dizziness
Dry mouth
Hypotension
Hepatotoxicity
23
Q

Tizanidine (Zanaflex) - clinical considerations:

A

Avoid in patients with liver disease

Withdrawal sx may occur if therapy stopped suddenly

24
Q

Dantrolene (Dantrium) - site of action:

A

Skeletal muscle Ca++ stores

25
Q

Dantrolene (Dantrium) - use:

A

For spasticity that limits rehab progression

26
Q

Dantrolene (Dantrium) - side effects:

A 
Fatigue
Dizziness
Weakness
Malaise
Diarrhea
Hepatotoxicity
27
Q

Dantrolene (Dantrium) - contraindications:

A

Patients who require spasticity to remain upright or balanced (SCI)
Liver disease

28
Q

Dantrolene (Dantrium) - interactions:

A

Methadone
Azelastine
Mirtiazapine
Zolpidem

29
Q

Dantrolene (Dantrium) - clinical considerations:

A

Fewer cognitive side effects

Alcohol enhances sedation

30
Q

For what is botulinum toxin (Botox) approved?

A

Treatment of UE spasticity

31
Q

For who is Botulinum toxin (Botox) indicated?

A

Patients with painful spasticity that limits skin hygiene and daily functioning (CP)

32
Q

Effects of botulinum toxin (Botox):

A

Decreased muscle tone

Increased ROM

33
Q

What is the black box warning associated with Botulinum toxin (Botox)?

A

Injected toxins may spread to distal sites and cause sx of botulism (can be fatal)

34
Q

Botulinum toxin (Botox) - side effects:

A 
Fatigue
Nausea
Bronchitis
Pain @ injection site
Weakness

Neuromuscular I - PnT - CVA/Muscular Spasms (7 decks)

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