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LVL7 revision > Botulinum Toxin > Flashcards

Botulinum Toxin Flashcards

1
Q

Which product has the greatest diffusion?

A

Azzalure (Dysport) - good for hyperhidrosis

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2
Q

Botulinum Toxin Types

A

Type A - Cosmetic

Type B - Rimabotulinumtoxin B - Cervical Dystonia

Type C - Rarely used, causes slow degeneration of motor neurones

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3
Q

Dysport (Azzalure) : Botox Ratio

A

2.5:1

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4
Q

Bocoture : Botox ratio

A

1:1

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5
Q

Botox storage - reconstituted

A

2-8C, use within 14 days

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6
Q

Botox reconstitution

A

2.5ml saline per 100 units, 4IU per 0.1ml, 2IU per 0.05ml

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7
Q

Bocouture reconstitution

A

2.5ml saline per 100 units, 4IU per 0.1ml, 2IU per 0.05ml

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8
Q

Azzalure reconstitution

A

0.63ml saline per 125SU, 10SU per 0.05ml

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9
Q

Toxin equipment - needles

A

21G for reconstitution, 30G and higher for adminiistration

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10
Q

Absolute contraindications

A

Botulinum allergy
Body dysmorphhia
Infection over site
Neuromuscular disorders
Dysphadi or aspiration history
Pregnancy & Breast feeding

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11
Q

Relative contraindications

A

Under 18
Anticoagulant & Antiplatelets
Aminoglycoside - enhance effect
Calcium antagonist - antagonise effect

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12
Q

Non-cosmetic uses

A

Spastic skeletal muscles
Antiparasympathetic - sweat and salivary glands
Prevention of wound dehiscence

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13
Q

Factors affecting dose

A

Sex
Extent of wrinkles
Previous response to toxins
Ethnicity
Dynamics of facial express
Size of muscles mass

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14
Q

BNT mode of action

A

Blocks acetylcholine excretion - selectively and irreversibly bind to the presynaptic terminal

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15
Q

Hyperkinetic patients

A

No concordance between muscular contraction and emotion expressed.

Stronger muscles. May contract involuntarily during speech.

Results may last 4-6 months.

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16
Q

Hypertonic patients

A

Lack of control of facial muscles

Wrinkles remain present after treatment.

Shorter results 1-2 months

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17
Q

Medications affecting botox

A

Calcium Antagonist - decrease effects

Aminoglycosides - increase effects

Immunosuprressants - increase risk of infection

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18
Q

When did BTX become FDA approved for hyperhidrosis treatment

A

2004

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19
Q

Mechanism of action for botox

A

inhibits the release of
acetylcholine at the neuromuscular junction
resulting in partial paralysis of the muscles.

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20
Q

Botox toxin type

A

onabotulinum toxin type A (Botox)

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21
Q

Dysport toxin type

A

abobotulinum toxin type A

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22
Q

Azzalure toxin type

A

onabotulinum toxin type A (Botox)

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23
Q

Bocouture toxin type

A

Incobotulinumtoxin type A

24
Q

What differs the different toxin A types

A

presence or absence of complexing proteins

25
Q

How was botox discovered

A

1895
Emile va Ermengem

Identified clostridium botulinum as a source of botulism

26
Q

Purification of botox

A

1940s

Edward Schantz

purified during military experiments for biological wapons

27
Q

First treatment/experimentation with botox

A

1977

Alan Scott

Strabismus in monkeys - extraocular muscles

28
Q

First aesthetics use/publication of botox

A

1992

Jean and Alistair Carruthers

Blepharospasm patients treated in perioribtal region

Reduced glabellar lines

29
Q

Botox moecule structure

A

Neurotoxin

150kDA

Heavy and light chain

30
Q

Heavy chain

A

100kDA

Binds synaptic membrane

allows light chain to enter cell and cleave proteins of the NSF receptor complex

31
Q

Light chain

A

50kDa

active part of the toxin

Zinc dependent endopeptidase

32
Q

How many serotypes of botulinum toxin

A

Eight

33
Q

How is botox toxin activated

A

cleavage between 448 & 449 AA

Producing Heavy and light chain connected via disulphide bond

bond reduced after cell internalisation

34
Q

Normal neuromusclar junction activity

A

Action potention causes calcium entry into presynaptic membrane

Triggers acetylcholine vesicle release into synaptic cleft

Binding of ACTH at posynaptic membrane gated channels allowin sodium entry

Sodium entry causes depolarisation at post synaptic membrane allowing calcium entry and muscle contraction

35
Q

Botox affect on NMJ

A

Heavy chain binds GT1b - a glycosphingolipid in the membrane of presynaptic vesicle

causing endocytosis of toxin and acidification of the endosome and translocation of the light chain into the axon terminal cytoplasm.

SNAP-25 is cleaved by the light chain and can no longer mediate fusion of vesicles to pre-synaptic membrane

36
Q

How does Botox wear off

A

SNARE protein are slowly regenerated.

formation of new NMJs to restore activity

37
Q

Which SNARE proteins are cleaved

A

Snap 25 by toxin A, C, E

Snaptobrevin by toxin B, D, E, F, G

Synactin by toxin C

38
Q

Snare protein targets of toxin

A

SNAP 35
Snaptobrebin
Syntacin

39
Q

Peak of botox action

A

14-30 days

40
Q

Immunogenicity

A

Antibody formation against Toxin

Rarely reported in litrature

Can be detected after repeated treatment for years

41
Q

Primary vs secondary immunity

A

Failed response after first treament

loses reponsiveness to product over time with repeated treatment

42
Q

Why is Bocouture marketed as “pure”

A

No accessory proteins only 150kDA neurotoxin

unlikely to cause immunogenic response

43
Q

Antibodies that dont intefered with toxin activity

A

Antibodies against the NAPs

non toxic accessory proteins

44
Q

Azzalure units

A

Speywood units

45
Q

Licensed applications of botox

A

cervical dystonia

severe primary axillary hyperhidrosis

blepharospasm,

neurogenic detrusor overactivity

chronic migraine,

upper limb spasticity

glabellar lines (moderate to severe)

46
Q

How allergan units are measured

A

cellular assay

47
Q

How speywood units are measured

A

amount of toxin that kills 50% of genetically homogenous mice population

48
Q

Company that produces dysport and azzalure

A

Medicis Pharmaceutical Corp

49
Q

Storage

A

2-8 degrees

discard after 24 hours

Bocouture does not require refrigeration

50
Q

Product spread

A

Azzalure has greater spread than botox and bocouture

51
Q

Product onset of action

A

Azzulure faster

52
Q

Factors affecting product selection(5)

A

Patient preference
Pricing
Spread
Onset of action
Storage

53
Q

When does muscle activity return

A

7-8 weeks

54
Q

When was botox FDA approved

A

2002, glabella lines

55
Q
A

LVL7 revision (18 decks)

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