Chapter 4.2

Question 1

1. State the mechanism of action of the following drugs used to treat spasticity: diazepam

Answer 1

increases GABA mediated inhibition

Question 2

baclofen MOA

Answer 2

stimulates GABA receptors in spinal cord

Question 3

tizanidine MOA

Answer 3

bind to alpha 2 receptors found primarily in CNS inhibiting small interneurons in neuronal pathways reducing activity of alpha motor neuron

Question 4

gabapentin MOA

Answer 4

inhibits calcium entry in presynaptic terminals decreasing release of glutamate and other excitatory neurotransmitters

Question 5

dantrolene sodium MOA

Answer 5

inhibits release of calcium from skeletal muscle sarcoplasmic reticulum

Question 6

botulinum toxin MOA

Answer 6

injected locally for severe spasms and is a muscle paralytic. Mechanism is inhibits Ach release at skeletal NMJ

Question 7

2. State the other pharmacologic actions of diazepam that may be useful in treating patients with spasticity.

Answer 7

helpful with spasticity and anxiety

Question 8

3. State the location for the intrathecal administration of baclofen.

Answer 8

subarachnoid space and is used for intense spasticity

Question 9

4. State the patient populations primarily targeted for gabapentin therapy of spasticity.

Answer 9

MS, spinal cord injury

Question 10

5. State the patient populations primarily targeted for botulinum toxin therapy for spasticity.

Answer 10

pasmodic torticollis, blepharospasm, laryngeal dystonia, strabismus, and several other types of focal dystonias

Question 11

6. Identify the time course of botulin toxin activity in a patient with spasticity.

Answer 11

3-7 days and lasts 2-3 months

Question 12

7. List the key adverse effects associated with the following drugs used to treat spasticity: diazepam

Answer 12

sedation

Question 13

baclofen

Answer 13

decreasing excitation of alpha motor neurons and sedation

Question 14

gabapentin

Answer 14

may cause sedation, dizziness and ataxia

Question 15

dantrolene

Answer 15

liver toxicity

Question 16

botulinum toxin

Answer 16

Carry over and long term effects on reflex activity in CNS. May cause death if it reaches the blood stream because it paralyzes all muscles

Question 17

8. List some of the problems that may arise when a patient is using intrathecal baclofen via a pump delivery system

Answer 17

pump malfunction or a problem with the delivery catheter can occur. tolerance could develop with long-term, continuous baclofen administration.

Question 18

9. State some of the benefits of botulinum toxin therapy when spastic dominance of a muscle group is reduced.

Answer 18

increased residual function like gait or posture, improved ADL, improved bracing

Question 19

10. List the signs and symptoms of intrathecal baclofen overdose or withdrawal.

Answer 19

signs of overdose: decreased respiration and cardiac function, stupor and coma
Signs of withdrawal: fever, confusion, hallucinations and seizures

Question 20

11. List the problems and limitation of botulinum toxin therapy.

Answer 20

local irritation at injection site, potential for antibody production, and signs of OD like drooping eyes, difficulty speak and swallowing, muscle weakness and respiratory distress

Question 21

12. State the considerations of a physical therapy working with patients being treated for spasticity.

Answer 21

weakness, sedation and drastic change in muscle tone