Drugs For Other Neurological Conditions

Question 1

Baclofen

Answer 1

Moa: muscle relaxant, structural analogue of GABA; GABAb agonist. Inhibits transmission of spinal level & depressed the CNS

Indication
Chronic spasticity a/w MS and spinal cord lesion, for chronic spasticity of cerebral origin intrathecal use seek specialist

Precautions
Peptic ulcer
Psy disorders
Epilepsy
Cerebrovascular disease
Parkinson disease
Respi disease
Hypertonic bladder sphincter
Dm- risk of increased blood glucose

Renal: renally excreted,reduce dose with caution in renal impairment. Toxicity such as encephalopathy occured after low doses in pt with renal impairment

Hepatic: use with caution due to risk of ADR

Common adr
Nausea, vomiting, constipation, diarrhoea,rash, hypotension

Dose: 5mg tds increase gradually by 15mg daily every fourth day until therapeutic effect achieved. Max 100mg od
Renal impairment: 5mg od

Take med with food to minimise stomach upset. Baclofen caused drowsiness, dizziness or affects vision
Avoid alcohol as it worsens side effects

Question 2

Dantrolene

Answer 2

Moa: Direct skeletal muscle relaxant. Decreases muscle contraction by interfering with calcium release from the sarcoplasmic reticulum

Indication

Chronic spasticity associated with spinal cord injury,head injury,MS, cerebral palsy or stroke(oral)
Malignant hyperthermia)

Precaution
Impaired cardiac or pulmonary function- dantrolene increases exacerbation

Hepatic
Risk of hepatotoxicity in pt with history of hepatic disease, ib those above 35yo

Adr: drowsiness, dizziness muscle weakness, headache

Dose
Chronic spasticity
Maintain each dose 4-7 days before increasing . Adult oral initially 25mg od… max 400mg od

Question 3

Riluzole

Answer 3

Moa: Exact mechanism unknown,inhibits glutamate neurotransmission, may also involve inactivation of voltage dependant sodium channel

Indication
Amyotrophic lateral sclerosis

Precaution

Asian ancestry -riluzole induced LFT
Hereditary fructose intolerance oral liquid contains 4g sorbitol in 10ml