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Onco/Neuro > MS, spasicity, muscle relaxants > Flashcards

MS, spasicity, muscle relaxants Flashcards

1
Q

What is multiple sclerosis?

A

Autoimmune disease

Degeneration of myelin sheaths in the nervous systems leading to inflammation and scarring characterised by progressive paralysis and loss of sensation

Patchy plaques (scars of lesions) of demyelination in the white matter of the brain and spinal cord

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2
Q

Why are symptoms of MS variable?

A

Symptoms are based upon which area of the CNS has been affected

Can include: 
Visual disturbances
Weakness
Spasticity
Altered sensation
Balance/ coordination problems
Abnormal speech
Bladder and bowel problems
Fatigue
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3
Q

What are the 4 types of MS?

A
  1. Relapsing- remitting MS 25%
  2. Benign MS 20%
  3. Secondary progressive MS 40%
  4. Primary progressive 15%
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4
Q

What is used for acute treatment of MS?

A 
Steroids
Methylperdnisolone (iv) can shorten the duration of attacks be lessening swelling and inflammation of MS lesions
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5
Q

What are some examples of chronic treatment for MS?

A 
Disease modifying treatment, such as: 
Interferon beta products
Glatiramer acetate
Mitoxantrone
Fingolimod
Natalizumab
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6
Q

Define spascity

A

Condition of performing involuntary contractile movements (ie: increased muscle tone)

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7
Q

What are 6 causes of spascity?

A
  1. MS, ALS, motorneurone disease
  2. Spinal cord injury
  3. Stroke, cerebral vascular disease
  4. Local injury or inflammation
  5. Cerebral palsy
  6. Tetanus
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8
Q

What are symptoms of ALS- amyotrophic lateral sclerosis? (6)

A
  1. Tripping, stumbling and falling
  2. Loss of muscle control
  3. Loss of strength in hands and arms
  4. Difficulty speaking, swallowing and/or breathing
  5. Chronic fatigue
  6. Muscle twitching and/or cramping
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9
Q

What is ALS?

A

Both upper and lower motor neurone damage

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10
Q

What causes ALS?

A
  1. Oxidative stress due to accumulation of reactive oxygen species, this causes neurones to become more susceptible to excitotoxic damage
  2. Defective superoxide dismutase- supposed to breakdown oxygen species
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11
Q

What is used as the treatment of ALS?

A

Riluzole

Inhibits release and postsynaptic action of glutamate- slowly excitotoxity

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12
Q

How does tetanus cause spascity?

A

Arises when wound is contaminated with spores of clostridium tetani found in the soil
These multiply and produce the protein neurotoxin tatanospasmin
Toxin diffuses along axons of motoneurones to CNS and interferes with inhibitory neuronal mechanisms by preventing release of transmitter.
Muscles become hypotonic, and death can occur as a consequence of spastic paralysis of respiratory muscles

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13
Q

How can you treat tetanus?

A

Prevent by immunization

Treat with artificial ventilation of lungs and prolong use of muscle relaxants

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14
Q

What is a type of centrally acting muscle relaxant?

A

Benzodiazepines- diazepam and lorazepam

Baclofen

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15
Q

How do centrally acting muscle relaxant work?

A

Act at supraspinal and spinal cord levelas allosteric enhancers.

They facilitate GABA receptors in the CNS to depress excessive motor activity

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16
Q

How is GABA formed and released?

A

GABA is formed in GABA synthesising neurones from glutamate by glutamic acid decarboxylase
Once formed, GABA is packaged into vesicles and ready for release following an action potential

17
Q

How is GABA inactivated after being released? (2)

A
  1. Removed from synaptic cleft by neuronal excitatory amino acid transporters (3,4) (to be repackaged)
  2. Taken up by glial cells by EAATs (1,2)
18
Q

Which GABA receptors are ion channel linked or G-proteins?

A

Ion channel linked receptors- GABAa+c
increase Cl- into cells

Gi protein coupled receptor- GABAb
block Ca and open K channels - slower but longer lasting than GABAa

19
Q

Which GABA receptor do BZDs bind to?

A

GABAa

20
Q

What are 2 ways that BZD work?

A
  1. Allosterically binds to BZD site which facillitates the binding of GABA to GABA site
  2. Increases the effectiveness of GABA for opening the ion channel
21
Q

What are 6 uses of benzodiazepines?

A
  1. Reduction of anxiety and aggression- tx for acute anxiety in procedures
  2. Sedation
  3. Muscle relaxant
  4. Anticonvulsant
  5. Anterograde amnesia- minor surgeries
  6. Drug withdrawal
22
Q

What is the MOA of baclofen?

A

Chlorophenyl derivative of GABA
More lipophilic which assist penetration of BBB
Selective agonist at GABAb receptors

23
Q

What are some examples of peripherally acting muscle relaxants?

A
  1. Botulinum toxin- prevents ach release

2. Dantrolene- prevents Ca release from sarcoplasmic reticulum

Onco/Neuro (7 decks)

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