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561 Pharm > MSK Pharmacology > Flashcards

MSK Pharmacology Flashcards

1
Q

what are muscle relaxants used to treat?

A

spasticity and muscle spasms

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2
Q

features of UMN lesions

A

site: cerebrum, cerebellum, brainstem, spinal cord
weakness: quad/hemi/para/diplegia
tone: spasticity, rigidity
fasciculation: absent
reflex: hyperreflexive
abdominal reflex: absent depending on spinal level
sensory loss: cortical
EMG: normal nerve conduction

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3
Q

features of LMN lesions

A

site: anterior horn cell, nerve root, peripheral nerves, NMJ, muscle
weakness: proximal or distal
tone: hypotonia
fasciculation: present
reflex: hyporeflexive
abdominal reflex: present
sensory loss: peripheral sensation
EMG: abn nerve conduction

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4
Q

what disordered are associated with spasticity

A

MS
stroke
CP
spinal cord/brain injury
neurodegenerative dxs

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5
Q

spasticity definition

A

muscle stiffness
muscle spasms
rapid muscle contractions/clonus
exaggerated muscle jerks
joint pain

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6
Q

goal of skeletal muscle relaxants

A

decrease skeletal muscle excitability
decrease pain
avoid profound decrease in muscle function

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7
Q

common generic names of skeletal muscle relaxants

A

baclofen
cyclobenzaprine
diazepam

also:
botuliniuum
carisoprodol
chlorzoxazone
dantrolene
maraxalone
methocabamol
orphenadrine
riluzole
tizanidine

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8
Q

common brand names of skeletal muscle relaxants

A

Lioresal
Flexeril
Valium

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9
Q

antispastic drugs

A

target spasticity, the velocity dependent increase from hyperirritability of the stretch reflex

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10
Q

spasmolytics

A

muscle relaxants
target muscle spasms- involuntary contractions of a muscle/muscle group

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11
Q

antispasticity drugs vs spasmolytics

A

antispasticity is for increased muscle tone due a CNS issue while spasmolytics are for painful, acute muscle contractions

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12
Q

polysynaptic inhibitors

list drugs

A

type of spasmolytics drug
includes carisoprodol/Soma
+ flexeril/cyclobenzaprine
methocarbamol/Robaxin
orphenadrine citrate/norflex

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13
Q

polysynaptic inhibitor MOA

A

acts on polysynaptic reflex in spinal cord
decrease alpha motor neuron excitability to relax skeletal muscle

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14
Q

polysynaptic inhibitor uses

A

relieve muscle spasms instead of PT/bed rest
can contain analgesic

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15
Q

polysynaptic inhibitor side effects

A

drowsiness
nausea
lightheadedness
vertigo
ataxia
headache
med tolerance

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16
Q

Diazepam

A

Valium
benzodiazepine
treat anxiety, seizures, spasticity

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17
Q

Diazepam MOA

A

increase inhibition at CNS synapses using GABA
increase effect of GABA by binding gamma receptors and alpha motor neuron inhibition

18
Q

Diazepam side effects

A

anxiolysis, anterograde amnesia, sedation, anticonvulsant, antiemesis, muscle relaxation
tolerance
withdrawal - anxiety/tachycardia/death/coma

19
Q

Diazepam uses

A

muscle spasms from MSK, spasticity, tetanus toxin spasms

20
Q

Baclofen

A

Lioresal
derived from GABA

21
Q

Baclofen MOA

A

stimulate GABA receptors in the spinal cord (agonist), inhibit spinal cord transmission to decrease alpha motor neuron firing and relax skeletal muscle

22
Q

Baclofen uses

A

spasticity associated with spinal cord lesions
treat para/quadplegia and MS demyelination

23
Q

Baclofen side effects

A

transient drowsiness
confusion
hallucination
nausea
mm. weakness
headache

24
Q

intrathecal injections

A

directly into subarachnoid space of spinal cord
inject baclofen to decrease severe spasticity

25
Q

intrathecal baclofen pump

A

surgical implant
programmable pump in abdominal wall to deliver drug at slow cont. rate
disruption can cause overdose/withdrawal
tolerance can develop

26
Q

Adrenergic alpha 2 receptor agonist
drug name
MOA

A

Zanaflex
stimulates alpha 2 receptors on spinal interneurons
inhibit interneurons to decrease excitation of alpha motor neurons

27
Q

uses of alpha 2 agonists

A

control spasticity (MS, SCI, CVA)
as effective as other drugs to decrease spasticity with less generalized mm weakness and other CV side effects

28
Q

alpha 2 agonist side effects

A

sedation
dizziness
dry mouth

29
Q

gabapentin
drug name
MOA

A

Neurontin
increase GABA effect in spinal cord (inhibition)
originally anti seizure

30
Q

uses of gabapentin

A

decrease central spasticity (SCI, MS)
used in combination w other drugs like baclofen
may reduce chronic pain in those w spasticity

31
Q

side effects of gabapentin

A

sedation
fatigue
dizziness
ataxia

32
Q

dantrolene sodium
drug name
MOA

A

Dantrium
inhibit Ca release from skeletal muscle SR

33
Q

dantrolene sodium uses

A

reduce severe muscle spasticity
not for muscle spasms from MSK

34
Q

dantrolene sodium side effects

A

generalized muscle weakness
hepatotoxicity
fatal hepatitis

35
Q

botulinum toxin
drug name
MOA

A

Botox
muscle paralytic by local injection for severe spasms
inhibits Ach release at skeletal m NMJ

36
Q

botulinum toxin uses

A

relax/paralyze muscle
remove spastic dominance to allow motor function, improved gait and function, stretch muscles to prevent joint contractures

37
Q

side effects of botulinum toxin

A

local irritation
limited amount of muscles can be injected
limit total dose
immune response making future injections less effective

38
Q

duration of skeletal muscle relaxants

A

chlorzoxazone - 3-4
carisoprodol - 4-6
metaxalone - 4-6
orphenadrine - 12
cyclobenzaprine - 12-24
diazepam - up to 24 hrs
methocarbamol - unknown

39
Q

alternative to skeletal muscle relaxants for acute low back pain

A

PT, ibuprofen

40
Q

alternative to skeletal muscle relaxants for chronic low back pain

A

skeletal muscle relaxants should not be used
PT, NSAIDs, tramadol, opioids

41
Q

alternative to skeletal muscle relaxants for spasticity

A

PT, baclofen, tizanidine, dantrolene

42
Q

effects of spasticity drugs interfering with rehabilitation

A

motor control problems
fxal decline in ADLs
decreased alertness
weakness
tolerance/physical dependence

561 Pharm (21 decks)

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