Muscle Spasticity

Question 1

Baclofen

Answer 1

GABA agonist & Substance P inhibitor
BBW; rebound neural activity: seizures, confusion, hallucination, psychiatric
-rhabdomyolysis and death
-hypotension, hyperglycemia, CNS depression
Taper dosing over 2+ wks
Adjust insulin drugs
CI: CNS drugs, MAOIs

Question 2

Botulinum toxin

Answer 2

Ach. Release inhibitor: Light chain to SNAP25

Question 3

Dantrolene

Answer 3

Ryanodine receptor inhibitor: uncoupling
Liver LFTs, CI: CCB -> Vfib/CV collapse
Drooling, dysarthria, enuresis, myalgias, bachached
Tx for malignant HTN

Question 4

Tizanidine

Answer 4

Presynaptic a-2 receptor agonist
Renal/elderly risk, liver, rebound hypertonicity, HTN at high dose, CNS additive, Additive hypoTN with:
Monitor LFTs
CI: clonidine, guanabenz, methyldopa, guanfacine