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Pharmacology Test 3 > Neural System 3: Spasticity > Flashcards

Neural System 3: Spasticity Flashcards

1
Q

What is spasticity?

A

caused by a lesion on the spine or brain which leads to reduced neural innervation and increased tone

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2
Q

Spasticity is synonymous with _________

A

hypertonicity

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3
Q

What is muscle tone?

A

continuous tension in muscle

  • normal tone enables motor function
  • low tone = flaccid
  • high tone = excessive muscle tension
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4
Q

spasticity is ___________ resistance to ________ stretch

A

velocity-dependent

passive

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5
Q

What scale measures spasticity?

A

Ashworth Scale (0-4)

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6
Q

Hypertonicity can lead to impairment with:

A
  1. ROM
  2. coordination
  3. skin hygiene
  4. pain
  5. functional mobility
  6. ADLs
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7
Q

What are muscle spasms?

A

increased muscle tension following musculoskeletal injury and inflammation

no damage to brain or spinal cord

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8
Q

What overall drug class is used to treat spasticity and muscle spasms?

A

Muscle Relaxants

and

Antispasticity meds

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9
Q

Drug list for treating muscle spasms and spasticity

A
  1. Tizanadine
  2. Cyclobenzaprine (Flexaril)
  3. Diazepam (Valium)
  4. Botox (botulinum toxin)
  5. Baclofen (Lioresal)
  6. ITB pump (intrathecal baclofen)
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10
Q

What type of drug is tizandine?

A

alpha-2 agonist

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11
Q

MOA of tizanadine

A

bind to alpha-2 receptors to decrease excitatory NTs which decrease excitability to post synaptic neurons

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12
Q

tizanadine instructions for use

A

2-3x/day

PO at night

must tritate to find correct dosage

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13
Q

tizanadine AEs

A
  1. drowsiness
  2. dizziness
  3. asthenia
  4. sedation (within 30 min, peaks 1.5 hrs after dose)
  5. hypotension (within 1 hr, peaks 2-3 hrs after dose)
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14
Q

what type of drug is cyclobenzaprine (Flexaril ) and diazepam (Valium)?

A

Centrally acting antispasmodic

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15
Q

MOA of centrally acting antispasmodics

A

Unknown

might inhibit polysnaptic reflex in spinal cord

possible GABA and serotonin effects

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16
Q

instructions for use of cyclobenzaprine (Flexaril)

A

onset: 1 hr
peak: 3-8 hrs
duration: 12-24 hr

17
Q

AEs of cyclobenzaprine (Flexaril)

A
  1. sedation
  2. dizziness
  3. **on the Beers list
18
Q

Note on Benzodiazepines (aka Valium)

A

Schedule IV drug

Sedation and respiratory depression when used with opiods

19
Q

how does botox work?

A

works at the neuromuscular junction to block the release of ACh

20
Q

T/F: botox has decreased efficacy with longterm use

A

TRUE

21
Q

instructions for Botox use

A

onset: 1-3 days

duration 3-6 months

22
Q

Botox (botulinum toxin) AEs

A

Boxed warnings!

may spread to distal tissues causing issues = distant paralysis

23
Q

what type of drug is Baclofen (Lioresal)?

A

Ethyl Alcohol and Phenol Direct Acting Agent

24
Q

Baclofen MOA

A

inhibits excitatory neurons = decreased NT release and K+ influx to increase inhibition

25
Q

Use of Baclofen (Lioresal)

A

PO

intrathecal pump (ITB)

26
Q

baclofen (Lioresal) AEs

A
  1. CNS depression
  2. muscle weakness
  3. memory and cognitive impairments in adults with TBI
27
Q

why would someone use an ITB?

A

better results with less AEs

generally need smaller doses

28
Q

PT notes for post-implantation of ITB?

A
  1. assess changes in motor skills due to muscle tone changes
  2. equipment modifications
  3. no modalities near pump site
  4. refill is needed every 3 months
  5. battery must be replaced every 4-5 years
29
Q

Complications of an ITB pump

A
  1. infection
  2. dislodgement
  3. kinking and blocking
  4. failure
  5. observe for signs of withdrawl or overdose
30
Q

Boxed warnings for ITB

A

abruptly stopping meds can cause:

  1. fever
  2. altered mental status (AMS)
  3. exaggerated rebound spasticity/rigidity
  4. in extreme cases
    1. rhabdomyolysis
    2. organ failure
31
Q

Therapeutic concerns for pts on muscle relaxants and antispastic meds

A
  1. sedation and weakness are biggest AEs
    1. can result in limited participation in PT
  2. requires intensive PT to develop new motor patterns and functional abilities
  3. must assess equipment
  4. be aware of ITB pump malfunctions

Pharmacology Test 3 (10 decks)

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