Neuro musc dz on test

Question 1

Spasticity tx

Answer 1

from stroke, brain/spinal injury, cerebral palsy, progressive MS
INCREASED RESISTANCE TO PASSIVE MOVEMENT PLUS HYPERREFLEXIA
can cause chronic pain

tx:
1. skeletal musc relaxants- baclofen, cyclobenzaprine, methocarbamol
2. benzodiazepines- clonazepam, diazepam
3. Centrally acting alpha 2 adrenergic agonist-
HIGH RISK OF SEDATION

Question 2

Spasticity- Skeletal musc relaxants

Answer 2

Baclofen- acts in CNS
MOA: inhibits transmission of both synaptic reflexes @ spinal cord level
Also: used for hiccups and musculoskeletal pain

BBW: ABRUPT DISCONTINUAITON OF INTRATHECAL BACLOFEN
- lead to high fever, AMS, exaggerated rebound spasticity, musc rigidity
-rare: rhabdomyolysis, multiple organ system failure, death

Question 3

musc relaxant

Answer 3

Cyclobenzaprine (Flexeril)
MOA: centrally acting skeletal musc relaxant pharm related to tricyclic antidepressants-> reduces tonic somatic motor activity influencing both alpha and gamma motor neurons
indicated: muscle spasm/musculoskeletal pain, fibromyalgia, acute TMJ

Question 4

musc relaxant

Answer 4

Methocarbamol (Robaxin)
MOA: general CNS depressants
indicated for muscle spasm
INJECTION FORM CONTRAINDICATED IN PTS W/ RENAL IMPAIRMENT

Question 5

musc relaxant

Answer 5

Metaxalone (Skelaxin)
MOA: not precise
INdicated: for musculoskeletal conditions and acute temporomandibular disorder
CONTRAIN: W/ SIGNIFICANT HEPATIC OR RENAL IMPAIRMENT, TENDENCY TO HAVE DRUG-INDUCED, HEMOLYTIC, OR OTHER ANEMIAS

Question 6

musc relaxant

Answer 6

Carisoprodol (Soma)
MOA: not clear- maybe cns depressants-> may also have anxiolytic and sedative effects
indicated: “musculoskeletal conditions”
CONTRA: PT W/ AN ALLERGY TO CARBAMATES (MEPROBAMATE) AND PTS W/ HX OF ACUTE INTERMITTENT PROPHYRIA (GENETIC CONDITION)

Question 7

musc relaxant

Answer 7

Dantrolene (Dantrium, Revonto, Ryanodex)
MOA: ACTS DIRECTLY ON SKELETAL MUSCLE BY INTERFERING W/ RELEASE OF CALCIUM ION FROM THE SARCOPLASMIC RETICULUM
-prevents or reduces the increase in myoplasmic calcium ion conc that activates the acute catabolic processes assoc w/ MALIGNANT HYPERTHERMIA

iNDICATION: CHRONIC SPASTICITY

BBW: POTENTIAL FOR HEPATOTOXICITY

Question 8

Spasticity: Benzodiazepines BZDs

Answer 8

risk for:
abuse, misuse, addiction
concurrent use w/ opioids can lead to PROFOUND SEDATION, RESPIRATORY DEPRESSION, COMA, DEATH
dependence and withdrawalk reactions

Clonazepam (Klonopin)
MOA: exact mech unknown
indications: anxiety, myoclonus, rapid eye movement sleep behavior disorder, refractory seizure disorders, tardive dyskinesia, acute episodes of vertigo

Diazepam (Valium)
MOA: GABA-enhancement
indications: muscle spasm, spasticity, rigidity, anxiety, intoxication, seizures, serotonin syndrome, substance withdrawal, acute episodes of vertigo

Question 9

Spasticity: Centrally acting alpha 2 adrenergic agonist

Answer 9

Tizanadine (Zanaflex)
MOA: DECREASES SPASTICITY BY INCREASING PRESYNAPTIC INHIBITION
indications: muscle spasm, musculoskeletal pain, spasticity
AE: reversible increase in LFT, hepatotoxicity, reversible hypoTN, orthostatic hypoTN, withdrawal syndrome
Caution: DRUG-DRUG INTERACTION AND DRUG FOOD INTERACTIONS