Neuromodulators Flashcards
Obligate anaerobe that caused botulism
Clostridium botulinum
Lethal dose of Botox in humans
40 U/kg
Mechanism of action of Botox
inhibits release of acetylcholine at pre-synaptic neuron, producing weakness or flaccid paralysis
BoNT-A cleaves which protein, required for membrane fusion and ACh release
SNARE proteins (SNAP-25)
How long does paralytic effect of BoNT-A last?
2-6 months
How long for therapeutic effect of Botox?
24-48 hrs
Describe the “rule of 3” for BoNT-A
The drug will take effect in 3 days, maximize by 3 weeks, and last about 3 months
Depressor muscles of the brow
Procerus
Corrugator supercilii
Medial orbicularis oculi
Elevator of the brow
Frontalis
Reconstitution concentration for 100-unit vial of Botox
4.00 units / 0.1 mL
When injecting, how far to stay away from bony orbit?
1.0 cm
What can happen if you inject < 1 cm from bony orbit?
Eyelid ptosis
Depth of insertion for injection of mimetic muscles
insert 1/2” needle one-third of it’s length
Discuss variability in BoNT-A response between patients
some patients are more sensitive or more resistant to neurotoxins than others, and may require a larger or smaller dose to achieve the desired effect. Some patients are nonresponders or minimal responders and injecting them with BoNT-A may not produce any
results.
Will existing rhytids (wrinkles) go away with injection of neuromodulators?
Patients must also understand that lines etched into the dermis are not going to resolve but will probably be improved as the resting tension is relaxed.
