Neuromuscular Pharmacology

Question 1

antiepileptic agents

Answer 1

action

• reduce or eliminate seizure activity within the brain
• inhibit the firing of certain cerebral neurons through various effects on the CNS
• include barbiturates, benzodiazepines, carboxylic acids, hydantoins, iminostilbenes, succinimides

indications
- seizure activity

side effects

• ataxia
• skin issues
• behavioral changes
• GI distress
• headache
• blurred vision
• weight gain

implications for PT
- must have adequate knowledge of established protocols for responding to a seizure as well as potential side effects of antiepileptic medications

Question 2

antispasticity agents

Answer 2

action

• promote relaxation in a spastic muscle
• spasticity is a secondary effect of CNS damage

indications
- increased tone, spasticity, spinal cord injury, CVA, MS

side effects

• drowsiness
• confusion
• headache
• dizziness
• generalized muscle weakness
• hepatotoxicity potential with Dantrium
• tolerance
• dependence

implications for PT

• must balance the need to decrease spastic muscles with the loss of function that a patient may experience with the reduction of hypertonicity
• therapists should focus on therapeutic handling techniques, facilitation, and strengthening to promote overall mobility
• sedation may alter the scheduling of therapy

Question 3

cholinergic agents

Answer 3

action

• mimic acetylcholine and bind directly to the cholinergic receptor to activate and create a response at the cellular level
• indirect acting cholinergic stimulants increase cholinergic synapse activity through the inhibition of acetylcholinesterase
• increase of acetylcholine at the synapse increases cholinergic synaptic transmission

indications
- glaucoma, dementia, postoperative disease in GI motility, myasthenia gravis, reversal of anticholinergic toxicity

side effects

• GI distress
• impaired visual accommodation
• bronchoconstriction
• bradycardia
• flushing

implications for PT

• may experience decrease in heart rate and dizziness
• be aware of characteristics of sympathetic and parasympathetic systems
• pt’s with alzheimers and myasthenia gravis may better partake in therapeutic activities

Question 4

dopamine replacement agents

Answer 4

action

• assist to relieve symptoms of parkinsons secondary to decrease in endogenous dopamine
• able to cross the blood brain barrier and transform to dopamine within the brain

indications

• parkinsons disease
• parkinsonism

side effects

• arrhythmias
• GI distress
• orthostatic hypotension
• dyskinesias
• mood and behavioral changes
• tolerance

implications for PT

• attain max benefit from scheduling therapy one hour after administration of levodopa
• must understand debilitating effects of drug holidays and should monitor the patient;s blood pressure frequently due to the potential for orthostatic hypotension

Question 5

muscle relaxant agents

Answer 5

action

• promote relaxation in muscles that typically present with spasm that is a continuous, tonic contraction
• spasms typically occur secondary to msk or peripheral nerve injury rather than CNS injury

indications
- muscle spasm

side effects

• sedation
• drowsiness
• dizziness
• nausea
• vomiting
• headache
• tolerance
• dependence

implications for PT

• be aware of potential side effects
• maximize the potential for relaxation through therapeutic techniques and the use of modalities
• prevention of reinjury through stretching, posture retraining, and education