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Pharm > Spasticity > Flashcards

Spasticity Flashcards

1
Q

Reticulospinal Tract

A

Inhibits muscle tone

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2
Q

Vestibulospinal Tract

A

Excites muscle tone of antigravity/extensor muscles

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3
Q

Damage to corticobulbar tracts in CP

A
  1. loss of reticulospinal inhabitation of muscle tone
  2. continued vestibulospinal excitation > increased lower extremity extensor tone
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4
Q

review the fibers and such

A
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5
Q

review research stuff

A
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6
Q

What are the temporary/focal medications for spasticity

A
  • Botulinum
  • Phenol (alcohol)
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7
Q

Types of Botulinum

A
  • botox
  • dysport
  • xeomin
  • myobloc
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8
Q

How does botulinum work?

A

it binds to synaptic vesicles and inhibits release of Act from pre-synaptic to post-synaptic

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9
Q

Therapeutic effects of botulinum conclusion

A
  • should be used as an adjunct therapy
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10
Q

tell me about phenol

A
  • Phenol
  • Neurolysis – causes Wallerian degeneration of neurons
  • Target larger muscle groups of lower extremity
  • Obturator, tibial, hamstring branches sciatic, femoral
  • Duration of action: 6 -12 months
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11
Q

potential complications of phenol

A
  • Injection site infection
  • Desensitization/dysesthesia followed by causalgia/neuralgia
  • Local edema
  • Venous thrombosis
  • Compartment Syndrome
  • Death
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12
Q

oral pharmacotherapy

A
  • Baclofen -GABA (B)
  • Benzodiazepines -Diazepam (Valium) and Clonazepam - GABA (A)
  • Tizanidine - ɑ2 adrenergic agonist
  • Dantrolene sodium – Ca channel blocker
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13
Q

Where and how does baclofen work

A
  • Acts at the level of the spinal cord
  • Binds to and activates GABA-B receptor sites, reduces tone, spasms and clonus
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14
Q

where is baclofen metabolized?

A

kidneys

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15
Q

What can happen with baclofen?

A
  • can lower seizure threshold
  • physiologic dependence
  • Sudden withdrawal may result in rebound spasticity/ muscle spasms/ hallucinations/ confusion/ seizures/ temperature elevations
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16
Q

What does Diazepam do?

A
  • Increases the effect of GABA pre and post synaptically at the spinal cord level by binding to
    its Benzodiazipine receptor resulting in pre-synaptic inhibition and CNS depression
17
Q

Where is Diazepam metabolized?

A

liver

18
Q

what can Diazepam cause?

A
  • sedation, impaired cognition, attention, coordination
  • physiologic dependence
19
Q

What is Clonazepam?

A
  • Benzodiazepine - Gaba RC couple
  • fast onset of action and highly effective
20
Q

how does Tizanidine work?

A

Central and spinal blocking release of excitatory catecholamines (NE and EPI)

21
Q

Where is Tizanidine metabolized?

A

Liver (check LFTs)

22
Q

What can Tizanidine result in?

A

significant sedation and hypotension
* better tolerated in older patients, adults

23
Q

How does Dantrolene Sodium work?

A
  • Peripheral acting upon skeletal muscle fibers inhibiting the release of Ca++ from the sarcoplasmic reticulum affecting muscle contractile response
  • Reduces spasms and clonus
  • May exacerbate muscle weakness/fatigue
24
Q

What is a risk with Dantrolene Sodium

A

Hepatotoxic effect noted in up to 2% of patients - must serially monitor LFTs

25
Q

check out the slides on page 41

A

they good

26
Q

What is intrathecal baclofen

A
  • The baclofen infusion system consists of an implantable pump, a spinal catheter, a battery and an external programmer to adjust drug delivery
  • Therapeutic dose is 1/100 the oral dose at higher CSF levels = less drowsiness
27
Q

what is intrathecal baclofen clinically effective in?

A

reducing hypertonia and dystonia globally

28
Q

indications for intrathecal baclofen

A
  • Severe and generalized spasticity (or dystonia, mixed tone)
  • Ease of care and pain control
  • Recurrent musculoskeletal deformities due to spasticity
29
Q

Contraindications of intrathecal baclofen

A
  • Negative response to trial infusion
  • Hypersensitivity, depression
  • Small stature, poor trunk control, scoliosis?
30
Q

Possible complications of intrathecal baclofen (I think this is on the test)

A
  • Infection and General Anesthesia
  • CSF leakage
  • Pump Malfunction
  • Kinking/Dislodging/Fracturing of the Catheter
31
Q

is there any evidence to support the use if ITB in tabulator children with spasticity of cerebral origin?

A

no

32
Q

what is spasticity

A

velocity-dependent resistance to stretch that occurs because of an inability of the CNS to suppress the stretch reflex

33
Q

Summary of medications

A

Medications exist that function either locally or systemically to primarily suppress excitatory neurotransmitters (Ach/NE/EPI) or enhance inhibitory neurotransmitters (GABA)

34
Q

What is the goal of PT

A

promote increased ROM, strength and functional training as an adjunct to medications that reduce spasticity

Pharm (12 decks)

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