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Pharmacology Exam 3 > Spasticity and Muscle Spasms > Flashcards

Spasticity and Muscle Spasms Flashcards

1
Q

Spasticity is defined by muscle tone. hat muscle tone results in flaccidity and what muscle tone results in excessive muscle tension?

A
  • Low tone=flaccid

- High tone=excessive muscle tension

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2
Q

Spasticity is synonymous with muscle what?

A

Hypertonicity

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3
Q

Spasticity is dependent on what?

A

Velocity- more noticeable with fast movements

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4
Q

Spasticity occurs from supraspinal inhibition from lesion on what?

A

Brain or spinal cord

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5
Q

Hypertonicity can lead to impairments with what?

A
  • ROM
  • Coordination
  • Functional mobility
  • ADLs
  • Pain
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6
Q

What is a muscle spasm?

A

Involuntary muscle tension, individual unable to control/relax –>PAINFUL!

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7
Q

How do a2 agonists work as a spasmolytic?

A

Decrease the release of excitatory neurotransmitters and decrease the excitability of postsynaptic neurons.

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8
Q

What is an example of an A2 agonist for treatment of spasticity?

A

tizanidine

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9
Q

What are the common AE?

A
  • drowsiness
  • dizziness
  • asthenia
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10
Q

What are some other things that can occur with these types of drugs?

A
  • Sedation within 30 minutes of dose, peak within 1.5hrs

- Hypotension in up to 33% within 1 hour of dose, peaks 2-3 hrs after dose

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11
Q

How do centrally acting antispasmodics work?

A

Unknown MOA but may inhibit polysynaptic reflex in spinal cord.

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12
Q

What is an example of a centrally acting antispasmodic drug?

A

cyclobenzaprine (Flexeril)

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13
Q

Long term of excessive use may contribute to what?

A

Tolerance and physical dependance

-carisoprodol (Soma) is a schedule IV drug

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14
Q

What are the most common AE associated with centrally acting antispasmodics?

A
  • sedation

- dizziness

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15
Q

All of these are on the Beers list for what reason?

A
  • increased sedation risk
  • fractures
  • some have anticholinergic effects
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16
Q

What is generally very variable with centrally acting antispasmodic drugs?

A
  • Onset
  • Peak
  • Duration
17
Q

What drug is also considered a centrally acting antispasmodic drug due to its inhibitory effect of GABA thus decreasing neuron excitability?

A

Diazepam (Valium)

18
Q

Diazepam is a schedule IV drug, meaning it has a risk of what?

A

Abuse

19
Q

What are the 3 classes of drugs that act at the NM junction?

A
  • Ethyl alcohol
  • Phenol
  • Botulinum toxin
20
Q

How do both ethyl alcohol and phenol work?

A

Denatures proteins to cause demyelination of nerves at site of injection.

21
Q

Are these drugs used more or less often than botox?

A

Less

22
Q

What is the main disadvantage of ethyl alcohol and phenol?

A

Dysesthesia- “abnormal sensation”

23
Q

How does botulinum toxin work for spasticity?

A

Blocks release of ACh into the NM junction.

24
Q

Long term use can develop antibodies which decreases what?

A

Efficacy

25
Q

What is the boxed warning associated with botulinum toxin?

A

Rare cases of spread to distal tissues hours to weeks after injection.

26
Q

What is the Direct Acting Agent for spasticity?

A

baclofen

27
Q

How does baclofen work?

A

inhibitory effect on alpha motor neuron through inhibition of excitatory neurons

28
Q

What is the boxed warning for baclofen?

A

DONT ABRUPTLY STOP, could lead to:

  • high fever
  • AMS
  • exaggerated rebound spasticity and muscle rigidity
  • rare cases of rhabdomyolysis and organ-system failure
29
Q

What are the AE associated with baclofen?

A
  • CNS depressant (sedation, ataxia, cardiac/respiratory depression)
  • muscle weakness
30
Q

-How else can baclofen be taken other than oral?
-When is this used?
Does the drug have increased effectiveness this way?

A

Intrathecal

  • Long term infusion used to treat severe spasticity unresponsive to PO.
  • Yes, increased effectiveness with smaller doses. Also less side effects.
31
Q

What is important to know for intrathecal baclofen (ITB)?

A
  • Baclofen screening process to determine ITB candidates
  • Postimplantation titration period
  • PT assessment post-implantation
32
Q

ITB pump refills are needed how often?

How long does the battery last?

A
  • 3 months
  • 4-5 years

There can be pump complication such as:

  • infection, dislodgment, kinking, blocked catheter, pump failure
  • it is important to recognize signs of overdose or withdrawal
33
Q

Does ITB have a high satisfactory rate?

A

Yes

34
Q

What are the main Antispasticity/Muscle relaxant drug concerns?

A

-Sedation and weakness is the most notable impact on patient participation in PT

Pharmacology Exam 3 (10 decks)

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