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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?

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?

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?

25
What is the boxed warning associated with botulinum toxin?
Rare cases of spread to distal tissues hours to weeks after injection.
26
What is the Direct Acting Agent for spasticity?
baclofen
27
How does baclofen work?
inhibitory effect on alpha motor neuron through inhibition of excitatory neurons
28
What is the boxed warning for baclofen?
DONT ABRUPTLY STOP, could lead to: - high fever - AMS - exaggerated rebound spasticity and muscle rigidity - rare cases of rhabdomyolysis and organ-system failure
29
What are the AE associated with baclofen?
- CNS depressant (sedation, ataxia, cardiac/respiratory depression) - muscle weakness
30
-How else can baclofen be taken other than oral? -When is this used? Does the drug have increased effectiveness this way?
Intrathecal - Long term infusion used to treat severe spasticity unresponsive to PO. - Yes, increased effectiveness with smaller doses. Also less side effects.
31
What is important to know for intrathecal baclofen (ITB)?
- Baclofen screening process to determine ITB candidates - Postimplantation titration period - PT assessment post-implantation
32
ITB pump refills are needed how often? | How long does the battery last?
- 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
Does ITB have a high satisfactory rate?
Yes
34
What are the main Antispasticity/Muscle relaxant drug concerns?
-Sedation and weakness is the most notable impact on patient participation in PT

Pharmacology Exam 3 (10 decks)

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