Spasticity, Tremor, RL... Flashcards
Define spasticity, including causes
Increase in muscle tone
Causes:
-disruption of motor pathways between CNS and PNS = loss of inhibitory spinal cord signals
Differentiate between GABA and glutamate
GABA = main inhibitory NT in CNS
Glutamate = main excitatory NT in CNS
What is the MOA of benzodiazepines
(Ex: diazepam)?
Bind to GABA(A) receptor to increase inhibitory GABA
= alleviate spasticity, muscle spasm, anxiolytics and sedative effects
What are side effects of diazepam?
Sedation
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Abuse potential
Short onset, long duration
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What is the MOA of Baclofen?
GABA(B) receptor agonist = decreases release of glutamate
What are pros/cons of baclofen?
Less sedation
Less abuse potential
Can cause weakness
What is the MOA of Tizanidine?
Alpha2 agonist
Not well understood
What are side effects of Tizanidine?
Sedation
Dry mouth
Differentiate between muscle spasm and spasticity
Muscle spasm = contraction at level of muscle
Not @ nervous system
Differentiate amongst
Cyclobenzaprine
Carisoprodol
Methocarbamol
Cyclobenzaprine = significant anti-cholinergic effects
Carisoprodol = can cause dependence, severe withdrawal symptoms with prolonged use
Methocarbamol = less likely to cause sedation
What is dantrolene used for?
What does it do?
Acute/tonic muscle spasm
Severe cases with pathological muscle breakdown that would cause large release of Ca
MOA:
Blocks intercellular Ca release and dec. muscle contraction
Describe essential tremor
Fast, low amplitude tremor
usually bilateral
Tx is symptomatic
What are contraindications and precautions for propranolol to treat essential tremor?
CI:
- asthma/COPD
- insulin-dep. diabetics
Careful about withdrawal => rebound HTN and tremor
What are side effects of propranolol
Beta blockade
+dizziness (from drop in HR, BP)
Can worse depression
What is the MOA of Primidone?
What are side effects and precautions?
MOA: anticonvulsant - promotes GABA
Side effects
+sedation
+liver/blood count abnormalities
+orthostasis
- *check CBC, LFTs if on this continuously
- *careful of withdrawal - can induce seizures
What is the MOA of gabapentin?
What are side effects and precautions?
MOA: anticonvulsant, promotes GABA (?)
Side effects:
+sedation
+unsteadiness
+nausea
**careful with withdrawal => can induce seizures
Describe clonazepam
Benzodiazepine with longer onset and offset = less abuse potential!!
Side effects: sedation
Watch withdrawal - for seizures!
What are side effects of topiramate?
Sedation
Renal stones
Hypochloremia (w/ tingling fingers)
Cognitive slowing
Describe restless legs
May be due to iron deficiency or dopamine deficiency ?
How is RLS treated?
Iron (if low)
Dopaminergic agents
What are other treatments for RLS?
Gabapentin
Opioids (tramadol or codeine at night)
Benzodiazepines (clonazepam)
Label the following neurons as sleep or wakefulness
Cholinergic Noradrenergic Serotonergic Histaminergic (H1) GABAergic (GABA-A)
Wakefulness Wakefulness Wakefulness Wakefulness Sleep
Describe benzodiazepines and hypnotics
GABAergic used to promote sleep
Two classes:
Benzos or non-benzodiazepine hypnotics
What is suvorexant?
Orexin receptor antagonist
Blocks the orexin neurons that produce neurotransmitters that promote wakefulness
What is Ramelteon?
M1 and M2 agonist
What is cataplexy ?
Complete loss of muscle tone with sleep onset
What is the MOA of amphetamine/ methamphetamine?
Release NE and prevent reuptake of NE, dopamine and serotonin
What is the MOA of methylphenidate?
Inhibits reuptake of NE and dopamine
What are side effects and precautions for amphetamines and methylphenidate?
Cardiac arrhythmias
Heart attack
Elevated BP leading to stroke
Cerebral vasculitis
Potential for addiction + abuse
What is modafinil?
Stimulant used in many neurological conditions that cause fatigue - multiple sclerosis, Parkinson’s
*potential abuse by students
What pharmaceutical agents are used for:
Spasticity
Benzodiazepines
Baclofen
Tizanidine
What pharmaceutical agents are used for:
Muscle spasm
Dantrolene
Cyclobenzaprine
What pharmaceutical agents are used for:
Essential tremor
Propranolol
Primidone
Clonazepam
Gabapentin
Topiramate
What pharmaceutical agents are used for:
Restless legs syndrome
Dopamine agonists
Carbidopa/levodopa
Gabapentin
Opioids
Clonazepam
What pharmaceutical agents are used for:
Sedatives/hypnotics
Benzodiazepines/ non-benzodiazepines
Antihistamines
Suvorexant
Melatonin
What pharmaceutical agents are used for:
Stimulants
Amphetamines
Methylphenidate
Modafinil
