Spasticity, Tremor, RL...

Question 1

Define spasticity, including causes

Answer 1

Increase in muscle tone

Causes:
-disruption of motor pathways between CNS and PNS = loss of inhibitory spinal cord signals

Question 2

Differentiate between GABA and glutamate

Answer 2

GABA = main inhibitory NT in CNS

Glutamate = main excitatory NT in CNS

Question 3

What is the MOA of benzodiazepines

(Ex: diazepam)?

Answer 3

Bind to GABA(A) receptor to increase inhibitory GABA

= alleviate spasticity, muscle spasm, anxiolytics and sedative effects

Question 4

What are side effects of diazepam?

Answer 4

Sedation

```
Abuse potential
Short onset, long duration
~~~

Question 5

What is the MOA of Baclofen?

Answer 5

GABA(B) receptor agonist = decreases release of glutamate

Question 6

What are pros/cons of baclofen?

Answer 6

Less sedation
Less abuse potential

Can cause weakness

Question 7

What is the MOA of Tizanidine?

Answer 7

Alpha2 agonist

Not well understood

Question 8

What are side effects of Tizanidine?

Answer 8

Sedation

Dry mouth

Question 9

Differentiate between muscle spasm and spasticity

Answer 9

Muscle spasm = contraction at level of muscle

Not @ nervous system

Question 10

Differentiate amongst

Cyclobenzaprine
Carisoprodol
Methocarbamol

Answer 10

Cyclobenzaprine = significant anti-cholinergic effects

Carisoprodol = can cause dependence, severe withdrawal symptoms with prolonged use

Methocarbamol = less likely to cause sedation

Question 11

What is dantrolene used for?

What does it do?

Answer 11

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

Question 12

Describe essential tremor

Answer 12

Fast, low amplitude tremor
usually bilateral

Tx is symptomatic

Question 13

What are contraindications and precautions for propranolol to treat essential tremor?

Answer 13

CI:

• asthma/COPD
• insulin-dep. diabetics

Careful about withdrawal => rebound HTN and tremor

Question 14

What are side effects of propranolol

Answer 14

Beta blockade
+dizziness (from drop in HR, BP)

Can worse depression

Question 15

What is the MOA of Primidone?

What are side effects and precautions?

Answer 15

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

Question 16

What is the MOA of gabapentin?

What are side effects and precautions?

Answer 16

MOA: anticonvulsant, promotes GABA (?)

Side effects:
+sedation
+unsteadiness
+nausea

**careful with withdrawal => can induce seizures

Question 17

Describe clonazepam

Answer 17

Benzodiazepine with longer onset and offset = less abuse potential!!

Side effects: sedation

Watch withdrawal - for seizures!

Question 18

What are side effects of topiramate?

Answer 18

Sedation

Renal stones

Hypochloremia (w/ tingling fingers)

Cognitive slowing

Question 19

Describe restless legs

Answer 19

May be due to iron deficiency or dopamine deficiency ?

Question 20

How is RLS treated?

Answer 20

Iron (if low)

Dopaminergic agents

Question 21

What are other treatments for RLS?

Answer 21

Gabapentin

Opioids (tramadol or codeine at night)

Benzodiazepines (clonazepam)

Question 22

Label the following neurons as sleep or wakefulness

Cholinergic
Noradrenergic
Serotonergic
Histaminergic (H1)
GABAergic (GABA-A)

Answer 22

Wakefulness
Wakefulness
Wakefulness
Wakefulness
Sleep

Question 23

Describe benzodiazepines and hypnotics

Answer 23

GABAergic used to promote sleep

Two classes:
Benzos or non-benzodiazepine hypnotics

Question 24

What is suvorexant?

Answer 24

Orexin receptor antagonist

Blocks the orexin neurons that produce neurotransmitters that promote wakefulness

Question 25

What is Ramelteon?

Answer 25

M1 and M2 agonist

Question 26

What is cataplexy ?

Answer 26

Complete loss of muscle tone with sleep onset

Question 27

What is the MOA of amphetamine/ methamphetamine?

Answer 27

Release NE and prevent reuptake of NE, dopamine and serotonin

Question 28

What is the MOA of methylphenidate?

Answer 28

Inhibits reuptake of NE and dopamine

Question 29

What are side effects and precautions for amphetamines and methylphenidate?

Answer 29

Cardiac arrhythmias
Heart attack
Elevated BP leading to stroke
Cerebral vasculitis

Potential for addiction + abuse

Question 30

What is modafinil?

Answer 30

Stimulant used in many neurological conditions that cause fatigue - multiple sclerosis, Parkinson’s

*potential abuse by students

Question 31

What pharmaceutical agents are used for:

Spasticity

Answer 31

Benzodiazepines

Baclofen

Tizanidine

Question 32

What pharmaceutical agents are used for:

Muscle spasm

Answer 32

Dantrolene

Cyclobenzaprine

Question 33

What pharmaceutical agents are used for:

Essential tremor

Answer 33

Propranolol

Primidone

Clonazepam

Gabapentin

Topiramate

Question 34

What pharmaceutical agents are used for:

Restless legs syndrome

Answer 34

Dopamine agonists

Carbidopa/levodopa

Gabapentin

Opioids

Clonazepam

Question 35

What pharmaceutical agents are used for:

Sedatives/hypnotics

Answer 35

Benzodiazepines/ non-benzodiazepines

Antihistamines

Suvorexant

Melatonin

Question 36

What pharmaceutical agents are used for:

Stimulants

Answer 36

Amphetamines

Methylphenidate

Modafinil