Treatment of spasticity

Question 1

What is the main concern/Side effects of dantrolene

Answer 1

Liver toxicity

Question 2

How does baclofen decrease pain

Answer 2

Reduces substance P in the spinal cord

Question 3

What are the four FDA approved medications for spasticity

Answer 3

1. baclofen
2. tizanidine
3. dantrolene
4. diazepam

Question 4

What dose do you start baclofen with

Answer 4

5mg BID or TID

Question 5

Which FDA approved medications work on GABA?

Answer 5

Baclofen and diazepam

Question 6

What Patients is clonidine mainly used for entreating spasticity

Answer 6

Spinal cord injury

Question 7

What is baclofen’s mechanism of action

Answer 7

GABAb receptor agonist

Question 8

What is the mechanism of action of gabapentin

Answer 8

GABA analogue

Question 9

Does baclofen work better on upper or lower extremity spasticity

Answer 9

Lower extremity

Question 10

What is the most common side effect of diazepam

Answer 10

Sedation

Question 11

What is so unique about the mechanism of action of dantrolene

Answer 11

It works peripherally

Question 12

What is the therapeutic dose of baclofen

Answer 12

20 mg/day

Question 13

What can happen with sudden withdrawal of baclofen

Answer 13

Seizure, Hallucination, rebound spasticity

Question 14

What is the dose limiting factor of baclofen

Answer 14

Sedation/Drowsiness

Question 15

Main side effect of clonidine

Answer 15

Hypotension and rebound hypertension

Question 16

What medication works well as an adjunctive therapy with baclofen for treating spasticity

Answer 16

Neurontin

Question 17

Mechanism of action of tizanidine

Answer 17

Alpha-2 adrenergic agonist

Question 18

What is the maximum dose of diazepam

Answer 18

60mg/day

Question 19

What is the starting dose of dantrolene

Answer 19

25 MG b.i.d.

Question 20

What needs to be monitored while taking tizanidine

Answer 20

Liver function tests

Question 21

First-line treatment of spasticity

Answer 21

• stretching/range of motion
• serial casting
• Splinting

Question 22

How do you titrate up the dose of baclofen

Answer 22

Increased dose by 5mg every 3 to 5 days

Question 23

Does clonidine work presynaptic or postsynaptic

Answer 23

Presynaptic

Question 24

What dose do you start diazepam at

Answer 24

4mg QHS or 2mg BID

Question 25

How does GABAa receptor agonist work

Answer 25

Increase in chloride influx resulting in membrane hyperpolarization

Question 26

What dose do you start tizanidine at

Answer 26

2-4 mg/day

Question 27

What does diazepam do to sleep cycle

Answer 27

Decreases REM sleep

Question 28

What antibiotic is tizanidine contraindicated with

Answer 28

Ciprofloxacin

Question 29

Main side effect of baclofen

Answer 29

Sedation

Question 30

Overdose of diazepam can be treated with what

Answer 30

flumazenil

Question 31

How does GABAb receptor agonist work?

Answer 31

It reduces presynaptic calcium influx and increases postsynaptic potassium influx

Question 32

What kind of patient is dantrolene best for

Answer 32

TBI patients or any patients with spasticity of cerebral origin

Question 33

What is the mechanism of action of clonidine

Answer 33

Alpha-2 adrenergic agonists

Question 34

What is the maximum dose of baclofen

Answer 34

80mg/day

Question 35

What is the mechanism of action of dantrolene

Answer 35

Block the release of calcium in the sarcoplasmic reticulum

Question 36

In addition to spasticity, what three main conditions is dantrolene also used to treat

Answer 36

1. Malignant hyperthermia 2. neuroleptic malignant syndrome 3. hyperthermia due to baclofen withdrawal

Question 37

What 2 types of patients do you not want to give diazepam to

Answer 37

TBI patients and myasthenia gravis

Question 38

What is the maximum dose of dantrolene

Answer 38

400 MG/day

Question 39

What is the mechanism of action of diazepam

Answer 39

facilitates GABAa receptor effects