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Spasticity > Treatment of spasticity > Flashcards

Treatment of spasticity Flashcards

1
Q

What is the main concern/Side effects of dantrolene

A

Liver toxicity

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2
Q

How does baclofen decrease pain

A

Reduces substance P in the spinal cord

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3
Q

What are the four FDA approved medications for spasticity

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

What dose do you start baclofen with

A

5mg BID or TID

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5
Q

Which FDA approved medications work on GABA?

A

Baclofen and diazepam

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6
Q

What Patients is clonidine mainly used for entreating spasticity

A

Spinal cord injury

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7
Q

What is baclofen’s mechanism of action

A

GABAb receptor agonist

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8
Q

What is the mechanism of action of gabapentin

A

GABA analogue

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9
Q

Does baclofen work better on upper or lower extremity spasticity

A

Lower extremity

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10
Q

What is the most common side effect of diazepam

A

Sedation

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11
Q

What is so unique about the mechanism of action of dantrolene

A

It works peripherally

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12
Q

What is the therapeutic dose of baclofen

A

20 mg/day

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13
Q

What can happen with sudden withdrawal of baclofen

A

Seizure, Hallucination, rebound spasticity

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14
Q

What is the dose limiting factor of baclofen

A

Sedation/Drowsiness

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15
Q

Main side effect of clonidine

A

Hypotension and rebound hypertension

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16
Q

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

A

Neurontin

17
Q

Mechanism of action of tizanidine

A

Alpha-2 adrenergic agonist

18
Q

What is the maximum dose of diazepam

A

60mg/day

19
Q

What is the starting dose of dantrolene

A

25 MG b.i.d.

20
Q

What needs to be monitored while taking tizanidine

A

Liver function tests

21
Q

First-line treatment of spasticity

A
  • stretching/range of motion
  • serial casting
  • Splinting
22
Q

How do you titrate up the dose of baclofen

A

Increased dose by 5mg every 3 to 5 days

23
Q

Does clonidine work presynaptic or postsynaptic

A

Presynaptic

24
Q

What dose do you start diazepam at

A

4mg QHS or 2mg BID

25
Q

How does GABAa receptor agonist work

A

Increase in chloride influx resulting in membrane hyperpolarization

26
Q

What dose do you start tizanidine at

A

2-4 mg/day

27
Q

What does diazepam do to sleep cycle

A

Decreases REM sleep

28
Q

What antibiotic is tizanidine contraindicated with

A

Ciprofloxacin

29
Q

Main side effect of baclofen

A

Sedation

30
Q

Overdose of diazepam can be treated with what

A

flumazenil

31
Q

How does GABAb receptor agonist work?

A

It reduces presynaptic calcium influx and increases postsynaptic potassium influx

32
Q

What kind of patient is dantrolene best for

A

TBI patients or any patients with spasticity of cerebral origin

33
Q

What is the mechanism of action of clonidine

A

Alpha-2 adrenergic agonists

34
Q

What is the maximum dose of baclofen

A

80mg/day

35
Q

What is the mechanism of action of dantrolene

A

Block the release of calcium in the sarcoplasmic reticulum

36
Q

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

A
  1. Malignant hyperthermia
  2. neuroleptic malignant syndrome
  3. hyperthermia due to baclofen withdrawal
37
Q

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

A

TBI patients and myasthenia gravis

38
Q

What is the maximum dose of dantrolene

A

400 MG/day

39
Q

What is the mechanism of action of diazepam

A

facilitates GABAa receptor effects

Spasticity (3 decks)

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