3 - Botulinum Toxin

Question 1

C. botulinum neurotoxins inhibit acetylcholine neurotransmitter release from the neuromuscular junction

Answer 1

True

Question 2

Inhibition of acetylcholine release from the neuromuscular junction leads to flaccid muscle paralysis

Answer 2

True

Question 3

There are 7 serotypes of C. Botulinum neurotoxins (A, B, C, D, E, F, G)

Answer 3

True

Question 4

C. Botulinum neurotoxin serotype A (Botox) is the most potent used in humans

Answer 4

True

Question 5

SNARE proteins are believed to mediate the mechanism of action of Botulinum neurotoxin

Answer 5

True

Question 6

SNARE proteins mediate all types of intracellular membrane fusion

Answer 6

True

Question 7

Botulinum toxin impairs neuromuscular function resulting in post synaptic cellular paralysis via the SNARE proteins

Answer 7

True

Question 8

It takes approximately 3 months to recover the neuromuscular function post botulinum toxin treatment

Answer 8

True

Question 9

Muscular atrophy may be seen with each botulinum toxin injection

Answer 9

True

Question 10

Each vial of Botox contains 100 units of neurotoxin

Answer 10

True

Question 11

Antibody formation may occur against botulinum toxin

Answer 11

True

Question 12

Botox (botulinum toxin A) vials are heat sensitive and may be stored in the fridge or freezer

Answer 12

True

Question 13

Injection pain may be reduced if Botox was reconstituted with saline preserved with benzyl alcohol

Answer 13

True

Question 14

Reconstitution of Botox with preservative-free saline may be associated with injection pain

Answer 14

True

Question 15

Reconstitution of Botox with Saline preserved with benzyl alcohol does not affect the safety and efficacy of the drug

Answer 15

True

Question 16

There is potential loss of efficacy of Botox if the vial was shaken

Answer 16

True

Question 17

Botox is used for treatment of dynamic rhytides (wrinkles) caused by muscle pull

Answer 17

True

Question 18

Botox is used for axillary hyperhidrosis

Answer 18

True

Question 19

Infection at the injection site is an absolute contraindication for botulinum toxin injection

Answer 19

True

Question 20

Botulinum toxin may exacerbate neuromuscular disease

Answer 20

True (relative contraindication)

Question 21

Inflammation at the injection site is relatively contraindicated in botulinum toxin injection

Answer 21

True

Question 22

Calcium channel blockers are relatively contraindicated with botulinum toxin

Answer 22

True (although calcium channel blockers are acceptable for doses of botulinum toxin used in dermatology)

Question 23

Aminoglycosides are relatively contraindicated with botulinum toxin

Answer 23

True

Question 24

Cholinesterase inhibitors are relatively contraindicated with botulinum toxin

Answer 24

True

Question 25

Succinylcholine are relatively contraindicated with botulinum toxin

Answer 25

True

Question 26

Quinidine is relatively contraindicated with botulinum toxin

Answer 26

True

Question 27

Lincosamides are relatively contraindicated with botulinum toxin

Answer 27

True

Question 28

Pregnancy and lactation is relatively contraindicated with botulinum toxin

Answer 28

True (although pregnant and nursing women have been inadvertently treated without I'll effects but no studies have been done)

Question 29

The cosmetic use of Botox at the approved dose has not been associated with botulism

Answer 29

True

Question 30

There is no evidence that use of botulinum toxin leads to permanent nerve or muscle injury

Answer 30

True

Question 31

Antibody production against botulinum toxin is serotype specific

Answer 31

True

Question 32

Another serotype of botulinum toxin may be used if resistance is encountered due to antibody production against one serotype

Answer 32

True

Question 33

Botulinum toxin resistance is associated with repetitive treatment with doses greater than 300 units, resulting in reduced efficacy

Answer 33

True

Question 34

Botulinum toxin resistance is associated with repetitive treatment with doses greater than 300 units, resulting in reduced efficacy

Answer 34

True

Question 35

Most reports on antibody production involve patients treated with the original more antigenic formulation of botulinum toxin

Answer 35

True

Question 36

Most adverse events of botulinum toxin relate to injection technique

Answer 36

True

Question 37

Pain is a common adverse event related to needle injection of botulinum toxin

Answer 37

True

Question 38

Swelling is a common adverse event related to needle injection of botulinum toxin

Answer 38

True

Question 39

Erythema is a common adverse event related to needle injection of botulinum toxin

Answer 39

True

Question 40

Bruising is a common adverse event related to needle injection of botulinum toxin

Answer 40

True

Question 41

Ptosis is an uncommon adverse event related to local diffusion of botulinum toxin

Answer 41

True

Question 42

Hand weakness is an uncommon adverse event related to local diffusion of botulinum toxin for palmar hyperhidrosis treatment

Answer 42

True

Question 43

Dysphagia is an uncommon adverse event related to local diffusion of botulinum toxin in neck injections

Answer 43

True

Question 44

Headache is an uncommon idiosyncratic adverse event related to botulinum toxin

Answer 44

True

Question 45

Distant inflammation is an rare idiosyncratic adverse event related to botulinum toxin

Answer 45

True

Question 46

Anaphylaxis is an rare idiosyncratic adverse event related to botulinum toxin

Answer 46

True

Question 47

Flu like symptoms is an rare idiosyncratic adverse event related to botulinum toxin

Answer 47

True

Question 48

Metallic taste is an rare idiosyncratic adverse event related to botulinum toxin

Answer 48

True

Question 49

In non-dermatologic use, dysphagia is common when treating cervical dystonia with botulinum toxin

Answer 49

True

Question 50

In non-dermatologic use, xerophthalmia (abnormal dryness of conjunctiva and cornea) is common when treating blepharospasm or strabismus with botulinum toxin

Answer 50

True

Question 51

In non-dermatologic use, transient headache can occur when treating cervical dystonia with botulinum toxin

Answer 51

True

Question 52

Keep botulinum toxin injections at least 1cm above the orbital rim to avoid ptosis

Answer 52

True

Question 53

Keep botulinum toxin injections at least 3cm above the brow to lessen the risk of diminished expressiveness

Answer 53

True

Question 54

Applying digital pressure with the non-injecting thumb along the orbital rim between the injection sites and the eye may reduce eyelid ptosis from botulinum toxin

Answer 54

True

Question 55

Muscular denervation occurs wherever the botulinum toxin spreads

Answer 55

True

Question 56

Botulinum toxin Injection > 1cm lateral to the orbital rim will avoid diplopia and lid ptosis

Answer 56

True

Question 57

Injections close to the inferior margin of the zygomatic arch risk weakening of the lip legato muscles causing lip ptosis

Answer 57

True

Question 58

Botulinum toxin injections for hyperhidrosis are spaced 1-1.5cm apart

Answer 58

True

Question 59

Approximately 0.1 mL of Botulinum toxin is injected per hyperhidrosis injection site (spaced 1-1.5cm apart)

Answer 59

True

Question 60

Botulinum toxin can be injected into superficial fat to target the dermal eccrine glands in axillary hyperhidrosis with no adverse effects

Answer 60

True

Question 61

Botulinum toxin is injected into dermis to target the eccrine glands in palmoplantar hyperhidrosis and to avoid dispersion of the toxin to underlying intrinsic hand muscles

Answer 61

True