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LVL7 revision > Botulinum Toxin > Flashcards

Botulinum Toxin Flashcards

1
Q

Which product has the greatest diffusion?

A

Azzalure (Dysport) - good for hyperhidrosis

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2
Q

Botulinum Toxin Types

A

Type A - Cosmetic

Type B - Rimabotulinumtoxin B - Cervical Dystonia

Type C - Rarely used, causes slow degeneration of motor neurones

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3
Q

Dysport (Azzalure) : Botox Ratio

A

2.5:1

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4
Q

Bocoture : Botox ratio

A

1:1

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5
Q

Botox storage - reconstituted

A

2-8C, use within 14 days

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6
Q

Botox reconstitution

A

2.5ml saline per 100 units, 4IU per 0.1ml, 2IU per 0.05ml

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7
Q

Bocouture reconstitution

A

2.5ml saline per 100 units, 4IU per 0.1ml, 2IU per 0.05ml

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8
Q

Azzalure reconstitution

A

0.63ml saline per 125SU, 10SU per 0.05ml

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9
Q

Toxin equipment - needles

A

21G for reconstitution, 30G and higher for adminiistration

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10
Q

Absolute contraindications

A

Botulinum allergy
Body dysmorphhia
Infection over site
Neuromuscular disorders
Dysphadi or aspiration history
Pregnancy & Breast feeding

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11
Q

Relative contraindications

A

Under 18
Anticoagulant & Antiplatelets
Aminoglycoside - enhance effect
Calcium antagonist - antagonise effect

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12
Q

Non-cosmetic uses

A

Spastic skeletal muscles
Antiparasympathetic - sweat and salivary glands
Prevention of wound dehiscence

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13
Q

Factors affecting dose

A

Sex
Extent of wrinkles
Previous response to toxins
Ethnicity
Dynamics of facial express
Size of muscles mass

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14
Q

BNT mode of action

A

Blocks acetylcholine excretion - selectively and irreversibly bind to the presynaptic terminal

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15
Q

Hyperkinetic patients

A

No concordance between muscular contraction and emotion expressed.

Stronger muscles. May contract involuntarily during speech.

Results may last 4-6 months.

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16
Q

Hypertonic patients

A

Lack of control of facial muscles

Wrinkles remain present after treatment.

Shorter results 1-2 months

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17
Q

Medications affecting botox

A

Calcium Antagonist - decrease effects

Aminoglycosides - increase effects

Immunosuprressants - increase risk of infection

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18
Q

When did BTX become FDA approved for hyperhidrosis treatment

A

2004

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19
Q

Mechanism of action for botox

A

inhibits the release of
acetylcholine at the neuromuscular junction
resulting in partial paralysis of the muscles.

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20
Q

Botox toxin type

A

onabotulinum toxin type A (Botox)

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21
Q

Dysport toxin type

A

abobotulinum toxin type A

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22
Q

Azzalure toxin type

A

onabotulinum toxin type A (Botox)

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23
Q

Bocouture toxin type

A

Incobotulinumtoxin type A

24
Q

What differs the different toxin A types

A

presence or absence of complexing proteins

25
How was botox discovered
1895 Emile va Ermengem Identified clostridium botulinum as a source of botulism
26
Purification of botox
1940s Edward Schantz purified during military experiments for biological wapons
27
First treatment/experimentation with botox
1977 Alan Scott Strabismus in monkeys - extraocular muscles
28
First aesthetics use/publication of botox
1992 Jean and Alistair Carruthers Blepharospasm patients treated in perioribtal region Reduced glabellar lines
29
Botox moecule structure
Neurotoxin 150kDA Heavy and light chain
30
Heavy chain
100kDA Binds synaptic membrane allows light chain to enter cell and cleave proteins of the NSF receptor complex
31
Light chain
50kDa active part of the toxin Zinc dependent endopeptidase
32
How many serotypes of botulinum toxin
Eight
33
How is botox toxin activated
cleavage between 448 & 449 AA Producing Heavy and light chain connected via disulphide bond bond reduced after cell internalisation
34
Normal neuromusclar junction activity
Action potention causes calcium entry into presynaptic membrane Triggers acetylcholine vesicle release into synaptic cleft Binding of ACTH at posynaptic membrane gated channels allowin sodium entry Sodium entry causes depolarisation at post synaptic membrane allowing calcium entry and muscle contraction
35
Botox affect on NMJ
Heavy chain binds GT1b - a glycosphingolipid in the membrane of presynaptic vesicle causing endocytosis of toxin and acidification of the endosome and translocation of the light chain into the axon terminal cytoplasm. SNAP-25 is cleaved by the light chain and can no longer mediate fusion of vesicles to pre-synaptic membrane
36
How does Botox wear off
SNARE protein are slowly regenerated. formation of new NMJs to restore activity
37
Which SNARE proteins are cleaved
Snap 25 by toxin A, C, E Snaptobrevin by toxin B, D, E, F, G Synactin by toxin C
38
Snare protein targets of toxin
SNAP 35 Snaptobrebin Syntacin
39
Peak of botox action
14-30 days
40
Immunogenicity
Antibody formation against Toxin Rarely reported in litrature Can be detected after repeated treatment for years
41
Primary vs secondary immunity
Failed response after first treament loses reponsiveness to product over time with repeated treatment
42
Why is Bocouture marketed as "pure"
No accessory proteins only 150kDA neurotoxin unlikely to cause immunogenic response
43
Antibodies that dont intefered with toxin activity
Antibodies against the NAPs non toxic accessory proteins
44
Azzalure units
Speywood units
45
Licensed applications of botox
cervical dystonia severe primary axillary hyperhidrosis blepharospasm, neurogenic detrusor overactivity chronic migraine, upper limb spasticity glabellar lines (moderate to severe)
46
How allergan units are measured
cellular assay
47
How speywood units are measured
amount of toxin that kills 50% of genetically homogenous mice population
48
Company that produces dysport and azzalure
Medicis Pharmaceutical Corp
49
Storage
2-8 degrees discard after 24 hours Bocouture does not require refrigeration
50
Product spread
Azzalure has greater spread than botox and bocouture
51
Product onset of action
Azzulure faster
52
Factors affecting product selection(5)
Patient preference Pricing Spread Onset of action Storage
53
When does muscle activity return
7-8 weeks
54
When was botox FDA approved
2002, glabella lines
55

LVL7 revision (18 decks)

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