Spasticity Meds Flashcards
(20 cards)
Reversible and focal Rx
Injectables (phenol and Botox)
Reversible and general Rx
Oral meds and intrathecal baclofen pump
Botulinum Toxin
Injected into the muslce - absorbed in presynaptic terminal - binds to synaptic vesicles with ACH - inhibit release of ACH - no more transmission
— WEARS OFF OVER TIME
— GREAT BUT HAS TO BE DONE AS AN ADJUNCT THERAPY
Phenol
Causes neurolysis — wallerian degeneration of the nerve so it targets larger muscle in LE.
Common nerve = obturator
Lasts 6-12 months
Complications
- injection site infection
- desensitization/neuralgia
- local edema
- venous thrombosis
- compartment syndrome
- death
Baclofen
GABA Agonists
- metabolized in kidney
- acts at level of SC — decreases tone, spasms, clonus
Diazepam
GABA B RC couple
- metabolized by liver
- increases effects of GABA at level of SC by binding benzo Rs
- physiologic dependence
- causes CNS depression
Tizanidine
Alpha 2 adrenergic agonists
- metabolized by liver
- central and spinal blocking release of excitatory catecholamines
- may result in sedation and hypotension
- better tolerated for older adults
Dantrolene Sodium
- acts on peripheral skeletal muscle fibers by inhibiting calcium from SR which affects muscle’s ability to contract
- decreases spasms and clonus
- may exacerbate mm weakness and fatigue
Diazepam side effects
Sedation
Behavioral changes
Baclofen side effects
- sedation
- hypotension
- nausea and vomitting
- weakness
Dantrolene sodium side effects
- sedation
- N+V
- weakness
- hepatitis
Tizanidine side effects
- sedation
- hypotension
- weakness
- hepatitis
PROS and CONS to oral therapies
Pros - treats generalized spasticity and variety of drugs available
Cons - systemic SE
PROS and CONS to phenol injections
Pros - potentially effective for focal spasticity, low cost, early onset of action
Cons - injection site pain, high incidence of dysesthesia and pain
PROS and CONS for Botox injections
Pros - effective for focal spasticity, very low systemic SE, high user satisfaction
Cons - NOT effective for generalized spasticity unless focal goals identified.
Indications for baclofen pump
Severe and generalized spasticity
Ease of care and pain control
Recurrent MSK deformities because of the spasticity
Contraindications for baclofen pump
Negative response to trial infusion
Hypersensitivity, depression
Small stature, poor trunk control, scoliosis
— patients need to be super screened for this machine
What does the baclofen pump do
Bypasses the systemic side effects of oral meds and delivers the baclofen right to the level of the SC
Therapeutic dose is 1/100th the oral dose so way less drowsiness
Great for kiddos GMFCS level 4-5
Possible complications of the baclofen pump
Infection and general anesthesia
CSF leakage
Pump malfunctions
Kinking, dislodging, fracturing of catheters
== can lead to death if don’t recognize signs of withdrawal
Goals of PT
Promote increased ROM
Strengthen
Increase functional training
ALL as an adjunct to meds that reduce spasticity
