Review
Which subtype of MS if defined episodes of neurologic dysfunction followed by remission?
relapsing-remitting MS (RRMS)
A patient abruptly stops taking a CNS drug and experiences a withdrawal syndrome. This indicates what is happening?
physical dependence
2 groups of drug therapy used for muscle spams
1. Centrally acting muscle relaxants
2. Analgesic anti inflammatory (aspirin)
Three common causes of spasticity
MS, spinal cord injury/lesions, and cerebral palsy
The only drug to treat spams and spasticity that does not produce their effects through the CNS
dantrolene (acts on smooth muscle)
What drug used in treatment of Parkinson's Disease treats levodopa induced dyskinesias?
Amantadine
Carbidopa enhances the effects of levodopa by:
It prolongs the affects of Levodopa (by preventing the breakdown of levodopa) in the system and allows us to use a smaller dose.
Central acting muscle relaxant used to treat muscle spams and give 2 (of 4 possible) therapeutic uses.
cyclobenzaprine [Amrix, Fexmid]
sedation, can increase ROM, can decrease local pain and tenderness, relief of localized spasm caused by muscle injury
Baclofen needs to be withdrawn over 1-2 weeks. If there is abrupt withdraw, what could occur?
Rhabdomyolysis (muscle breakdown)
Baclofen is not used with patients who have experienced a
stroke
What drug causes a patient's urine to be yellow-orange?
Entacapone
A patient with Parkinson's disease is taking levodopa/carbidopa. They experience "wearing off" at the end of the dosing interval. Which intervention might be helpful?
shortening the dosing interval
Giving a drug that prolongs levodopa’s plasma half-life (eg, entacapone)
Giving a direct-acting dopamine agonist
3 non-pharmacologic measures for treating muscle spams
1. immobilization of affected muscle
2. whirlpool baths
3. physical therapy
Direct acting muscle relaxer that acts directly on the skeletal muscle and can also be used to treat malignant hyperthermia
dantrolene [Dantrium]
Cyclobenzaprine is contraindicated with what inhibitors
MAO's
also SSRIs, SNRIs, tricyclic antidepressants, trazodone, and tramadol
Which drug to treat MS is associated with flu-like symptoms, hepatotoxicity, and injection-site reactions?
Can a patient treat with NSAIDS and/or acetaminophen for the flu-like symptoms?
Yes
Most troubling adverse effect of Levodopa?
dyskinesias
4 possible causes of muscle spasms
1. epilepsy
2. hypocalcemia
3. pain syndrome: adult and chronic
4. trauma: localized skeletal muscle injury
List 3 adverse effects of Dantrolene
hepatic toxicity (Fe > 35 y.o.)
muscle weakness
drowsiness
diarrhea
acne-like rash
Name 3 drugs/disorders Baclofen is contraindicated with?
BPH
Schziophrenia
anti-cholinergics
alcohol
opioids
benzodiazapine
What are the two drug classes used to treat Parkinson's Disease? Give an example of each.
Dopaminergic agents: levodopa/carbidopa, pramipexole, ropinirole
Anticholinergic agent: benztropine
4 questions:
1. CNS drugs act on what?
2. What are the two main hallmarks of Alzheimer's disease?
3. What are 2 side effects of donepezil?
4. What labs need to be drawn when a patient is taking Memantine?
1. Brain and spine
2. Tangles and tau (inside neurons) and beta amyloid, neuritic plaques (outside of neurons)
3. nausea, diarrhea, bradycardia, fainting, falls, fall related fractures
4. LFTs and renal labs (BUN, creatinine)
Centrally acting Muscle Relaxants [cyclobenzaprine and diazepam] can have 3 main adverse effects. List them.
1. generalized CNS depression
2. hepatic toxicity
3. physical dependence
The only medication labeled to treat spasticity
Diazepam
Dantrolene is contraindicated with what two things
CNS depressants
hepatic disease