Chapter 25: Muscle Relaxants

What is the most important teaching point to emphasize from the plan of care when a client is prescribed a skeletal muscle relaxant?

Do not drive or operate machinery until individual drug effects are known

A patient is taking tizanidine (Zanaflex) to treat spasticity from multiple sclerosis. Which of the following adverse effects of muscle relaxants is most pronounced with this medication?

Hypotension

Baclofen is not

Metabolized

The drug of choice if a child needs to be treated for tetanus

Methocarbamol

A client in the ambulatory care clinic is experiencing shortness of breath, and facial and throat edema, while receiving a pegloticase infusion. What is the nurse's best action?

Notify emergency personnel

Cyclobenzaprine is available in

controlled release oral form for continual control of the discomfort without repeated dosings

Muscle spasticity is the result of

damage to neurons within the CNS.

The drug of choice for a patient experiencing severe muscle spasms and pain precipitated by anxiety is

diazepam

Pyramidal Tract

fibers within the CNS that control precise, intentional movement

Spasticity

sustained muscle contractions

Premenopausal women are also at increased risk for the hepatotoxicity associated

with dantrolene

A nurse should administer skeletal muscle relaxants cautiously and monitor a client closely if they have which of the following medical conditions?

• Cerebrovascular accident • Epilepsy • Pregnancy • Parkinsonism

Baclofen (Lioresal) is used in the treatment of muscle spasticity associated with which of the following disease processes?

• Spinal cord injury • Muscle rigidity • Multiple sclerosis

The use of neuromuscular junction blockers may sometimes cause a condition known as malignant hyperthermia. The drug of choice for prevention or treatment of this condition is

Dantrolene.

Spinal reflexes are the simplest nerve pathways that monitor movement and posture

True

Interneuron

neuron in the CNS that communicates with other neurons, not with muscles or glands

Methocarbamol is available in

oral and parenteral forms

Dantrolene is available in

oral or parenteral forms

Which of the following instructions should the nurse specifically stress when administering drugs used for muscle spasm and cramping?

Avoid alcohol or other CNS depressants

Hypertonia

state of excessive muscle response and activity

Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area

True

A female client age 25 years is prescribed methotrexate to treat rheumatoid arthritis (RA). The nurse should teach the client to do which of the following?

Use an effective contraceptive.

Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?

Vitamin D and calcium

A nurse is instructing a patient who was recently diagnosed with multiple sclerosis about dantrolene (Dantrium). The patient is a 38-year-old-male and the foreman for a construction company. In order to minimize one important adverse effect of the drug, the nurse will give the patient which of the following instructions?

Wear appropriate clothing and sunscreen whenever he is in direct sunlight

A patient has been prescribed methocarbamol (Robaxin) for fibromyalgia. The nurse has spent an hour educating the patient on the use of methocarbamol for muscle pain. Which of the following statements by the patient indicates that she has an understanding of at least one of the significant side effects of methocarbamol?

"My urine could be discolored while I take this drug."

Spasmolytics, or centrally acting muscle relaxants, block the reflexes in the central nervous system that lead to spasm. While a patient is taking one of these drugs, which of the following interventions should be implemented?

- Rest for the affected muscle - Heat to the affected area - Use of anti-inflammatory agents - Positioning to decrease pain and spasm

Muscle relaxants would be used in which of the following circumstances?

- To treat spasticity related to spinal cord injury - To treat spasticity that is related to toxins, such as tetanus - To treat spasticity that is a result of neuromuscular degeneration - To reduce the severity of head position associated with cervical dystonia - To reduce the appearance of frown lines (glabellar lines)

A patient with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?

Baclofen

Centrally Acting Skeletal Muscle Relaxant Prototype

Baclofen

Often used to relieve the muscle spasticity associated with cerebral palsy

Baclofen

The nurse should review which lab result before advising a client about taking the first dose of ibandronate (Boniva)?

Calcium

The centrally acting skeletal muscle relaxant of choice for older patients and for those with hepatic or renal impairment

Carisoprodol

The extra pyramidal tract is made up of cells from which of the following areas?

Cerebral cortex

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer?

Dantrolene

A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which of the following drugs would the nurse expect the physician to order?

Dantrolene

Acts within skeletal muscle fibers, interfering with the release of calcium from the muscle tubules

Dantrolene

Direct-Acting Skeletal Muscle Relaxant Prototype

Dantrolene

Used to treat upper motor neuron spasticity in children

Dantrolene

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient?

Risk for Injury related to CNS depressant effects

An alpha-adrenergic agonist and is thought to increase inhibition of presynaptic motor neurons in the CNS

Tizanidine

The physician orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition?

When close supervision is available for monitoring drug effects

A nurse is working with a 39-year-old patient who is experiencing muscle spasms associated with multiple sclerosis. The patient reports that she needs help with basic care and that her 15-year-old daughter has been helping bathe and dress her for a week. The patient's physician has prescribed baclofen (Lioresal). The nurse and the patient agree that an appropriate goal related to helping her maintain her self-worth would be to

increase self-care in activities of daily living

A muscle spasm often results from

injury to the musculoskeletal system

Dantrolene (Dantrium) differs from the other skeletal muscle relaxants because

it acts directly within the skeletal muscle fiber and not within the CNS

Basal Ganglia

lower area of the brain, associated with coordination of unconscious muscle movements that involve movement and position

In clients with spinal cord injury, spasticity requires treatment when:

It impairs safety, mobility, or the ability to participate in activities of daily living.

A 43-year-old woman was diagnosed with multiple sclerosis 2 years ago and has experienced a recent exacerbation of her symptoms, including muscle spasticity. Consequently, she has been prescribed Dantrolene (Dantrium). In light of this new addition to her drug regimen, what teaching point should the woman's nurse provide?

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."

May discolor the urine, becoming orange to purple-red when metabolized and excreted

Chlorzoxazone

A patient has been started on dantrolene (Dantrium). What is the most serious adverse effect on which the patient should be instructed?

Fatal hepatitis

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of which of the following?

Hepatocellular disease

What is the best position for the client after the administration of a bisphosphonate medication?

High Fowler's

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What patient teaching should the nurse provide?

"Make sure to see your doctor promptly if you develop yellowish skin or eyes."

Spindle Gamma Loop System

simple reflex arcs that involve sensory receptors in the periphery that respond to stretch and spinal motor nerves and cause muscle fiber contraction: responsible for maintaining muscle tone and keeping an upright position against the pull of gravity

A client needs further teaching about medication prescribed for muscle spasms and cramping when making which of the following statements?

"I take my medicine with three to four beers each evening."

After teaching a group of students about skeletal muscle relaxants, the instructor determines a need for additional teaching when the students identify which of the following as a centrally acting skeletal muscle relaxant?

Botulinum toxin type A

A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client?

Liver function tests

The patient is taking cyclobenzaprine for muscle spasms secondary to an injury to his lumbar spine that occurred while lifting a motor at work. He is being seen for a follow-up visit by the physician. He is complaining of dry mouth, blurred vision, and constipation. Why is the patient having these side effects from cyclobenzaprine?

Cyclobenzaprine produces an anticholinergic response, resulting in these side effects.

Extrapyramidal Tract

cells from the cortex and subcortical areas, including the basal ganglia and the cerebellum, which coordinate unconsciously controlled muscle activity; allows the body to make automatic adjustments in posture or position and balance

Cerebellum

lower portion of the brain, associated with coordination of muscle movements, including voluntary motion, as well as extrapyramidal control of unconscious muscle movements

If a child older than 12 years of age requires a skeletal muscle relaxant after an injury

metaxalone has an established pediatric dosage

Signs and symptoms of tetanus, which includes severe muscle spasm, are best treated with

methocarbamol.

spinal motor neurons

nerves that regulate posture, balance, and movement are the result of a constantly fluctuating sequence of muscle contraction and relaxation

Bind directly to the receptor sites of motor nerve terminals and inhibit the release of acetylcholine, leading to local muscle paralysis

- botulinum toxins A and B - incobotulinumtoxin A

Baclofen is available in

- oral - intrathecal forms and can be administered via a delivery pump

Which of the following is an example of a skeletal muscle relaxant?

Baclofen (Lioresal)

Spasticity may result from

an increase in excitatory influences or a decrease in inhibitory influences within the CNS.

Dantrolene is associated with potentially fatal cellular damage. If your patient's condition is being managed with dantrolene, the patient should

be monitored for signs of liver damage and have liver function tests done regularly.