Pharm 154 Psychotherapeutic Drugs and Muscle Relaxants

clozapine

"Clozaril" atypical antipsychotic Indication: schizophrenia, schizoaffective disorder Action: blocks dopamine and serotonin receptors, depresses the RAS, anticholinergic, antihistaminic, alpha-adrenergic blocking Metabolized: liver Excreted: urine and feces Adverse effects: drowsiness, sedation, seizures, dizziness, syncope, headache, tachycardia, nausea, vomiting, fever, neuroleptic malignant syndrome

dantrolene

"Dantrium" direct-acting skeletal muscle relaxant Indication: spasticity resulting from upper motor neuron disorders; malignant hyperthermia Action: interferes with the release of calcium from the sarcoplasmic reticulum with skeletal muscles, preventing muscle contraction; does not interfere with neuromuscular transmission Excreted: urine Adverse effects: drowsiness, dizziness, weakness, fatigue, diarrhea, hepatitis, myalgia, tachycardia, transient blood pressure changes, rash, urinary frequency Similar drugs: rimbotulinum toxin type B (abnormal head position and neck pain with cervical dystonia), incobotulinum toxin A (cervical dystonia and blepharospasm), onabotulinum toxin A (glabellar lines and cervical dystonia, primary axillary hyperhidrosis, strabismus, blepharospasm)

baclofen

"Lioresal" CNS muscle relaxant and antispasmodic Indication: spasticity, spinal cord injuries or spinal cord diseases Action: gamma-aminobutyric acid analogue; inhibits monosynaptic and polysynaptic spinal reflexes, CNS depressant Metabolized: not metabolized Excreted: urine Adverse effects: transient drowsiness, dizziness, weakness, fatigue, constipation, headache, insomnia, hypotension, nausea, urinary frequency Similar drug: methocarbamol

lithium

"Lithobid" bipolar disorder drug Indication: bipolar disorder Actions: alters sodium transport in nerve and muscle cells; inhibits the release of norepinephrine and dopamine, but not serotonin, from the stimulated neurons; increases the intraneuronal stores of norepinephrine and dopamine slightly; decreases the intraneuronal content of second messengers Excreted: urine Adverse effects: CNS problems including lethargy, slurred speech, muscle weakness, and fine tremor; polyuria, gastric toxicity with nausea, vomiting, and diarrhea progressing; CV collapse; coma; (adverse effects are related to serum drug levels)

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen?

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply."

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

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes."

methylphenidate

"Ritalin" CNS stimulant Indication: narcolepsy and ADD Action: mild cortical stimulant with CNS actions similar to those of amphetamines Metabolized: liver Excreted: urine Adverse effects: nervousness, insomnia, increased or decreased pulse rate and blood pressure, tachycardia, loss of appetite, nausea, abdominal pain Similar drug: lisdexamfetamine

chlorpromazine

"Thorazine" antipsychotic/neuroleptic Indication: psychotic disorders, preoperative restlessness, tetanus, porphyria, behavior problems in children, and control of hiccups, nausea, and vomiting Action: blocks postsynaptic dopamine receptors in the brain, depresses those parts of the brain involved in wakefulness and emesis, anticholinergic, alpha-adrenergic blocking Metabolized: liver Excreted: urine Adverse effects: drowsiness, insomnia, vertigo, extrapyramidal symptoms, orthostatic hypotension, photophobia, blurred vision, dry mouth, nausea, vomiting, anorexia, urinary retention, photosensitivity

Dyskinesias are a common side effect of antipsychotic drugs. Nursing interventions for the patient receiving antipsychotic drugs should include which of the following? Positioning to decrease discomfort of dyskinesias Implementing safety measures to prevent injury Encouraging the patient to chew tablets to prevent choking Careful teaching to alert the patient and family about this adverse effect Applying ice to the joints to prevent damage Pureeing all food to decrease the risk of aspiration

-Positioning to decrease discomfort of dyskinesias -Implementing safety measures to prevent injury -Careful teaching to alert the patient and family about this adverse effect

Muscle relaxants would be used in which of the following circumstances? To treat spasticity related to spinal cord injury To treat spasticity that contributes to locomotion, upright position, or increase in function 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)

-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)

Attention deficit disorders (the inability to concentrate or focus on an activity) and narcolepsy (sudden episodes of sleep) are both most effectively treated with the use of: neuroinhibitors. dopamine receptor blockers. major tranquilizers. CNS stimulants.

CNS stimulants.

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

Dantrolene

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction?

Drowsiness

Dantrolene (Dantrium) is designed to relax skeletal muscles by blocking neuromuscular transmission. (True or False)

False

Patients prescribed both methylphenidate and phenytoin may experience decreased serum levels of both drugs.(True or False)

False

Spasmolytics, or centrally acting muscle relaxants, block the reflexes in the CNS 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 Ice packs to the affected area Use of anti-inflammatory agents Body temperature check every 2 hours to watch for malignant hyperthermia Positioning to decrease pain and spasm

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

Your patient, a 6-year-old boy, is starting a regimen of Ritalin (methylphenidate) to control an attention deficit disorder. Family teaching should include which of the following? This drug can be shared with other family members who might seem to need it. This drug may cause insomnia, weight loss, and GI upset. Do not alert the school nurse to the fact that this drug is being taken because the child could have problems later on. This drug should not be stopped for any reason for several years.

This drug may cause insomnia, weight loss, and GI upset.

Cyclobenzaprine (Flexeril) is an example of a spasmolytic that works in the CNS to interfere with the reflexes that cause a muscle spasm. (True or False)

True

Methylphenidate helps children with attention-deficit disorder by helping them focus on one activity for longer periods of time. (True or False)

True

Spinal reflexes are the simplest nerve pathways that monitor movement and posture. (True or False)

True

Women planning on taking dantrolene (Dantrium) should be advised to stop taking birth control pills and switch to barrier protection methods. (True or False)

True

Intrathecal administration of _______________ is helpful in treating muscle spasticity from spinal cord injuries.

baclofen (Lioresal)

Dantrolene is associated with potentially fatal cellular damage. If your patient's condition is being managed with dantrolene, the patient should: have repeated complete blood counts during therapy. have renal function tests done monthly. be monitored for signs of liver damage and have liver function tests done regularly. have a thorough eye examination before and periodically during therapy.

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

extrapyramidal tract

cells from the cortex and subcortical areas including the basal ganglia and cerebellum, which coordinate unconsciousness controlled muscle activity; autonomic activity

Muscle spasticity is the result of: direct damage to a muscle cell. overstretching of a muscle. tearing of a ligament. damage to neurons within the CNS.

damage to neurons within the CNS.

Malignant hyperthermia crisis following anesthesia is treated by giving intravenous ___________.

dantrolene (Dantrium)

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: baclofen. diazepam. dantrolene. methocarbamol.

dantrolene.

The drug of choice for a patient experiencing severe muscle spasms and pain precipitated by anxiety is: methocarbamol. baclofen. diazepam. carisoprodol.

diazepam.

Antipsychotic drugs are basically: serotonin reuptake inhibitors. norepinephrine blockers. dopamine receptor blockers. acetylcholine stimulators.

dopamine receptor blockers.

Adverse effects associated with antipsychotic drugs are related to the drugs' effects on receptor sites and can include: insomnia and hypertension. dry mouth, hypotension, and glaucoma. diarrhea and excessive urination. increased sexual drive and improved concentration.

dry mouth, hypotension, and glaucoma.

pyramidal tract

fibers within the CNS; central precise, intentional movement

Before administering lithium to a client the nurse should check for the concomitant use of which of the following drugs, which could cause serious adverse effects? ibuprofen haloperidol thiazide diuretics antacids ketoconazole theophylline

ibuprofen haloperidol thiazide diuretics antacids

A muscle spasm often results from: damage to the basal ganglia. CNS damage. injury to the musculoskeletal system. chemical imbalance within the CNS.

injury to the musculoskeletal system.

Dantrolene (Dantrium) differs from the other skeletal muscle relaxants because: it acts in the highest levels of the CNS. it is used to treat muscle spasms as well as muscle spasticity. it cannot be used to treat neuromuscular disorders. it acts directly within the skeletal muscle fiber and not within the CNS.

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

Signs and symptoms of tetanus, which includes severe muscle spasm, are best treated with: baclofen. diazepam. carisoprodol. methocarbamol.

methocarbamol.

Mental disorders are now thought to be caused by some inherent dysfunction within the brain that leads to abnormal thought processes and responses. They include: depression. anxiety. seizures. schizophrenia.

schizophrenia.

Lithium toxicity can be dangerous. Patient assessment to evaluate for appropriate lithium levels would look for: serum lithium levels >3 mEq/L. b serum lithium levels >4 mEq/L. serum lithium levels <1.5 mEq/L. undetectable serum lithium levels.

serum lithium levels <1.5 mEq/L.

Haloperidol (Haldol) is a potent antipsychotic that is associated with: severe extrapyramidal effects. severe sedation. severe hypotension. severe anticholinergic effects.

severe extrapyramidal effects.

spindle gamma loop system

simple reflex arcs that involve sensory receptors in the periphery tract 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

Muscle spasms result from injury to the musculoskeletal system, but muscle ___________ results from injury to the neurons in the central nervous system.

spasticity

Antipsychotic drugs are also known as neuroleptic drugs because: they cause numerous neurological effects. they frequently cause epilepsy. they are also minor tranquilizers. they are the only drugs known to directly affect nerves.

they cause numerous neurological effects.