Ch. 25

This drug is available oral, intrathecal, and a delivery pump - used to treat central spasticity

Baclofen

(COURSEPOINT)A patient is administered cyclobenzaprine (Flexeril). Which adverse effect can the nurse expect with this medication?

drowsiness

(COURSEPOINT)When prescribed dantrolene, what is the most serious adverse effect the client should be instructed about?

hepatitis

A client with muscular dystrophy has recently begun taking dantolene for the treatment of muscle spasms. When assessing for adverse effects, what assessment questions should the nurse include? Select all that apply.

"Do you find that the medication gives you an upset stomach?" "Are you getting any sudden or frequent urges to urinate?" "Have you experienced any new or unusual aches and pains since starting the medication?"

(COURSEPOINT)A client has been prescribed baclofen and will be taking the drug on an outpatient basis. The client asks the nurse if it is still okay to drink wine with meals or end the day with a "nightcap." What is the nurse's best response?

"The combination of baclofen and alcohol could depress your nervous system to a dangerous level."

(COURSEPOINT)A client who is experiencing lower back pain has been prescribed cyclobenzapine. The nurse should provide what health education in order to ensure safe and effective treatment?

"This will likely make you drowsy, so don't take it before doing anything that would require alertness."

(COURSEPOINT) 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."

Contraindications and Cautions of skeletal muscle relaxants

-Allergy/hypersensitivity -skeletal muscle spasms resulting from rheumatic disorders, which would not benefit from these drugs -pregnancy and lactation -cardiac depression, epilepsy, muscle weakness CAUTION -renal/Hepatic dysfunction -clients who's spasticity contribute to mobility/posture/balance- to prevent loss of this function

Adverse Effects of Dantrolene

-CNS (due to CNS depression) -Drowsiness, fatigue, weakness, confusion, headache and insomnia, and visual disturbances -GI disturbances may be linked to direct irritation or to alterations in smooth muscle function caused by the drug-induced calcium effects. - GI EFFECTS include GI irritation, diarrhea, constipation, and abdominal cramps. Urinary frequency, enuresis, and feelings of urinary urgency reportedly occur, and crystalline urine with pain or burning on urination may result.

Signs that a muscle relaxant may be exhibiting toxic effects on client

-Hypersensitivity -liver dysfunction (jaundice- yellowing of skin/eyes)

Baclofen Indications

Alleviation of signs and symptoms of spasticity- may be used to treat spinal cord injuries or spinal cord diseases

(COURSEPOINT) An older adult client's health care provider believes that the client's back pain would respond well to a centrally acting skeletal muscle relaxant. The nurse is aware that the client's glomerular filtration rate has fallen in recent months. Which medication would be most appropriate?

C

Adverse Effects of Muscle Relaxants

CNS Drowsiness, fatigue, weakness, confusion, headache, insomnia GI Nausea, dry mouth, anorexia, and constipation CV Hypotension, arrhythmias GU Urinary frequency, enuresis, and feelings of urinary urgency reportedly may occur.

Muscle Relaxant (Spasmolytics) safest for elders and patients with renal/hepatic dysfunction

Carisoprodol

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

Dantrolene

(COURSEPOINT) A patient is being treated for intractable muscle spasticity with a peripherally acting spasmolytic. The nurse should anticipate administering which medication?

Dantrolene

Nursing consideration for patients taking Baclofen

Drug must be tapered between 1 to 2 weeks to prevent development of psychoses and hallucinations

(COURSEPOINT) A 32-year-old female patient is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the patient and her husband that the adverse effect that poses the greatest safety risk to the patient is

Hypotension

Which adverse effect of muscle relaxants is most pronounced when a client is prescribed tizanidine therapy?

Hypotension is the most significant adverse effect of tizanidine.

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

One significant side effect of methocarbamol is that it causes urine to be discolored.Central-acting muscle relaxants such as methocarbamol usually cause fatigue and loss of energy along with constipation, not diarrhea.Methocarbamol is not designed to treat tension headaches.

Clinically Important Drug - Drug Interactions for Botulinum Toxins

if used with other drugs that interfere with neuromuscular transmission (neuromuscular junction blockers, lincosamides, quinidine, magnesium sulfate, anticholinesterases, succinylcholine, or polymyxin—or with aminoglycosides) There is a risk of additive effects. If Meds must be given together take extreme caution

Important Nursing consideration for Dantrolene considering adverse effect

-Dantrolene may also cause direct hepatocellular damage and hepatitis that can be fatal Monitor for liver toxicity -> jaundice - yellowing of skin and eyes Severe unusual adverse effects may occur, including: -Acne -abnormal hair growth -rashes -photosensitivity -abnormal sweating -chills -myalgia

Therapeutic effects of Dantrolene

-Indications: Directly affects peripheral muscle contractions and is used in the management of spasticity associated with neuromuscular diseases. -Long-term use of dantrolene commonly results in a decrease of the amount and intensity of required nursing care. -Continued long-term use is justified as long as the drug reduces painful and disabling spasticity. -This agent is not used for the treatment of muscle spasms associated with musculoskeletal injury or rheumatic disorders -Used to treat/prophylaxis MALIGNANT HYPERTHERMIA

Therapeutic effects of centrally acting muscle relaxants

-Relief of discomfort associated with acute, painful musculoskeletal conditions -adjunct to rest, physical therapy, and other measures.

Baclofen Adverse Effects

-Transient drowsiness -insomnia -hypotension -nausea -dizziness - weakness -fatigue -urinary frequency

Centrally Acting Skeletal Muscle Relaxants

Baclofen •Carisoprodol •Cyclobenzaprine *Diazepam

Direct-Acting Skeletal Muscle Relaxants

Dantrolene

Centrally acting skeletal muscle relaxants lyse or destroy the spasm.

True- They are also known as spamolytics

(COURSEPOINT)A nurse administers carisoprodol to a client for the treatment of an acute musculoskeletal condition. The nurse would be alert for which adverse effect after administering the drug?

drowsiness

A client with multiple sclerosis asks the nurse to explain why deep tissue massages do not relieve spasticity. The nurse should explain that spasticity is caused by:

nerve damage in the brain and spinal cord, and it is a permanent condition.

(COURSEPOINT)The client is taking cyclobenzaprine for muscle spasms secondary to an injury to the lumbar spine that occurred while lifting a motor at work. The client is being seen for a follow-up visit by the health care provider. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine?

Cyclobenzaprine produces an anticholinergic response

Clinically Important Drug - Drug Interactions for Dantrolene

-combination with estrogens -> incidence of hepatocellular toxicity is apparently increased (avoid combination if possible) Monitor if pt. Is using birth control or hormone therapy

A nurse is caring for a male patient who has a spinal cord injury due to a motorcycle accident. He has been taking dantrolene (Dantrium) for 2 weeks. The nurse will monitor:

The nurse will monitor alanine aminotransferase and total bilirubin levels, because a serious adverse effect of dantrolene is drug-induced hepatitis. The nurse will also educate the patient and family concerning signs and symptoms of hepatitis. Prothrombin time and partial thromboplastin time would be monitored for someone taking an anticoagulant, not for someone taking dantrolene. Urine specific gravity is part of a urinalysis and would be used to assess urinary function, which is not affected by dantrolene use. Follicle-stimulating hormone level is important to the female reproductive system and would not be assessed in a male.

(COURSEPOINT)A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient?

Cyclobenzaprine affects muscle tone, thereby causing reduction of muscle spasm. Administration of cyclobenzaprine does not result in prevention of convulsion, relief from anxiety, or relief from nervous disorder.

Drug - Drug Complications for muscle relaxants

If any of the centrally acting skeletal muscle relaxants are taken with other CNS depressants or alcohol, CNS depression may increase. -avoid alcohol!!! if this combination cannot be avoided, they should take extreme precautions.

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

Liver Function tests

Contradictions and Cautions for Dantrolene

-allergy (hypersensitivity) -Spasticity that contributes to locomotion, upright position, or increased function, which would be lost if that spasticity were blocked -Active hepatic disease (interfere with metabolism/hepatic toxicity) -lactation: drug may cross into breast milk and cause adverse effects in the infant. CAUTION -if pt is experiencing liver toxicity - may experience a prodrome - ANOREXIA, NAUSEA, FATIGUE <- Warning syndrome -women and in all pt > 35 years b/c increased risk of potentially fatal hepatocellular disease -hepatic impairment -pt with respiratory depression, which could be exacerbated by muscular weakness -pt with cardiac disease (cardiac muscle depression may be a risk) -Pregnancy

Muscle relaxant best to treat spasms and anti-anxiety agent

Diazepam (Valium), - acting skeletal muscle relaxant. It may be advantageous in situations in which anxiety may be precipitating the muscle spasm.