Skeletal Muscle Relaxant

Cyclobenzaprine use is contraindicated in __________ and in individuals with spinal cord injuries, cerebral palsy, diabetes mellitus, or __________ ileus.

children paralytic

The nurse should collect a thorough medical history to determine the presence of any _________________ to cyclobenzaprine.

contraindications

Intravenous _________________ is used for the management of skeletal muscle spasms that accompany the crisis condition known as malignant hyperthermia

dantrolene

Evaluation for Cyclobenzaprine: Evaluate the patient for ___________ stiffness and swelling, increased joint mobility, reduced joint ___________, and improved grip strength.

decreased tenderness

Muscle relaxants ____________ neuronal action in the spinal cord or brain and may even augment neuronal inhibition in the skeletal muscles.

depress

Less common adverse effects of Cyclobenzaprine include:

diarrhea GI upset headache slurred speech muscle stiffness constipation sexual difficulties in males hypotension tachycardia weight gain

Patient teaching for Cyclobenzaprine: Patients should be warned not to participate in ____________ ________________ (eg, driving) if CNS depression is significant.

hazardous activities

Centrally acting muscle relaxants are prescribed in cases of spasticity to repress ___________ reflexes.

hyperactive

Pre-Administration Assessment for Cyclobenzaprine includes collecting a thorough medical history because cyclobenzaprine is only effective for muscle spasms of ______ origin.

local

Cyclobenzaprine is the most commonly used drug in the skeletal muscle relaxants class, and is often prescribed to reduce spasms caused by ______________ injuries.

musculoskeletal

Cyclobenzaprine use is contraindicated in patients with narrow-angle glaucoma or ____________ _________ .

myasthenia gravis

The exact mechanism of action of cyclobenzaprine is unknown, but it is believed to block _________ ________ at the brainstem level.

nerve impulses

Various centrally acting muscle relaxants are used for muscle spasm to decrease ________ and increase _______.

pain ROM

Evaluation for Cyclobenzaprine: Evaluate the effectiveness of the medication by using a _______ __________ to determine whether the patient's muscular pain and/or spasms have diminished.

pain scale

Muscle relaxants are most effective when used in conjunction with ____________ therapy.

physical

Patient teaching for Cyclobenzaprine: Advise the patient that these drugs must be used cautiously in what two patient populations?

pregnant women nursing mothers

Use of all muscle relaxants is contraindicated in patients who have shown a hypersensitivity reaction to them or have compromised ______________ function, active _________ disease, or impaired myocardial function.

pulmonary liver

Patient teaching for Cyclobenzaprine: Teach the patient that the muscle relaxant should not be abruptly stopped and that it should be tapered over 1 week to avoid _________ muscle spasms.

rebound

Centrally acting muscle relaxantsare also prescribed for muscle spasms that are _________ to antiinflammatory medications, physical therapy, or other treatment modalities.

resistant

Carefully observe patients with myasthenia gravis and patients receiving skeletal muscle relaxants or general anesthetics because aminoglycosides can inhibit neuromuscular transmission, causing potentially fatal _____________ _______________ .

respiratory depression

Alcohol, barbiturates, tricyclic antidepressants, sedative-hypnotics, and other CNS depressants used with muscle relaxants will increase ___________.

sedation

Patients can display signs of from use of cyclobenzaprine, so it should be used with great caution.

sedation

Patient teaching for Cyclobenzaprine: Advise the patient not to drive, operate heavy machinery, or make important legally-binding decisions when taking muscle relaxants. These medications have ___________ effects and may cause ___________.

sedative drowsiness

The onset of action, peak concentration time, and duration of action for cyclobenzaprine is _______.

short

Instruct patients taking cyclobenzaprine to go to the nearest emergency department or call 911 if they develop _________ ___ ______ or _______ ______.

shortness of breath chest pain

Patient teaching for Cyclobenzaprine: Encourage the patient to report _______ ___________ of the muscle relaxant

side effects ex: nausea, vomiting, dizziness, fainting, headache, and diplopia.

Muscle relaxants are medications used to relieve muscular _______ and the ____ associated with them.

spasms pain

Skeletal muscle _____________ is a form of muscular hyperactivity that causes painful contractions of the muscles, resulting in limited mobility.

spasticity

Centrally acting muscle relaxants act on the _______ muscles.

spinal

Muscle spasms may be attributed to _________ injuries or __________ ___________ diseases (e.g., MS, CVA, cerebral palsy, or head or spinal cord injuries)

traumatic chronic debilitating

Which statement made by Ms. Wilson regarding cyclobenzaprine indicates further teaching is required by the nurse? "I should avoid alcohol while taking this medication." "I can take this medication as long as I want." "I should take this medication with food." "I need to taper this medication if I want to stop taking it."

"I can take this medication as long as I want." Most muscle relaxants are usually taken for no longer than a few weeks, not for as long as the patient wants.

A nurse is providing discharge teaching to a patient prescribed cyclobenzaprine. Which statement would be most appropriate? "Notify your health care provider if you think you might be pregnant." "Finish the entire prescription, even if you feel better." "You may drive 4 hours after you take the medication." "You may take a sleeping pill, if needed, but only if you have 8 hours to sleep."

"Notify your health care provider if you think you might be pregnant." Cyclobenzaprine should be used with caution in patients who are pregnant, so the health care provider should be notified if the patient thinks she might be pregnant.

A patient has been prescribed a skeletal muscle relaxant and asks the nurse, "Why was I told not to drive or participate in activities that require mental alertness while taking this drug?" How should the nurse respond? "Sedation is a common side effect of skeletal muscle relaxants." "A decrease in peripheral vision is a side effect of skeletal muscle relaxants." "A decrease in muscle tone is a side effect of skeletal muscle relaxants." "Short-term memory loss is a side effect of skeletal muscle relaxants."

"Sedation is a common side effect of skeletal muscle relaxants." Muscle relaxants have a sedative effect and can cause drowsiness. Patients taking muscle relaxants should avoid driving or participating in activities that require mental alertness.

Interventions for Cyclobenzaprine: Observe the patient for any CNS side effects or CNS depression like.... ________, ______________, or decreased ______________

(e.g., dizziness, hypotension, or decreased respirations).

The nurse educates a patient to avoid which drugs while taking muscle relaxants? Select all that apply. Alcohol Ibuprofen Over-the-counter vitamins Kava kava Valerian

Alcohol Alcohol is a central nervous system (CNS) depressant that can increase depression and lead to serious side effects. Kava kava Kava kava is a CNS depressant that can increase CNS depression and lead to serious side effects. Valerian Valerian is a CNS depressant that can increase CNS depression and lead to serious side effects.

Cyclobenzaprine is not effective against muscle spasms caused by __________ disorders.

CNS

The main adverse effects of muscle relaxants result from their effects on the ____ and ___________ muscles.

CNS skeletal

In which way do centrally-acting muscle relaxants relieve muscular spasms and pain associated with traumatic injuries and spasticity from chronic debilitating disorders? Increase neuron activity in the spinal cord or brain, or decrease neuronal inhibition on the skeletal muscles. Sedate the patient the spasms and spasticity are decreased. Depress neuron activity in the spinal cord or brain or by enhancing neuronal inhibition on the skeletal muscles. Increase the hyperactive reflex which blocks the spasms and spasticity.

Depress neuron activity in the spinal cord or brain or by enhancing neuronal inhibition on the skeletal muscles. Increased stimulation from the cerebral neurons cause hyper-excitable neurons, which leads to increased muscle tone and spasticity. Central-acting muscle relaxants depress the neuron activity in the spinal cord or brain, or enhance the neuronal inhibition on the skeletal muscles.

Which are two common side effects of centrally-acting muscle relaxants? Select all that apply. Dizziness Drowsiness Bradycardia Hypertension Dyspnea Polydipsia

Dizziness Dizziness is a common side effect of centrally-acting muscle relaxants. Correct Drowsiness Drowsiness is a common side effect of centrally-acting muscle relaxants.

common side effects of Cyclobenzaprine

Feelings of euphoria Lightheadedness dizziness drowsiness fatigue confusion muscle weakness

To reduce GI upset, it is recommended that patients take Cyclobenzaprine with __________ or ______.

Food or Milk

Interventions for Cyclobenzaprine: Administer the medication with food or milk if ____ _______ occurs.

GI Upset

Where is cyclobenzaprine absorbed? Skin Gastrointestinal (GI) tract Liver Blood

Gastrointestinal (GI) tract Cyclobenzaprine is given by mouth and is absorbed from the GI tract.

What causes dizziness and fainting in patients taking muscle relaxants? Orthostatic (postural) hypotension Taking medication without food Low blood glucose levels Dehydration

Headache Headache is a side effect of muscle relaxants that should be reported to the health care provider. Nausea Nausea is a side effect of muscle relaxants that should be reported to the health care provider. Muscle weakness Muscle weakness is a side effect of muscle relaxants.

Use of all muscle relaxants is contraindicated in patients with which condition? Brain tumor Diabetes Acromegaly Hepatic disease

Hepatic disease Muscle relaxants are metabolized in the liver; therefore, a patient with hepatic disease would be contraindicated.

Which herbals may interact with cyclobenzaprine?

Herbs kava valerian gotu kola SAMe St. John's wort

Where is cyclobenzaprine excreted? Kidneys Liver Lungs Skin

Kidneys Cyclobenzaprine is excreted via the kidneys through urine.

A patient who has been on oral muscle relaxants for 6 weeks asks for a prescription renewal. When contacting the health care provider, what is the nurse most concerned about? Length of time patient has been on medication Need for an order to increase the dose Need for an order to decrease the dose Route that current medication is prescribed

Length of time patient has been on medication The nurse would be most concerned about the length of time the patient has been on the prescribed muscle relaxant. Patients with acute spasm should only be on the medication for no longer than 3 weeks due to risk of addiction.

Which nursing assessments are important for a patient prescribed cyclobenzaprine? Select all that apply. Level of consciousness Breathing Blood pressure Blood glucose Vision checks

Level of consciousness Due to the sedative effects of cyclobenzaprine, the patient's level of consciousness should be frequently monitored. Breathing Due to the sedative effects of cyclobenzaprine, breathing should be assessed frequently. Blood pressure Muscle relaxants can cause orthostatic hypotension, which can lead to dizziness and fainting.

Which lab values would need to be monitored based on the metabolism of cyclobenzaprine? Liver function tests Blood urea nitrogen (BUN) and creatinine Serum amylase and lipase Arterial blood gases

Liver function tests Cyclobenzaprine is metabolized in the liver; therefore liver function tests should be monitored.

__________ used with muscle relaxants may increase the risk of hypertensive crisis and seizures.

MAOIs

A patient is complaining of gastrointestinal symptoms when taking a prescribed muscle relaxant. What should the patient drink to help with these symptoms? Water Lemonade Milk Tea

Milk Milk can coat the lining of the stomach and can be helpful with a patient who is having gastrointestinal symptoms with muscle relaxants.

The nurse will teach the patient that cyclobenzaprine can relieve which symptoms? Select all that apply. Muscle stiffness Muscle paralysis Localized muscle spasms Pain with range of motion Spasticity caused by myasthenia gravis

Muscle stiffness Localized muscle spasms Pain with range of motion

Two considerations for pre-admission assessment for Cyclobenzaprine

Obtain baseline vital signs. Obtain the patient's current or most recent drug history to help avoid any possible drug interactions.

Which side effects of muscle relaxants should patients report to the health care provider? Select all that apply. Coughing Headache Nausea Tinnitus Amber urine Muscle weakness

Orthostatic (postural) hypotension Muscle relaxants can cause orthostatic (postural) hypotension which can lead to dizziness and fainting. Encourage the patient to stand up slowly from either a lying or sitting position.

__________ used with muscle relaxants may increase the risk of seizures.

Tramadol

___________ can result from either increased muscle tone caused by increased CNS stimulation from cerebral neurons or from a lack of inhibition in the spinal cord or the skeletal muscles.

Spasticity

Because cyclobenzaprine increases sun sensitivity and can lead to severe sunburn, remind patients to use __________, hats, and protective clothing during sun exposure.

Sunscreen

Patients should change positions purposefully and slowly when taking muscle relaxants to prevent which condition? Muscle spasms Syncope or dizziness Increased muscle pain Skin breakdown

Syncope or dizziness Patients should change positions purposefully and slowly to prevent orthostatic (postural) hypotension that could lead to dizziness and syncope.

The nurse plans on providing patient teaching to Ms. Wilson regarding cyclobenzaprine. Which would be considered appropriate information for the nurse to share with Ms. Wilson? Teach Ms. Wilson to avoid concomitant use with alcohol and other CNS depressants. Cyclobenzaprine should be taken every 8 hours around the clock. Instruct Ms. Wilson to take cyclobenzaprine every morning prior to driving to work to increase range of motion in her cervical spine. Instruct Ms. Wilson to take cyclobenzaprine on an empty stomach.

Teach Ms. Wilson to avoid concomitant use with alcohol and other CNS depressants. Concomitant use of cyclobenzaprine and alcohol and other CNS depressants may intensify CNS depressant effects of the drug.

What is the rationale in teaching a patient that the muscle relaxant should not be abruptly stopped? To avoid rebound spasms. To prevent heart palpitations. To decrease chances of depression associated with chronic pain. To prevent permanent nerve damage.

To avoid rebound spasms. Muscle relaxants should be tapered, rather than stopped abruptly, to avoid rebound spasms.

Why should a patient taking cyclobenzaprine report any side effects to the health care provider? To prevent respiratory depression To decrease prescribed dose To increase prescribed dose To prevent hypertension

To prevent respiratory depression Muscle relaxants cause central nervous system depression, especially at toxic levels. Early identification is necessary to prevent respiratory depression.

How would a nurse show respect when offering a prescription to Pacific Islanders regarding muscle relaxants? Use one hand when presenting the information. Use two hands when presenting the information. Nod when presenting the information. Shake the patient's hand before presenting the information.

Use two hands when presenting the information. In showing respect, the nurse should use two hands to offer prescriptions to Pacific Islanders.

Patient teaching for Cyclobenzaprine: Inform the patient that most centrally acting muscle relaxants for acute spasms are usually taken for no longer than a few _______.

Weeks

Patient teaching for Cyclobenzaprine: Teach the patient to avoid combining muscle relaxants with __________ and CNS ____________ . If muscle relaxants are taken concomitantly, CNS effects may be intensified.

alcohol depressants

Serious adverse reactions of Cyclobenzaprine include :

allergic reaction angioedema myocardial infarction seizures ileus.

Interventions for Cyclobenzaprine: Assist the patient with ____________ if necessary to prevent falls.

ambulation

Cyclobenzaprine use is contraindicated in patients with certain _________________ disorders, hyperthyroidism, and _________ impairment and in patients taking MAOIs.

cardiovascular hepatic

Evaluation for Cyclobenzaprine: Be alert to both ___________ and ______ ___________ indications of pain and/or pain relief.

verbal and non-verbal

Interventions for Cyclobenzaprine: Record the patient's ______ _______ prior to administration and report any abnormal results.

vital signs

The muscle relaxant effect also causes muscle ________ and increases the risk for _______.

weakness falls