Chapter 25 t
Direct-Acting Skeletal Muscle Relaxant Prototype
Dantrolene
Most muscle relaxants drugs are CNS depressants. Which of the following medications acts only on the muscle?
Dantrolene
Used to treat upper motor neuron spasticity in children
Dantrolene
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.
A patient has been admitted to your unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the patient is taking baclofen (Lioresal). Which of the following outcomes would you expect to be associated with use of this medication?
Decreased muscle spasms
One of the adverse effects of dantrolene (Dantrium) includes:
Potentially fatal hepatitis.
Which of the following medications is classified as an antianxiety medication but is also used to treat muscle spasms?
Diazepam (Valium)
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 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."
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 patient teaching should the nurse provide?
"Make sure to see your doctor promptly if you develop yellowish skin or eyes."
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."
A client is receiving botulinum toxin type A as treatment for her frown lines. The nurse would instruct the client about which of the following?
Drooping eyelids
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
A client is receiving baclofen at 8 AM. The nurse would monitor the client for evidence of maximum effect at which time?
10 AM
A patient receives baclofen intrathecally at 8 AM. The nurse would expect the drug to peak at which time?
12 PM
A patient receives intrathecal baclofen at 10 AM. The nurse would expect to see the maximum effect of this drug at approximately what time?
3 PM
A nurse administers carisoprodol to a patient for the treatment of an acute musculoskeletal condition. What adverse reaction of the administration of carisoprodol should the nurse monitor for in this patient?
Drowsiness
A patient is administered cyclobenzaprine (Flexeril). Which adverse effect can you expect with this medication?
Drowsiness
Which of the following is the most common adverse reaction to carisoprodol (Soma) that the nurse should discuss with the patient? (Choose one)
Drowsiness
Which of the following would a nurse identify as increasing a client's risk for hepatic disease with dantrolene use?
Age over 35 years
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
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.
A patient has been started on dantrolene (Dantrium). What is the most serious adverse effect on which the patient should be instructed?
Fatal hepatitis
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
Which of the following is an example of a skeletal muscle relaxant?
Baclofen (Lioresal)
Which of the following is an example of a skeletal muscle relaxant? (Choose one)
Baclofen (Lioresal)
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
May discolor the urine, becoming orange to purple-red when metabolized and excreted
Chlorzoxazone
What is the best position for the client after the administration of a bisphosphonate medication?
High Fowler's
When reviewing the medical record of a patient who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring?
Respiratory depression
Which of the following would a nurse include when describing the action of dantrolene?
Interference with calcium release from the muscles
Baclofen is not
Metabolized
The drug of choice if a child needs to be treated for tetanus
Methocarbamol
Which agent would the nurse identify as also being used to treat tetanus?
Methocarbamol
Which of the following is the drug of choice in children who need to be treated with tetanus?
Methocarbamol (Robaxin)
When reviewing a client's history, which condition would the nurse identify as contraindicating the use of a centrally acting skeletal muscle relaxant?
Rheumatic disorder
An alpha-adrenergic agonist and is thought to increase inhibition of presynaptic motor neurons in the CNS
Tizanidine
Centrally acting skeletal muscle relaxants lyse or destroy the spasm.
True
Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area
True
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 muscle spasm often results from
injury to the musculoskeletal system
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.
Interneuron
neuron in the CNS that communicates with other neurons, not with muscles or glands
Hypertonia
state of excessive muscle response and activity
Muscle spasticity is the result of
damage to neurons within the CNS.
Which of the following adverse effects would a nurse most likely assess in a patient who is receiving a centrally acting skeletal muscle relaxant? Select all that apply.
• Drowsiness • Insomnia • Dry mouth • Constipation
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
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 client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client?
Liver function tests
An operating room nurse is assisting the anesthesiologist in the preparation of an intravenous dose of dantrolene. What emergent issue most likely prompted the need to give the patient dantrolene?
Malignant hyperthermia
A nurse is caring for a patient who is receiving cyclobenzaprine. Which of the following is the action of the drug on the patient?
Reduction of muscle spasm
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
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
Which vitamin supplements should the nurse recommend while a postmenopausal client is taking alendronate (Fosamax)?
Vitamin D and calcium
Signs and symptoms of which of the following would necessitate discontinuation of dantrolene therapy?
Hepatic dysfunction
Spinal reflexes are the simplest nerve pathways that monitor movement and posture.
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.
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
Spasticity may result from
an increase in excitatory influences or a decrease in inhibitory influences within the CNS.
Dantrolene (Dantrium) differs from the other skeletal muscle relaxants because
it acts directly within the skeletal muscle fiber and not within the CNS
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."
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)
Baclofen is available in
- oral - intrathecal forms and can be administered via a delivery pump
A nurse should not administer which of the following skeletal muscle relaxants to a patient with skeletal muscle spasms caused by systemic lupus erythematosus? (Choose one)
Baclofen (Lioresal)
After reviewing information about skeletal muscle relaxants, a group of students demonstrate understanding of the material when they identify which drug as a direct-acting muscle relaxant?
Botulinum toxin type A
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
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.
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
Which of the following medications can be used to treat or prevent malignant hyperthermia?
Dantrolene (Dantrium)
A patient who experienced a lower back injury while doing yard work has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the patient's drug regimen?
Risk for Injury related to CNS depression
A patient's physician has prescribed baclofen in an effort to treat the patient's neuropathic cancer pain. What patient education should the nurse prioritize when teaching the patient about this new medication?
The importance of ensuring safety related to possible sedation
Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area.
True
Spinal reflexes are the simplest nerve pathways that monitor movement and posture
True
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
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
Cyclobenzaprine is available in
controlled release oral form for continual control of the discomfort without repeated dosings
The drug of choice for a patient experiencing severe muscle spasms and pain precipitated by anxiety is
diazepam
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.
Basal Ganglia
lower area of the brain, associated with coordination of unconscious muscle movements that involve movement and position
Cerebellum
lower portion of the brain, associated with coordination of muscle movements, including voluntary motion, as well as extrapyramidal control of unconscious muscle movements
spinal motor neurons
nerves that regulate posture, balance, and movement are the result of a constantly fluctuating sequence of muscle contraction and relaxation
Methocarbamol is available in
oral and parenteral forms
Dantrolene is available in
oral or parenteral forms
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
Spasticity
sustained muscle contractions
Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of which of the following?
Hepatocellular disease
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
A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the physician to do?
Reduce the dose
Which of the following adverse effects would a nurse most likely assess in a patient who is receiving a centrally acting skeletal muscle relaxant? Select all that apply.
• Constipation • Insomnia • Dry mouth • Drowsiness
Patients receiving chlorzoxazone (Paraflex) should be cautioned that which of the following will occur with administration?
Discoloration of urine
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.
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.
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 nurse should review a client's medical conditions prior to administering a dantrolene (Dantrium) as its use is contraindicated in clients with which of the following? Select all that apply:
• Hepatic disease • Lactation
A patient has been diagnosed with cervical dystonia. The nurse would expect which of the following medications to be ordered for this patient?
Botulinum toxin type B
An older client is to receive a centrally acting skeletal muscle relaxant. Which of the following would the nurse expect to be prescribed?
Carisoprodol
Pyramidal Tract
fibers within the CNS that control precise, intentional movement
