Muscle spastcity

mechanism of action of Dantrolene

Acts directly on skeletal muscle Suppresses the release of calcium from the sarcoplasmic reticulum

Mechanism of action of diazepam

Acts in the CNS Mimics action of GABA

Mechanism of action of Baclofen [Lioresal]

Acts in the spinal cord Suppresses hyperactive reflexes Mechanism unknown May mimic the action of GABA on spinal neurons

A patient with multiple sclerosis is prescribed baclofen [Lioresal]. Which assessment by the nurse indicates that the medication is exerting its desired effect? Decreased strength Suppression of spasticity Improved muscle tone Increased muscle resistance

Answer: B Rationale: Baclofen suppresses the hyperactive reflexes involved in the regulation of muscle movement. The drug will suppress spasticity, which consists of heightened muscle tone, spasm, and loss of dexterity.

A patient is prescribed metaxalone [Skelaxin]. Which sign or symptom should the nurse teach the patient to report immediately to the healthcare provider? Drowsiness Yellow skin color Dizziness Decreased pain

Answer: B Rationale: The intended effect of metaxalone is to decrease pain caused by muscle spasms. Drowsiness and dizziness are expected adverse effects of this drug. Jaundice (yellow skin color) indicates hepatotoxicity and possible liver failure. The healthcare provider needs to be contacted, and the drug needs to be discontinued.

The nurse instructs a patient about taking orphenadrine [Norflex]. The nurse determines that teaching is successful if the patient makes which statement? "It is common to experience insomnia when taking this drug." "Prescription muscle relaxants do not cause dependence." "I should avoid drinking alcohol while taking this medication." "This medication may cause increased saliva and diarrhea."

Answer: C Rationale: Adverse effects of centrally acting muscle relaxants such as orphenadrine include central nervous system depression; patients should avoid alcohol and all other central nervous system depressants. Other adverse effects of orphenadrine include atropine-like symptoms (for example, dry mouth, constipation) and drowsiness. Orphenadrine may also cause physical dependence.

What two drugs act in the CNS to treat spacsity?

Baclofen [Lioresal] and diazepam

What drug used to treat spasity and Acts directly on the smooth muscle

Dontrolene

Any anticholinergic (Cyclobenzaprine and orphenadrine) and benzodiazipines can be a high risk medication to administer to elderly population! why??

Fall and cognitive impairment

Adverse effects of centrally acting muscle reactors

Generalized CNS depression Hepatic toxicity Tizanidine [Zanaflex] and metaxalone [Skelaxin] can cause damage Check Liver Labs! Chlorzoxazone [Paraflex] can cause hepatitis and necrosis Not used often because of harm vs benefit Physical dependence Abstinence syndrome

Adverse effects of Dantrolene [Dantrium]

Hepatic toxicity Check liver function before and during tx Muscle weakness Drowsiness Diarrhea Acne-like rash

Physical measure to prevent spasm?

Immobilization of affected muscle Cold compresses Whirlpool baths Physical therapy

Muscle spasm

Involuntary contraction of muscle or muscle group Causes Epilepsy Hypocalcemia Pain syndromes: Acute and chronic Trauma: Localized skeletal muscle injury

Diazepam is what?

Member of the benzodiazepine family The only one labeled to treat spasticity

What is Spasticity?

Movement disorders of CNS origin Most common causes: Multiple sclerosis and cerebral palsy Characteristics include the following: Heightened muscle tone Spasm Loss of dexterity

Theraputic uses of Barlofen

Multiple sclerosis, spinal cord injury, and cerebral palsy NOT used with stroke Decreases flexor and extensor spasms Suppresses resistance to passive movement No direct effect on skeletal muscle

Adverse effects of Barlofen

No antidote for overdose Gradual withdrawal over 1 to 2 weeks Abrupt intrathecal withdrawal: Risk for rhabdomyolysis CNS depressant Gastrointestinal symptoms (for example, nausea, constipation) Urinary retention

Central acting muscle reactants theraputic use..

Relief of localized spasm caused by muscle injury Can decrease local pain and tenderness Can increase range of motion Sedation

Theraputic uses of Dantrolene

Spasticity associated with multiple sclerosis, cerebral palsy, and spinal cord injury Malignant hyperthermia -Potentially fatal condition caused by succinylcholine and general anesthetics

Tizandine can cause...

can cause dry mouth, hypotension, hallucinations, and psychotic symptoms

Carisoprodol can cause

hazardous to patients predisposed to intermittent porphyria, so it is contraindicated for this group

Methocarbamol can cause.....

may turn urine brown, black, or dark green; patients should be forewarned of this harmless effect.

adverse effects of diazepam

sedation