Pharmacology Chapter 25: Muscle Relaxants
A patient has been diagnosed with cervical dystonia. The nurse would expect which medication to be ordered for this patient?
Botulinum toxin type B
An older adult resident of a long-term care facility is experiencing muscle spasticity and has just been prescribed a centrally acting skeletal muscle relaxant. The client has comorbidities of early stage Alzheimer's disease and chronic obstructive pulmonary disease (COPD). What nursing action should the nurse prioritize for adding to the client's care plan?
Falls prevention measures
T/F: OnabotulinumtoxinA (Botox Cosmetic) is designed to be used over the counter, while rimabotulinumtoxinB (Myobloc) is available by prescription only
False
The nurse instructs a client prescribed the muscle relaxant baclofen that the medication should be tapered slowly to prevent which adverse effect?
Hallucinations
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
When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as a common adverse reaction?
Drowsiness
The nurse is caring for a 59 year-old female client who was diagnosed with multiple sclerosis two years ago. In recent weeks, the client has developed increasing muscle spasticity and the care team is considering the use of dantrolene. What assessment question should the nurse prioritize?
"Are you on hormone replacement therapy?"
A nurse is teaching a client about musculoskeletal medication that has been prescribed. The client needs further teaching about the medication when making which statements?
"I take my medicine with three to four beers each evening."
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."
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:
Alanine aminotransferase and total bilirubin levels
The nursing instructor is teaching a group of students about drugs used for muscle spasms and cramping. The instructor determines the session is successful when the students correctly choose which instruction as relevant to skeletal muscle relaxants?
Avoid alcohol or other CNS depressants
A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered?
Baclofen
A patient with severe spasticity it receiving a medication that is administered intrathecally. Which medication is the client receiving?
Baclofen
Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation?
Baclofen
The nurse is caring for a patient who has sustained a spinal cord injury and is experiencing muscle spasticity. Which can the nurse expect to administer?
Baclofen (Lioresal)
Which skeletal muscle relaxant is also available in intrathecal form?
Baclofen (Lioresal)
A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms?
Cardiac arrhythmias
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?
Carisoprodol
The extra pyramidal tract is made up of cells from which areas?
Cerebral cortex
The nurse instructs a client about the possibility of his urine turning orange to purple-red if the client were receiving:
Chlorzoxazone
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
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 drug would the nurse expect the physician to order?
Dantrolene
A surgical client has developed malignant hyperthermia. Which medication can be used to treat this health emergency?
Dantrolene
During surgery to repair a ruptured Achilles tendon, the client develops severe muscle contractions and a dramatic rise in body temperature. Which medication will be administered?
Dantrolene sodium
A client has been admitted to the unit for treatment of a multiple sclerosis exacerbation. The admission order indicates that the client is taking baclofen. Which outcome would the nurse expect to be associated with use of this medication?
Decreased muscle spasms
Which medication is classified as an antianxiety medication but is also used to treat muscle spasms?
Diazepam (Valium)
What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant?
Do not drive or operate machinery until individual drug effects are known
A female client has been taking dantrolene for several years and has now requested a prescription for oral contraceptives from her primary care provider. What is the nurse's best action?
Ensure all members of the care team are aware of the risk for hepatoxicity
Lower level movements of an uncontrolled and unconscious nature that allow for automatic adjustments in posture and balance are controlled by the _____________ tract fibers
Extrapyramidal tract fibers
T/F: Dantrolene (Dantrium) is designed to relax skeletal muscles by blocking neuromuscular transmission
False
The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching?
Hepatitis
The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching?
Hypotension
A client with spastic hypertonia resulting from cerebral palsy has not responded appreciably to oral baclofen. During the client's care conference, the nurse should anticipate a discussion about what possible treatment?
Intrathecal baclofen infusion
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
The nurse assesses a patient with muscle spasticity. The nurse knows this spasticity resulted from injury to which?
Neurons
Which controls precise, intentional movement and higher level movements?
Pyramidal tract fibers
When does a client with spinal cord injury-associated spasticity require treatment for this condition?
Safety, mobility, and activities of daily living are impaired
The nurse is reviewing new medication orders for a client with severe muscle spasms. For which condition would the nurse question providing the client with a dose of baclofen?
Seizure disorder
A 60 year-old female client has multiple sclerosis accompanied by muscle spasticity. The client has responded well to dantrolene 200 mg PO daily in divided doses. What assessment finding should the nurse prioritize for communication to the client's provider?
The client's most recent laboratory results show an upward trend in AST and ALT levels
A client's health care provider has prescribed baclofen in an effort to treat neuropathic cancer pain. What education should the nurse prioritize when teaching the client about this new medication?
The importance of ensuring safety related to possible sedation
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 instruction?
Wear appropriate clothing and sunscreen whenever
Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of:
hepatocellular disease
A 32-year-old female client is taking tizanidine (Zanaflex) for spasticity related to her multiple sclerosis. The nurse will inform the client and her husband that the adverse effect that poses the greatest safety risk to the client is:
hypotension
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
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?
"My urine could be discolored while I take this drug."
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."
A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response"
"This drug causes your urine to change color, so it's not likely blood that you're seeing."
Signs and symptoms of what would necessitate discontinuation of dantrolene therapy?
Hepatic dysfunction
After anesthesia, the patient experiences a malignant hyperthermia. The nurse expects an order for intravenous:
dantrolene (Dantrium)
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."
A nurse is preparing a teaching plan for a client who is receiving baclofen therapy. Which would the nurse include as possible adverse effects? (Select all that apply.) -Drowsiness -Hypertension -Urinary frequency -Agitation -Drooling -Constipation
-Drowsiness -Urinary frequency -Constipation
A 1-month-old newborn weighing 11 lb. who was a precipitous birth is diagnosed with tetanus. How many milligrams (mg) of methocarbamol should the client receive intravenously (IV) per day when the prescribed amount is 15 mg/kg? Record your answer using a whole number.
75
A client with muscle spasticity following a back injury has been prescribed tizanidine (Zanaflex) 8 mg t.i.d. for use on an outpatient basis. When filling this prescription for a two-week supply, how many 4-mg tablets will the pharmacy provide the client with?
84
Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping?
Avoid alcohol or other CNS depressants
A client is receiving botulinum toxin type A as treatment for frown lines. The nurse would instruct the client about:
drooping eyelids
T/F: RimabotulinumtoxinB (Myobloc) is used to relax facial muscles and decrease the appearance of "frown lines"
False
T/F: Centrally acting skeletal muscle relaxants lyse or destroy the spasm
True
T/F: Cyclobenzaprine (Amrix) is an example of spasmolytic that works in the CNS to interfere with the reflexes that cause a muscle spasm
True
T/F: Muscle spasms are thought to arise from the blood of sensory impulses coming to the spinal cord from an injured area
True
T/F: Patients who take birth control pills who are prescribed dantrolene (Dantrium) should switch to a barrier pregnancy protection method
True
The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for?
Drowsiness
A client with a lower back injury was recently prescribed chlorzoxazone 250 mg PO t.i.d. The client has phoned the clinic, telling the nurse, "My pain's better, but I'm worried that my bladder is bleeding because there's been blood in my urine." What is the nurse's best response."
"This drug causes your urine to change color, so it's not likely blood that you're seeing."
A client with muscle spasticity has been prescribed baclofen. In order to promote the safe use of this medication, the nurse should encourage the client to:
Avoid drinking alcohol for the duration of treatment