Ch. 44 Drugs Used to Treat the Musculoskeletal System

Which medication does the nurse expect to be ordered for a patient with cerebral palsy who is experiencing significant muscle contractions and stiff, involuntary muscle movements and spasticity?

dantrolene (Dantrium)

A student nurse is caring for a patient with a traumatic spinal cord injury who just received a neuromuscular blocking agent. Which statement made by the student requires correction by the supervising nurse?

"The patient has received a neuromuscular blocking agent, and that's all that will be needed."

Nurse monitors adverse effects up to 48 hours or more after administration of neuromuscular blocking agents

- Observe respiratory function, ability to swallow secretions, cough reflex - Monitor VS and arterial blood gases = CO2 level - Watch for hypoxia, hypercapnia (tachycardia, hypotension, cyanosis) - Suction, oxygen, mechanical ventilator, resuscitation equipment should be nearby

Nursing Implications: Musculoskeletal Disorders

1. Adapt procedures for self-care 2. Administer prescribed medications 3. Instruct on application of heat/cold packs, elevate extremity immediately after injury 4. Maintain prescribed activity level and immobilization of affected part 5. Range-of-motion exercises 6. Promote relaxation

Assess for skeletal muscle disorders

1. Current history: Reason for treatment, degree of impairment. Pain level and use of analgesics. Extent of muscle spasticity and muscle groups affected 2. History: Diagnoses that caused impairment, details of additional injuries 3. Medication history 4. Activity and exercise: - Extent of daily exercise - Determine which ADLs require help - Ask about assistive devices (cane, walker, wheelchair, etc.) 5. Sleep and rest 6. Elimination 7. Nutrition: history and weight 8. Physical examination 9. Review diagnostic studies and laboratory reports

Drug Class: Centrally Acting Skeletal Muscle Relaxants

1. Examples: - carisoprodol (Soma), chlorzoxazone (Lorzone), cyclobenzaprine (Flexeril, Amrix), metaxalone (Skelaxin), methocarbamol (Robaxin), orphenadrine citrate (Norflex), tizanidine (Zanaflex). 2. Actions: - Act by CNS depression, although exact mechanism of action not known 3. Uses: In combination with physical therapy, rest, and analgesics to relieve muscle spasm associated with painful musculoskeletal conditions 4. Common adverse effects: - Sedation, weakness, lethargy, GI complaints 5. Serious adverse effects: - Hepatotoxicity, blood dyscrasias

Nursing Implications: Neuromuscular Blockers

1. Used during anesthesia and surgery to relax muscle groups; used during mechanical ventilation to improve oxygenation 2. PATIENT MUST BE INTUBATED AND RECEIVING MECHANICAL VENTILATION! 3. May produce increased salivation, keep suction nearby 4. Monitor for respiratory distress 5. Assist with deep-breathing exercises, coughing activities

Drug Therapy for Muscle Disorders: Skeletal Muscle Relaxants

1. Used to treat low back pain and spastic muscle conditions 2. Spasticity: muscle hypertonicity and involuntary jerks; stiff, awkward movements; complication of multiple sclerosis, cerebral palsy 3. Muscle spasms: sudden alternating contractions and relaxations or sustained contractions of muscles

Patient Education

1. pain relief 2. activity and exercise 3. psychosocial 4. sedative effect of certain medications

Drug: dantrolene (Dantrium)

1.Actions: Produces generalized mild weakness of skeletal muscles; decreases force of reflex muscle contractions 2. Uses: Controls spasticity of chronic disorders like cerebral palsy, multiple sclerosis, spinal cord injury, stroke syndrome 3. Common adverse effects: Weakness, drowsiness, dizziness, lightheadedness; diarrhea 4. Serious adverse effects: photosensitivity, hepatotoxicity.

1. Drug: baclofen (Lioresal, Kemstro)

2. Actions: Act somewhat differently from the centrally acting agents 3. Uses: Manage muscle spasticity resulting from multiple sclerosis, spinal cord injuries, cerebral palsy 4. Common adverse effects Nausea, fatigue, headache, drowsiness, dizziness 5. *Do not abruptly stop baclofen. May cause severe exacerbation of spasticity and hallucinations may result.

Common Musculoskeletal Disorders

Cerebral palsy, Multiple sclerosis, Spinal Cord Injury, Muscular Dystrophy, Oseoarthritis, Scoliosis, Stroke syndrome

Neuromuscular blockers

PARALYZE but do NOT relieve pain. Never just give it alone, they can still hear, feel and see!

What is the function of centrally acting skeletal muscle relaxants?

Treat acute muscle injuries with associated muscle spasm

Which is an important action of neuromuscular blocking agents?

Producing muscle relaxation and reducing the use of anesthetic agents during general surgery.

Detection of respiratory depression

Restlessness, anxiety, lethargy, decreased alertness, headache are early signs. Use of abdominal, intercostal, or neck muscles -flaring of nostrils Cyanosis (late sign)