PHARM 25 PU

Dantrolene should be avoided in all patients who are 35 or older because of the increased risk of: hepatocellular disease. congestive heart failure. cerebral hemorrhage. diabetic ketoacidosis.

hepatocellular disease. Caution should be used with dantrolene in all patients older than 35 years because of increased risk of potentially fatal hepatocellular disease.

A nurse is caring for a patient who is receiving cyclobenzaprine. Which of is the action of the drug on the patient? Prevention of convulsion Relief from nervous disorder Relief from anxiety Reduction of muscle spasm

Reduction of muscle spasm Cyclobenzaprine has an effect on the muscle tone, thereby causing reduction of muscle spasm. Administration of cyclobenzaprine does not result in prevention of convulsion, relief from anxiety, or relief from nervous disorder.

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? "Have you ever been treated for fibromyalgia?" "At what age did you begin menopause?" "Have you had a hysterectomy?" "Are you on hormone replacement therapy?"

"Are you on hormone replacement therapy?" The combination of dantrolene and estrogen creates an unacceptable risk for hepatotoxicity. For this reason, concurrent use of dantrolene and hormone therapy would be unsafe. The age at which the client began menopause and any history of fibromyalgia or hysterectomy would be much less relevant to the safety and effectiveness of dantrolene.

A client with muscular dystrophy has recently begun taking dantrolene for the treatment of muscle spasms. When assessing for adverse effects, what assessment questions should the nurse include? Select all that apply. "Are you getting any sudden or frequent urges to urinate?" "Have you experienced any new or unusual aches and pains since starting the medication?" "Do you find that the medication gives you an upset stomach?" "Have you noticed any changes in the color of your urine?" "Have you had any nosebleeds or bleeding gums since you started taking this?"

"Do you find that the medication gives you an upset stomach?" "Are you getting any sudden or frequent urges to urinate?" "Have you experienced any new or unusual aches and pains since starting the medication?" Dantrolene is associated with urinary urgency and frequency as well as myalgia and GI irritation. It does not normally change the color of urine or create a risk for bleeding.

A 56-year-old woman with a diagnosis of multiple sclerosis has begun taking dantrolene. What client teaching should the nurse provide? "Take an over-the-counter laxative so that you don't get constipated." "You'll find that your muscles will get progressively stronger over the next several weeks." "You'll have to come to the hospital daily to be administered this drug." "Make sure to see your health care provider promptly if you develop yellowish skin or eyes."

"Make sure to see your health care provider promptly if you develop yellowish skin or eyes." Dantrolene carries a significant risk of hepatitis; signs and symptoms must be reported promptly. It typically causes diarrhea, not constipation, and muscle weakness, not increases in strength. Dantrolene may be administered on an outpatient basis.

Which medication would the nurse expect to administer if prescribed to achieve skeletal muscle relaxation? Alendronate Allopurinol Baclofen Hydroxychloroquine

Baclofen Baclofen is an example of a skeletal muscle relaxant. Allopurinol would be administered to treat gout. Alendronate would be administered to treat osteoporosis. Hydroxychloroquine would be used to treat rheumatoid arthritis.

Which skeletal muscle relaxant is also available in intrathecal form? Tizanidine (Zanaflex) Carisoprodol (Soma) Baclofen (Lioresal) Cyclobenzaprine (Flexeril)

Baclofen (Lioresal) Baclofen is available in oral and intrathecal forms and can be administered via a delivery pump for the treatment of central spasticity.

A client sustained a musculoskeletal injury to his left leg that has resulted in occasional spasticity. What should the nurse expect the health care provider to prescribe? Botulinum toxin type B Cyclobenzaprine Dantrolene Baclofen

Cyclobenzaprine Cyclobenzaprine is used for the treatment of discomfort of acute musculoskeletal conditions. Baclofen is used to treat muscle spasticity associated with neuromuscular diseases. Dantrolene is used to treat upper motor neuron-associated muscle spasticity. Botulinum toxin type B is used to reduce the severity of abnormal head position and neck pain associated with cervical dystonia.

A client with amyotrophic lateral sclerosis is experiencing muscle spasticity. Which drug would the nurse expect the physician to order? Metaxalone Dantrolene Chlorzoxazone Methocarbamol

Dantrolene Dantrolene is indicated for the control of spasticity resulting from upper motor neuron disorders such as amyotrophic lateral sclerosis. Chlorzoxazone, metaxalone, and methocarbamol are used to treat acute musculoskeletal conditions.

A client with a history of malignant hyperthermia is scheduled for surgery. Which agent would the nurse most likely expect to administer? Methocarbamol Botulinum toxin type B Baclofen Dantrolene

Dantrolene Dantrolene is the drug that would be used as prevention and treatment of malignant hyperthermia.

Which medication will inhibit the release of calcium in skeletal muscle cells to minimize the development of muscle contractions? Dantrolene sodium Cyclobenzaprine Carisoprodol Baclofen

Dantrolene sodium Dantrolene sodium relieves spasticity by inhibiting the release of calcium in skeletal muscle cells. All the remaining options act centrally.

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? Carisoprodol Dantrolene sodium Baclofen Cyclobenzaprine

Dantrolene sodium The signs indicated in the scenario suggest malignant hyperthermia. Of the choices offered, dantrolene is the only agent used to treat the condition.

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? Increased muscle strength Decreased severity and duration of exacerbations Reduction in the appearance of new lesions in magnetic resonance imaging (MRI) studies Decreased muscle spasms

Decreased muscle spasms Baclofen, a GABA agonist, is used in the treatment of spasms. It can be administered orally or by intrathecal injection. Avonex and Betaseron reduce the appearance of new lesions in MRI studies. Corticosteroids limit the severity and duration of exacerbations. Anticholinesterase agents increase muscle strength in the upper extremities.

A nurse has admitted two patients to the unit and is are developing care plans for both of them. One of the patients is having a pump placed to deliver intrathecal baclofen. The other patient will be receiving dantrolene as a muscle relaxant. What nursing diagnosis would be appropriate for both care plans?

Deficient knowledge regarding drug therapy Appropriate nursing diagnoses for both patients include: Deficient knowledge regarding drug therapy; Acute pain related to GI and CNS effects; Disturbed thought processes related to CNS effects; and Risk for injury related to CNS effects.

The nurse is caring for a client who is receiving cyclobenzaprine for relief of muscle spasms. What adverse effect should the nurse assess for? Urinary incontinence Drowsiness Muscle spasms Insomnia

Drowsiness A common adverse effect with cyclobenzaprine is drowsiness. The client will not experience muscle spasms, insomnia, or urinary incontinence as a result of this medication therapy.

When developing a teaching plan for a client who is to receive carisoprodol, which sign or symptom would the nurse include as the most common adverse reaction? Dyspnea Tachycardia Drowsiness Hypertension

Drowsiness Drowsiness is the most common adverse reaction to skeletal muscle relaxants like carisoprodol (Soma) that the nurse should discuss with the client. No correlation is found with skeletal muscle relaxants causing dyspnea. The Disease-modifying antirheumatic medication of leflunomide has the adverse reaction of hypertension. Tachycardia can be seen in the use of skeletal muscle relaxants but is not the most common and is seen in the use of dantrolene and diazepam.

The nurse is providing education to a client who has been prescribed dantrolene. What serious adverse effect should the nurse mention during teaching? Hypercarbia Metabolic acidosis Hepatitis Renal calculi

Hepatitis The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene.

The nurse is providing education to a client who has been prescribed tizanidine. What adverse effect should the nurse mention during teaching? Hypotension Eczema Dark black urine Excessive salivation

Hypotension Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine.

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? Myocardial ischemia Malignant hyperthermia Uncontrolled hypertension Cerebrovascular accident

Malignant hyperthermia IV dantrolene is the drug of choice, when accompanied by supportive measures, for acute treatment of malignant hyperthermia. The drug is not used in the treatment of emergent CVA, myocardial ischemia, or hypertension.

Which is the drug of choice in children who need to be treated with tetanus? Carisoprodol (Soma) Methocarbamol (Robaxin) Dantrolene (Dantrium) Baclofen (Lioresal)

Methocarbamol (Robaxin) Methocarbamol is the drug of choice if a child needs to be treated for tetanus.

When reviewing the medical record of a client who is to receive dantrolene, which condition would alert the nurse to the need for close monitoring? The client has respiratory depression from opioid analgesia The client received a blood transfusion less than 24 hours ago The client has an infected surgical wound The client is 67 years old

The client has respiratory depression from opioid analgesia Clients with respiratory depression need to be monitored closely because the use of dantrolene can increase muscular weakness and exacerbate the respiratory depression. None of the other listed client factors would necessarily require increased monitoring.

A history of what medical condition would contraindicate the use of cyclobenzaprine for acute muscle spasms? diabetes mellitus chronic obstructive pulmonary disease (COPD) cardiac arrhythmias transient ischemic attacks (TIA)

cardiac arrhythmias Contraindications to cyclobenzaprine include acute myocardial infarction, arrhythmia, heart block, conduction disturbances, heart failure, and hyperthyroidism. The other listed health problems do not contraindicate its use.

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? Insomnia Anxiety Constipation Drowsiness

Drowsiness The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration. Depression is not an adverse reaction of carisoprodol administration. Insomnia and anxiety are adverse reactions associated with bisphosphonate drugs.

A client with spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? Baclofen Carisoprodol Chlorzoxazone Cyclobenzaprine

Baclofen Baclofen is used for the treatment of muscle spasticity associated with spinal cord injuries. Carisoprodol is used for the relief of discomfort of acute musculoskeletal conditions. Chlorzoxazone is used for the relief of discomfort of acute musculoskeletal conditions. Cyclobenzaprine is used for the relief of discomfort of acute musculoskeletal conditions.

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? Insomnia Constipation Drowsiness Anxiety

Drowsiness The nurse should monitor for drowsiness in the client as the adverse reaction of carisoprodol administration. Depression is not an adverse reaction of carisoprodol administration. Insomnia and anxiety are adverse reactions associated with bisphosphonate drugs.

A patient comes to the clinic for a botox injection around her eyes. While making an assessment, the nurse finds that the patient is taking polymyxin for an infection. What would the nurse do first? Notify the physician. Prepare the patient for the injection. Document the polymyxin on the chart. Wash her hands.

Notify the physician. If the botulinum toxins are used with other drugs that interfere with neuromuscular transmission—neuromuscular junction (NMJ) blockers, lincosamides, quinidine, magnesium sulfate, anticholinesterases, succinylcholine, or polymyxin—or with aminoglycosides, there is a risk of additive effects. If any of these must be given in combination, extreme caution should be used.

Dantrolene is being considered for the treatment of a client's spasticity. Which aspect of the client's current health status is most likely to contraindicate the use of this medication? The client takes opioid analgesics on a regular basis The client's adherence to drug therapy has been irregular The client's spasticity is due to rheumatoid arthritis The client has type 1 diabetes and takes insulin regularly

The client's spasticity is due to rheumatoid arthritis Dantrolene is not used for the treatment of muscle spasms associated with musculoskeletal injury or rheumatic disorders. Diabetes, opioids and issues with adherence would not necessarily contraindicate the use of dantrolene, though these factors must be addressed.

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" "It's likely that your chlorzoxazone is reacting with one of your other medications." "This drug causes your urine to change color, so it's not likely blood that you're seeing." "Please check in again if it doesn't clear up within the next 24 hours." "There's a risk of that with this particular medication, so you should come be assessed promptly."

"This drug causes your urine to change color, so it's not likely blood that you're seeing." Chlorzoxazone causes discoloration of the urine that can mimic hematuria. This is not due to a drug-drug interaction. Telling the client to monitor this for the next day without giving any explanation will not alleviate the client's concern.

A client with impaired liver function secondary to hepatitis C requires a centrally acting skeletal muscle relaxant for temporary pain relief. What medication would put the least metabolic burden on the client's liver? Orphenadrine Baclofen Methocarbamol Diazepam

Baclofen Baclofen is not metabolized. The other answer choices are centrally acting skeletal muscle relaxants that are all metabolized by the liver to differing degrees.

The client is taking baclofen. What would be the most important safety instruction for the nurse to give to this client? Take a laxative when needed. Discontinue the use of alcohol. Learn to self-administer the drug. Do not walk or drive after taking the drug.

Discontinue the use of alcohol. In a client experiencing spasticity, the nurse should advise the client to stop drinking alcohol. Alcohol consumption may increase the adverse effect of sedation, causing sleepiness, dizziness, and blurred vision. The client should not drive or walk after taking the drug; the client should learn to self-administer the drug; and constipation is a concern. However, the most important safety concern is to avoid alcohol.

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? Deep breathing and coughing exercises Continuous pulse oximetry Falls prevention measures Seizure precautions

Falls prevention measures The client's combination of CNS depression from the muscle relaxant and an underlying cognitive deficit creates a risk for falls. This combination is not associated with seizures and will not likely exacerbate the client's COPD; respiratory assessments and interventions would not likely need to be amended.

Signs and symptoms of what would necessitate discontinuation of dantrolene therapy? Urinary retention Intermittent gastrointestinal upset Visual disturbances Hepatic dysfunction

Hepatic dysfunction Dantrolene therapy must be discontinued at any sign of liver dysfunction. Intermittent GI upset, visual disturbances, and urinary retention are associated adverse effects of the drug and, although problematic, do not necessitate discontinuing the drug.

A client has told the nurse that she has been invited to a work colleague's house where she and some of her peers will be able to receive Botox injections. What is the nurse's best response? "What effect are you hoping to achieve with the injections? "It's safest to have these injections performed under medical supervision." "Have you ever received a Botox injection before?" "These injections have serious side effects so it's best to avoid them."

"It's safest to have these injections performed under medical supervision." Botox injections are not deemed unsafe and clients are not normally counselled to avoid them absolutely. However, it is recommended that they be administered under appropriate medical supervision because they are prescription medications and are not risk-free. This caution is more important than asking the client's intentions or previous history of Botox injections.

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? "If you combine baclofen and alcohol you could suffer a severe allergic-type reaction." "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants." "You're not permitted to drink alcohol while you're taking baclofen."

"The combination of baclofen and alcohol could depress your nervous system to a dangerous level." The nurse should explain the rationale for avoiding alcohol while taking baclofen. The nurse should ideally promote abstinence rather than low intake. The nurse should avoid giving a prohibition without explaining. This combination does not result in an allergic reaction.

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? "We'll need to closely monitor your blood sugar levels for the next week." "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time." "There's a small risk that you might experience some hallucinations in the first few days that you begin taking this drug." "You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity." Dantrolene causes weakness because of its generalized reduction of muscle contraction. It is not associated with drug dependence, hyperglycemia, hypoglycemia, or hallucinations.

What is the most important teaching from the plan of care, to emphasize, when a client is prescribed a skeletal muscle relaxant? Drink eight to 10 glasses of water daily to prevent constipation. Report increased muscle spasm to the health care provider immediately. Always take this medication with food to prevent nausea and vomiting. Do not drive or operate machinery until individual drug effects are known.

Do not drive or operate machinery until individual drug effects are known. Drowsiness is the most common reaction seen with the use of skeletal muscle relaxants. The priority of care is safety; therefore, the most important teaching is to tell the client not to drive or operate machinery until the client knows how the drug affects him/her individually. Nausea and constipation may occur, but are not safety priorities. Increased muscle spasm may indicate the drug is not effective, but is not a high safety concern.

The nurse is caring for a client whose current medication regimen includes baclofen 60 mg PO daily. What assessment should the nurse prioritize when assessing for therapeutic effects? Comparison of fine motor and gross motor skills Inspection for muscle spasticity and range of motion assessment Bilateral assessment of muscle strength Assessment for seizure activity

Inspection for muscle spasticity and range of motion assessment Baclofen is prescribed to treat muscle spasticity and/or acute musculoskeletal discomfort. It is not an anticonvulsant and does not affect fine motor versus gross motor skills. An absence of spasticity may increase muscle strength but this is not the most direct effect of the medication.

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? Myocardial ischemia Uncontrolled hypertension Cerebrovascular accident Malignant hyperthermia

Malignant hyperthermia IV dantrolene is the drug of choice, when accompanied by supportive measures, for acute treatment of malignant hyperthermia. The drug is not used in the treatment of emergent CVA, myocardial ischemia, or hypertension.

An older adult is prescribed a skeletal muscle relaxant for reports of neck pain. What is the top priority of care for the nurse to teach the family? Instruct on how to assess client's pain level. Give the medication at the same time each day. Monitor the client before ambulating. Administer the medication with meals.

Monitor the client before ambulating. Safety is the top priority concern, because skeletal muscle relaxants can cause drowsiness. Administering the medication with meals can reduce GI distress but is not the top priority safety concern. Checking the client's pain level is important but not the top priority safety concern. Giving the medication at the same time each day may help the caregivers remember it, but is not the top priority safety concern.

Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. False True

True It is thought that muscle spasms are caused by the flood of sensory impulses coming to the spinal cord from the injured area.

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 he is in direct sunlight. Have a complete blood cell count done weekly. Decrease the dosage if any adverse effect is experienced. Eat a high-protein diet.

Wear appropriate clothing and sunscreen whenever he is in direct sunlight. The nurse will need to caution the patient about the adverse effect of photosensitivity, especially considering his work. He should be advised to wear protective clothing and sunglasses and to use sunscreen whenever he is outside on the job site. A complete blood cell count should be done before therapy begins but would not be needed again unless indicated. A nurse must check with the prescriber before advising a patient to decrease a drug dosage. A diet high in protein is not necessary with this drug.

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: fatigue. dry mouth. constipation. hypotension.

hypotension Tizanidine (Zanaflex) has been associated with hypotension, which could be a safety risk, especially if the client is also taking an antihypertensive drug. Constipation, dry mouth, and fatigue are common adverse effects that do not pose a safety risk.

The nurse who is a case manager is overseeing the care of several clients, both inpatient and community-dwelling. Which client is most likely to benefit from the administration of baclofen? A client with longstanding lower back pain from working long hours at a desk A client with Parkinson's disease who has tremors and gait disturbances affecting quality of life A client with chronic migraines who has not responded to conventional treatment A client who is undergoing rehabilitation following a spinal cord injury at C7

A client who is undergoing rehabilitation following a spinal cord injury at C7 Baclofen treats muscle spasticity and is of particular benefit to clients with spinal cord injuries. It is less commonly used to treat chronic musculoskeletal pain. Baclofen is not normally used to treat Parkinson's disease or migraines.

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. prothrombin time and partial thromboplastin time. follicle-stimulating hormone levels. urine specific gravity.

alanine aminotransferase and total bilirubin levels. The nurse will monitor alanine aminotransferase and total bilirubin levels, because a serious adverse effect of dantrolene is drug-induced hepatitis. The nurse will also educate the patient and family concerning signs and symptoms of hepatitis. Prothrombin time and partial thromboplastin time would be monitored for someone taking an anticoagulant, not for someone taking dantrolene. Urine specific gravity is part of a urinalysis and would be used to assess urinary function, which is not affected by dantrolene use. Follicle-stimulating hormone level is important to the female reproductive system and would not be assessed in a male.