Pharm Ch 27 Muscle Spasms and Spasticity

A client who has cerebral palsy is beginning to experience spasticity of the muscles in the upper arm. Which medications would the nurse question if prescribed for this client? Select all that apply. 1. Metaxalone (Skelaxin) dosed three times a day 2. Chlorzoxazone (Parafon Forte) dosed four times a day 3. Carisoprodol (Soma) dosed three times a day 4. Intrathecal baclofen (Lioresal) 5. Tizanidine (Zanaflex) dosed twice a day

1,2,5. Metaxalone (Skelaxin) is ineffective in the treatment of spasticity-related neurologic disorders. Chlorzoxazone (Parafon Forte) is ineffective in the treatment of spasticity related to neurodegenerative disorders. Carisoprodol (Soma) is effective in relieving the pain, muscle spasms, and spasticity associated with cerebral palsy and is dosed three times a day. Baclofen (Lioresal) is effective in reducing muscle spasticity and can be delivered intrathecally. Tizanidine (Zanaflex) is used for muscle spasticity but has a short half-life and must be dosed every 6-8 hours.

The client is being treated with collagenase (Xiaflex) for Dupuytren's contracture. When developing this client's care plan, which nursing diagnoses will the nurse include? Select all that apply. 1. Disturbed Body Image 2. Fatigue 3. Pain, Chronic 4. Risk for Injury, Falls 5. Risk for Altered Tissue Perfusion, Peripheral

1,5. Dupuytren's contracture causes malformation of the hand, which may result in disturbance of body image. Dupuytren's contracture does not result in fatigue. Dupuytren's contracture is generally not painful. Acute pain may occur with treatment. There is no risk for falls associated with Dupuytren's contracture. A possible adverse effect of injection of collagenase is swelling of the affected hand, which could compromise tissue perfusion.

A client scheduled for surgery has a family history of malignant hyperthermia. The circulating nurse will be responsible for seeing that which medication is immediately available for administration? 1. Dantrolene sodium (Dantrium) 2. Baclofen (Lioresal) 3. Tizanidine (Zanaflex) 4. Orphenadrine (Myophen)

1. Dantrolene is a direct-acting skeletal muscle relaxant that interferes with the release of calcium ions that produce hypermetabolism and intense muscle rigidity in malignant hyperthermia. Baclofen is a centrally acting muscle relaxant. Tizanidine is a centrally acting muscle relaxant. Orphenadrine is a centrally acting muscle relaxant.

The parents of a 2-year-old who has cerebral palsy are only now beginning to accept that their child will have permanent disability. The nurse has been instructing the parents about the treatment for the spasticity their child is experiencing. Which statements by the parents indicate that the nurse should plan additional teaching sessions? Select all that apply. 1. "At some point, our child may require surgery to correct this spasticity." 2. "As long as we continue our child's medications, the spasticity can be controlled." 3. "Our physical therapy sessions should focus on flexing our child's muscles." 4. "We should repeat the exercises several times with each muscle group." 5. "It is best to give our child a rest from physical therapy by skipping 1 week a month."

2,3,5. Surgery is sometime necessary in these cases, so this statement reflects accurate knowledge. Medication alone is generally not enough to control spasticity in these children. The parents need additional teaching. The physical therapy sessions for spasticity focus on muscle stretching, not flexion. The parents need additional teaching. Repetitive motion exercises are beneficial in reducing and controlling spasticity. The parents have expressed accurate knowledge. Physical therapy should be routine and consistent in order to reduce or control spasticity. These parents need additional teaching.

The nurse is discharging a 72-year-old man who was hospitalized after a muscle strain injury to his back. One of the discharge prescriptions for this client is cyclobenzaprine (Flexeril) 10 mg three times per day with food. The prescription is written for 90 tablets and there are three refills available. Which information from this situation would alert the nurse for the need to collaborate with the client's health care provider? Select all that apply. 1. The dosage amount is too low for the type of injury this client sustained. 2. Cyclobenzaprine should be used with great caution in those over 65. 3. If taken as directed, the client would be able to take the medication for 120 days. 4. Cyclobenzaprine is not effective for back pain. 5. Cyclobenzaprine should not be taken with food.

2,3. The dosage of 10 mg three times daily is standard. The adverse reactions from cyclobenzaprine include confusion, hallucinations, and cardiac events, which are more common in clients over 65. The manufacturer recommends that treatment not extend beyond 3 weeks or 21 days. Cyclobenzaprine is not effective for muscle spasm due to spinal cord injury, but is useful in the treatment of back pain from muscle strain. The drug may be taken with food or milk if gastric upset occurs.

The client's health care provider prescribed dantrolene sodium (Dantrium) 25 mg daily for the treatment of neck spasms secondary to spinal cord injury. The client reports that the medication is "not working," even though it has been 45 days since the medication was started. What changes in this client's plan of care would the nurse anticipate? Select all that apply. 1. Increase in the dosage frequency to twice a day 2. Discontinuation of the medication 3. Increase in the frequency of hepatic function tests 4. Change to a different medication 5. Addition of succinylcholine (Anectine) to the client's medications

2,4. If no therapeutic effect of the medication is noted after 45 days of treatment, increasing the dosage in not indicated. If there has been no therapeutic effect from the dantrolene after 45 days of therapy, the medication should be discontinued. Simply increasing the frequency of liver tests will not prevent damage to the liver. Since there have been no therapeutic effects from this medication, a different medication is indicated. Succinylcholine (Anectine) is a drug used during surgery, not on an outpatient basis.

The nurse's neighbor says, "My son has been waking up with bad cramps in his calf for the last two nights. He has been working out with his football team, and it has been so hot." Which additional statement would indicate to the nurse that the neighbor needs more information concerning muscle spasms? 1. "I have my son take a multivitamin every day to help replenish calcium and other minerals." 2. "I think I will give him one of my muscle relaxers before practice today." 3. "I've told my son to point his toes upward and gently massage the calf muscle." 4. "I send three 64-ounce bottles of Gatorade and water with my son to practice every day."

2. Hypocalcemia can be a cause of muscle spasms. Muscle relaxers can cause drowsiness and would be inappropriate in this situation. Sharing prescription medications is not a good idea. Gentle massage is therapeutic for muscle spasms. Electrolyte imbalances and dehydration can cause muscles to spasm, so providing plenty of water and electrolyte-replacement fluids such as Gatorade would help prevent cramps.

A 63-year-old female taking the anticholinergic oxybutynin (Ditropan) for urinary incontinence is admitted to the unit with acute muscle spasms after twisting her back in a fall. Which medication used for muscle spasm relaxation would cause the nurse the most concern? 1. Ibuprofen 600 mg 2. Cyclobenzaprine (Flexeril) 3. Tizanidine (Zanaflex) 4. Chlorzoxazone (Parafon Forte)

2. There is no contraindication for use of ibuprofen with anticholinergics. Cyclobenzaprine will enhance anticholinergic side effects and is contraindicated with anticholinergics. There is no contraindication for use of tizanidine with anticholinergics. There is no contraindication for use of chlorzoxazone with anticholinergics.

The client tells the nurse, "The doctor is going to start me on Botox for the muscle spasms in my neck. I've always wanted to try that. It will make me look younger." What information should the nurse provide to this client regarding onabotulinumtoxinA (Botox)? Select all that apply. 1. "Once you start on the medication, it may take a week or so before you notice a change in your skin." 2. "Be certain you take the medication with a full glass of water because it can be hard on your kidneys." 3. "There are many different uses for that drug, depending on how it is administered." 4. "You may have to have additional treatments with the medication in a few months." 5. "You should be aware that side effects of the medication can occur hours or weeks after your treatment."

3,4,5. OnabotulinumtoxinA (Botox) in this client's case will not change the skin. OnabotulinumtoxinA (Botox) is administered by injection into the muscle. OnabotulinumtoxinA (Botox) has many clinical indications. Action depends on the area where the medication is administered. The effects of onabotulinumtoxinA (Botox) generally last from 3 to 6 months. Side effects of onabotulinumtoxinA (Botox) may not occur immediately upon administration, and the client should watch for their development for several hours to weeks later.

A client tells the nurse, "I have been reading about using castor oil as a treatment for muscle cramping. Do you know anything about that?" How should the nurse respond to this question? Select all that apply. 1. "Why don't you ask the doctor about whether it works or not?" 2. "I think you take a tablespoon twice a day." 3. "The castor oil should be warmed before use." 4. "Soak a flannel cloth with the castor oil and apply it to your muscle." 5. "You must wear gloves when handling castor oil."

3,4. The nurse should be prepared to discuss pharmaceutical and nonpharmaceutical methods of symptom management, including complementary and alternative therapies. There is no reason to defer to the health care provider. Castor oil is used as a topical application when it is used for muscle cramping. Warming the castor oil has the added benefit of warming the muscle tissue, which helps to relieve discomfort. The flannel cloth absorbs the castor oil and holds it on the skin. The flannel also holds in the warmth of the oil. There is no indication that contact between castor oil and the hands is detrimental.

A client who was discontinued from using an MAOI 1 week ago has injured his back and is in pain from severe muscle spasms. The client has been prescribed cyclobenzaprine (Flexeril) for the muscle spasms. Which nursing action is the most important? 1. Inform the client to watch for added CNS depression. 2. Warn the client not to operate a motorized vehicle until the effects of the medication are known. 3. Hold the Flexeril and notify the health care provider. 4. Give the Flexeril as prescribed.

3. Added CNS depression is not the important concern here. Although the client should not operate a motorized vehicle until effects of the drug are known, this is not the most important issue. A potentially fatal hypertensive crisis could occur if cyclobenzaprine is used within 14 days of a MAOI. The health care provider needs to be notified that the client has not been off the MAOI for the required minimum of 14 days before the Flexeril was prescribed.

The operating room (OR) nurse is scheduled as the circulator in a case that involves a client with a family history of malignant hyperthermia. The nurse checks to see that dantrolene is readily available. What other medication should the nurse check for availability in case dantrolene must be administered? 1. Dilantin 2. Romazicon 3. Regitine 4. Lovenox

3. Dantrolene is a derivative of Dilantin. Romazicon is used to reverse sedation due to benzodiazepines. Regitine should be available in the event of extravasation of dantrolene. Lovenox is a low-molecular-weight heparin not used in malignant hyperthermia.

A client has been seen for muscle spasms in the upper thigh. The nurse anticipates instructing the client on the use of which medication? 1. Nonsteroidal anti-inflammatory drugs 2. Muscle relaxants 3. Both nonsteroidal anti-inflammatory drugs and muscle relaxants 4. Nonsteroidal anti-inflammatory drugs, muscle relaxants, and narcotic pain relievers

3. Pain relief is greater when nonsteroidal anti-inflammatory drugs are used in combination with another type of medication. Pain relief is greater when muscle relaxants are used in combination with another type of medication. When skeletal muscle relaxants are used in combination with nonsteroidal anti-inflammatories, pain relief is greater than when either agent is used alone. Narcotic pain relievers are typically not prescribed along with muscle relaxants due to the additive effect of sedation.

A client is admitted to the unit from surgery for insertion of pins for traction due to a compound fracture to the left femur. The client has a Foley catheter for gravity drainage. Chlorzoxazone (Parafon Forte) is ordered for the client. The next day, it is noted that the urine has a reddish-orange discoloration. How should the nurse respond to this development? 1. Call the health care provider for an order for a urinalysis. 2. Check the urine for bacteria with a urine chemstick. 3. Continue to monitor I & O. 4. Notify the health care provider about the discoloration in the urine.

3. Red-orange urine is an adverse effect of chlorzoxazone but does not in itself warrant a urinalysis. Red-orange urine is an adverse effect of chlorzoxazone but does not in itself warrant a dipstick for bacteria. Red-orange urine is an adverse effect of chlorzoxazone, so the nurse should continue to monitor I & O. Red-orange urine is an expected adverse effect of chlorzoxazone. It is not necessary to notify the health care provider.

The nurse is caring for a client who has been prescribed cyclobenzaprine (Flexeril) for lower back pain following a work injury. The client has been quite drowsy and dozes off and on throughout the day while taking the Flexeril. Which nursing action is necessary? 1. Holding the cyclobenzaprine until the client can be further evaluated 2. Notifying the health care provider that the client is experiencing extreme drowsiness 3. Continuing the medication as ordered 4. Providing caffeinated beverages to help the client stay awake

3. There is no need to hold the medication, as the sedative effect is expected. Skeletal muscle relaxants, such as Flexeril, act on the CNS and produce sedation, which helps the client with muscle spasms to sleep. The client should continue the medication as ordered. Centrally acting muscle relaxants work through their sedating effects. It is the sedative effect of centrally acting muscle relaxants that helps the muscle spasms.

A client who suffers from frequent calf muscle cramping asks the nurse about using nonprescription capsaicin for pain relief. What information should the nurse provide this client? 1. Capsaicin is seldom effective in the treatment of cramping in calf muscles. 2. The client should plan to use the medication two times each day. 3. This medication should be taken with a full glass of water. 4. The client should wear gloves when handling this medication.

4. Capsaicin increases blood flow to the muscle and can be very effective in increasing mobility and reducing pain. To be most effective, the medication should be applied four times each day. Capsaicin for cramping is a topical ointment and is not taken internally. The medication can cause irritation to the tissues of the hands, so gloves should be worn.

A client is started on cyclobenzaprine for muscle spasms. Which nursing diagnosis should the nurse add to this client's care plan? 1. Risk for Infection 2. Risk for Impaired Urinary Elimination 3. Risk for Impaired Tissue Perfusion 4. Risk for Injury

4. Muscle spasms without skeletal injury do not pose a risk for infection. Bladder spasms are treated with a different medication. There is generally no risk for tissue perfusion in muscle spasms unless the client is immobile and not turned appropriately. The client should be protected from injury related to falls due to excessive drowsiness.

A 45-year-old female client is prescribed dantrolene sodium ((Dantrium) for spasms related to progression of her multiple sclerosis. Which intervention is most important for the nurse to include in this client's care plan? 1. Teach the client the importance of using sunscreen when taking this medication. 2. Assess the client for pain using the pain scale and range of motion. 3. Monitor the client for sedation. 4. Monitor liver function tests.

4. Sunscreen should be worn by the client whenever exposure to sun is expected, but this is not the most important intervention. Assessing for pain is important, but it is not the most important issue. Some sedation is expected with skeletal muscle relaxants. The risk of dantrolene-induced hepatotoxicity is greatest in women over the age of 35, so it should be administered cautiously in these clients.

The nurse is providing discharge instructions for a client who has experienced pulled muscles in the back after lifting a heavy item at work. Which statement by the client indicates the need for further instruction? 1. "I should apply heat for 10 minutes, followed by cold for 10 minutes." 2. "I may sit in a warm whirlpool tub to help relax the back muscles." 3. "I may take 2 to 3 ibuprofen 200 mg each every 6 hours by mouth." 4. "I am to go home and stay on bed rest for the next 2 to 3 days."

4. The application of heat or cold will reduce or relieve muscle spasm and pain. Hydrotherapy increases blood circulation to the site of the muscle spasm to help relieve pain. Nonsteroidal anti-inflammatory drugs relieve muscle pain and reduce inflammation. The client should perform gentle range of motion exercises to the point of physical discomfort, but not pain, several times each day.

A client is going to physical therapy to reduce muscle spasms related to a bulging disc L4-L5. The client is prescribed methocarbamol (Robaxin) for the muscle spasms prior to each physical therapy session. Which instructions should the nurse review with the client? 1. Long-term use can lead to dependence. 2. Do not take the medication with grapefruit juice or grapefruit. 3. The medication can lead to gastric ulcers. 4. Plan on getting a driver for the physical therapy sessions.

4. The medication does not cause dependence. There is no contraindication for taking this medication with grapefruit. Gastric ulcers are not an adverse effect of this medication. The client should not drive until the effects of the medication are known.

A client who is taking baclofen (Lioresal) for muscle spasms due to a spinal cord injury that occurred 5 years ago was hospitalized with pyelonephritis 2 days ago. The client is receiving ciprofloxacin IV for the infection and phenazopyridine (Pyridium) for the bladder discomfort. None of the medications the client takes at home have been continued during the hospitalization. The nurse should monitor this client for which condition? 1. Contractures of the hands and feet 2. Irritable tendon reflexes and scissoring movement of the lower extremities 3. Diminished kidney function 4. Fever and seizures, or hallucinations

4. There is no indication that contractures of the hands and feet might occur. There is no indication that irritable tendon reflexes or scissoring of the lower extremities might occur. While it is important to monitor for urine output, there is nothing in the scenario to indicate that there is diminished kidney function. Abrupt discontinuation following prolonged therapy with baclofen can cause high fever, seizures, severe rebound muscle spasticity, and hallucinations.