Pharm Chapter 25 - Muscle Relaxants

Which medication is classified as an antianxiety medication but is also used to treat muscle spasms? Carisoprodol (Soma) Tizanidine (Zanaflex) Chlorzoxazone (Paraflex) Diazepam (Valium)

Diazepam (Valium)

What is the most important teaching point to emphasize from the plan of care 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. Do not drive or operate machinery until individual drug effects are known. Always take this medication with food to prevent nausea and vomiting.

Do not drive or operate machinery until individual drug effects are known.

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

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

A client has received a prescription for baclofen. The home care nurse would schedule which laboratory tests to monitor this client? CBC and electrolytes Liver function tests Cardiac function tests Hemoglobin and hematocrit

Liver function tests Baclofen is metabolized in the liver and excreted in urine. The client must be monitored for adverse effects on liver function.

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? Uncontrolled hypertension Myocardial ischemia Malignant hyperthermia Cerebrovascular accident

Malignant hyperthermia

Which agent would the nurse identify as also being used to treat tetanus? Methocarbamol Orphenadrine Tizanidine Metaxolone

Methocarbamol

A patient is taking tizanidine (Zanaflex) to treat spasticity from multiple sclerosis. Which adverse effect of muscle relaxants is most pronounced with this medication? Hypotension Dark black urine Excessive salivation Eczema

Hypotension

Spinal reflexes are the simplest nerve pathways that monitor movement and posture. T/F?

True The spinal reflexes are the simplest nerve pathways that monitor movement and posture.

A client asks the nurse about herbal therapies for osteoarthritis. What is the nurse's best response? "Most herbal therapies are deemed unsafe and their use is not recommended." "Glucosamine and chondroitin are generally well tolerated and not considered harmful." "Calcium and vitamin D are recommended in increased dosages." "Glucosamine is recommended in an injectable form for osteoarthritis."

"Glucosamine and chondroitin are generally well tolerated and not considered harmful."

A 50-year-old woman has begun taking baclofen to treat her recently diagnosed multiple sclerosis (MS). What teaching point should the nurse provide to the patient about her new drug regimen? "It's best to avoid taking a dose of baclofen unless your spasticity becomes impossible to manage." "Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." "Even though baclofen is a drug that's available over the counter, it still has the potential to cause serious adverse effects if taken incorrectly." "You'll likely have to stop taking your other medications for a week to ten days before starting to take baclofen."

"Make sure that you don't stop taking baclofen suddenly because it might cause your symptoms to rebound quite sharply." Abrupt discontinuation of baclofen should be avoided, as it may result in severe side effects such as confusion, seizures, exacerbations of severe spasticity, hallucinations, and other psychiatric disorders. Baclofen is not available over the counter and is prescribed on a scheduled basis, rather than in response to acute symptoms. It is not necessary to stop taking other drugs prior to or during treatment with baclofen.

A patient who is receiving chlorzoxazone reports that his urine is somewhat orange in color. Which response by the nurse would be most appropriate? "Your kidneys aren't properly getting rid of the drug." "We need to discontinue the drug immediately." "There must be some bleeding that is occurring somewhere." "This discoloration sometimes occurs with this drug."

"This discoloration sometimes occurs with this drug."

Which instruction should the nurse specifically stress when administering drugs used for muscle spasm and cramping? Take the drug with food. Stay upright for 30 minutes after taking the drugs. Avoid alcohol or other CNS depressants. Take the drug with 6 to 8 oz of water.

Avoid alcohol or other CNS depressants. The nurse should instruct the patient to avoid alcohol or other CNS depressants when taking a drug for muscle spasms and cramping. The nurse should instruct patients taking drugs for osteoporosis to take them with 6 to 8 oz of water and to stay upright for 30 minutes after taking drugs. The nurse should instruct patients with gout to take drugs for treating gout with food.

An older patient with a history of renal dysfunction is to receive a centrally acting skeletal muscle relaxant. Which agent would be most appropriate? Carisoprodol Cyclobenzaprine Baclofen Chlorzoxazone

Baclofen

Which is an example of a skeletal muscle relaxant? Alendronate (Fosamax) Allopurinol (Zyloprim) Baclofen (Lioresal) Hydroxychloroquine (Plaquenil)

Baclofen (Lioresal)

After teaching a group of students about skeletal muscle relaxants, the instructor determines a need for additional teaching when the students identify what as a centrally acting skeletal muscle relaxant? Botulinum toxin type A Orphenadrine Methocarbamol Diazepam

Botulinum toxin type A

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

Dantrolene

Most muscle relaxants drugs are CNS depressants. Which medication acts only on the muscle? Metaxalone Dantrolene Tizanidine Carisoprodol

Dantrolene

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

Which is the most common adverse reaction to carisoprodol (Soma) that the nurse should discuss with the patient? Tachycardia Dyspnea Drowsiness Hypertension

Drowsiness (muscle relaxer)

A nurse should review a client's medical conditions prior to administering a dantrolene as its use is contraindicated in clients with which issues? (Select all that apply.) Hypertension Atrial fibrillation Hepatic disease Diabetes Lactation

Hepatic disease Lactation The use of dantrolene (Dantrium) is contraindicated during lactation and in clients with active hepatic disease and muscle spasm caused by rheumatic disorders.

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

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

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.

A male client routinely takes baclofen as a skeletal muscle relaxant for a neuromuscular disorder. His last lab results indicate that he is experiencing renal insufficiency. Based on these data, what would the nurse expect the health care provider to do? Increase the dose Titer the dose Maintain the current dose Reduce the dose

Reduce the dose The skeletal muscle relaxants should be used cautiously in clients with renal impairment. Dosage of baclofen must be reduced.

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

A 29-year-old client who experienced a lower back injury has seen his range of motion decrease and his pain increase over the past several weeks. As a result, he has been prescribed cyclobenzaprine. What nursing diagnosis should the nurse prioritize in light of the client's drug regimen? Risk for Injury related to CNS depression Risk for Impaired Swallowing related to adverse neuromuscular effects Risk for Sexual Dysfunction related to endocrine changes Risk for Ineffective Airway Clearance related to increased secretions and decreased lung function

Risk for Injury related to CNS depression The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The drug is not noted to impact the patient's ability to swallow, cough, or function sexually.

When does a client with spinal cord injury-associated spasticity require treatment for this condition? Ambulation is possible only with an assistive device. Safety, mobility, and activities of daily living are impaired. Pain is present in all affected extremities. Orthopedic procedures are indicated.

Safety, mobility, and activities of daily living are impaired. In clients with spinal cord injury, spasticity requires treatment when it impairs safety, mobility, and the ability to perform activities of daily living (e.g., self-care in hygiene, eating, dressing, and work or recreational activities). The treatment should be implemented before the other options occur.

Baclofen (Lioresal) is used in the treatment of muscle spasticity associated with which disease processes? (Select all that apply.) Quinidine-induced leg cramps Spinal cord injury Tetanus Muscle rigidity Multiple sclerosis

Spinal cord injury Muscle rigidity Multiple sclerosis Baclofen is used in the treatment of muscle spasticity associated with neuromuscular diseases such as multiple sclerosis, muscle rigidity, and spinal cord injuries.

For which patient would cyclobenzaprine not be prescribed for muscle spasms? The patient who underwent a lumbar laminectomy and is having back spasms The patient who is having muscle spasms because of cerebral palsy The patient who is having muscle spasms in the left leg after a fracture The patient who strained a quadriceps muscle playing baseball

The patient who is having muscle spasms because of cerebral palsy

The physician orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition? When close supervision is available for monitoring drug effects When the spasms cause uncontrolled pain When the client needs to be alert during pain management During school hours to increase alertness and management of spasms

When close supervision is available for monitoring drug effects

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. avoid eating grapefruit or drinking grapefruit juice until treatment is discontinued. increase intake of foods that are high in potassium. increase fluid intake and self-monitor for decreased urine output.

avoid drinking alcohol for the duration of treatment. The CNS depressant effects of baclofen can be dangerously exacerbated by alcohol, which should be avoided. Grapefruit is not contraindicated and there is no reason to increase potassium or fluid intake while taking baclofen.

A nurse is working with a 39-year-old patient who is experiencing muscle spasms associated with multiple sclerosis. The patient reports that she needs help with basic care and that her 15-year-old daughter has been helping bathe and dress her for a week. The patient's physician has prescribed baclofen (Lioresal). The nurse and the patient agree that an appropriate goal related to helping her maintain her self-worth would be to experience improved motor function. experience relief of pain. increase self-care in activities of daily living. take her medication independently.

increase self-care in activities of daily living.

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 physician. The client reports dry mouth, blurred vision, and constipation. Why is the client having these side effects from cyclobenzaprine? Cyclobenzaprine produces an anticholinergic response, resulting in these side effects. Cyclobenzaprine acts in the peripheral nervous system, resulting in these side effects. Cyclobenzaprine has an effect at the neuromuscular junction, resulting in these side effects. Cyclobenzaprine is structurally similar to amitriptyline, resulting in these side effects.

Cyclobenzaprine produces an anticholinergic response, resulting in these side effects. Cyclobenzaprine relieves muscle spasms through a central action, possibly at the level of the brain stem, with no direct action on the neuromuscular junction or the muscle involved. The common adverse effects of cyclobenzaprine are related to its CNS depression and anticholinergic activity. The most common adverse effects are drowsiness, dizziness, and dry mouth.

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

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.

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? a. A musculoskeletal injury b. Insomnia c. Epilepsy d. Agitation

ANS: A Cyclobenzaprine (Flexeril) is the muscle relaxant most commonly used to reduce spasms following musculoskeletal injuries. It is not appropriate for insomnia, epilepsy, or agitation.

Which medications can be used to treat or prevent malignant hyperthermia? Carisoprodol (Soma) Methocarbamol (Robaxin) Dantrolene (Dantrium) Metaxalone (Skelaxin)

Dantrolene (Dantrium)

A nurse administers carisoprodol to a patient for the treatment of an acute musculoskeletal condition. What adverse reaction of the administration of carisoprodol should the nurse monitor for in this patient? Insomnia Drowsiness Constipation Anxiety

Drowsiness

A patient is administered cyclobenzaprine (Flexeril). Which adverse effect can the nurse expect with this medication? Muscle spasms Insomnia Urinary incontinence Drowsiness

Drowsiness

A 40-year-old woman with a diagnosis of fibromyalgia has been prescribed cyclobenzaprine (Flexeril) as an adjunct to her existing drug regimen. What nursing diagnosis should the nurse prioritize when updating the nursing care plan for this patient? Altered Nutrition, Less than Body Requirements, related to appetite suppression Risk for Injury related to CNS depressant effects Diarrhea related to anticholinergic effects Impaired Swallowing related to increased muscle tone

Risk for Injury related to CNS depressant effects

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." "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." "This will likely relieve your muscle spasms but you'll probably develop a certain amount of dependence on the drug over time."

"You might find that this drug exacerbates some of your muscle weakness while it relieves your spasticity."

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 regularly scheduled liver function testing The need to maintain a diet that is high in iron and folic acid The importance of ensuring safety related to possible sedation The importance of maintaining a sterile central venous catheter

The importance of ensuring safety related to possible sedation Baclofen carries a risk of CNS depression and a consequent threat to safety. The use of baclofen does not necessitate regular liver function testing or dietary changes. Baclofen is administered orally or intrathecally, not intravenously.

Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area. T/F?

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

Centrally acting skeletal muscle relaxants lyse or destroy the spasm. True False

True The centrally acting skeletal muscle relaxants work in the CNS to interfere with the reflexes that are causing the muscle spasm. Because these drugs lyse or destroy spasm, they are often referred to as spasmolytics.

The health care provider orders short-term skeletal muscle relaxants for an 11-year-old client. The nurse is responsible for the family education plan and teaches the parents that the medications should be used only under which condition? When close supervision is available for monitoring drug effects When the spasms cause uncontrolled pain When the client needs to be alert during pain management During school hours to increase alertness and management of spasms

When close supervision is available for monitoring drug effects For most of the skeletal muscle relaxants, safety and effectiveness for use in children 12 years of age and younger have not been established. The drugs should be used only when clearly indicated, for short periods, when close supervision is available for monitoring drug effects (especially sedation), and when mobility and alertness are not required.

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

"Make sure to see your doctor 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.

A client who is experiencing lower back pain has been prescribed cyclobenzaprine. The nurse should provide what health education in order to ensure safe and effective treatment? "This will likely make you drowsy, so don't take it before doing anything that would require alertness." "Don't use this for more than five consecutive days to prevent damage to your liver." "If you experience sedation, seek care promptly since it could be a sign of a serious drug reaction." "Make sure to avoid grapefruit juice and fresh grapefruit until treatment is complete."

"This will likely make you drowsy, so don't take it before doing anything that would require alertness." Cyclobenzaprine causes drowsiness because of CNS depression. There is no absolute prohibition against using the drug for more than five days; it is metabolized in the liver but is not noted to be highly hepatotoxic. Sedation is an anticipated adverse effect, not a sign of a serious drug reaction.