Chapter 25: Muscle Relaxants
Define basal ganglia
Lower area of the brain, associated w/ coordination of unconscious muscle movements that involve movement and position
Define cerebellum
Lower portion of the brain, associated w/ coordination of muscle movements, including voluntary motion, as well as extrapyramidal control of unconscious muscle movements
Define interneuron
Neuron in the CNS that communicates w/ other neurons, not w/ muscles or glands
True or False: Centrally acting skeletal muscle relaxants lyse or destroy the spasm.
True
True or False: Muscle spasms are thought to arise from the flood of sensory impulses coming to the spinal cord from an injured area.
True
True or False: Spinal reflexes are the simplest nerve pathways that monitor movement and posture.
True
A muscle spasm often results from: A) Damage to the basal ganglia B) CNS damage C) Injury to the musculoskeletal system D) Chemical imbalance within the CNS
C
A pt w/ spinal cord injury is experiencing muscle spasticity. Which agent would most likely be ordered? A) Baclofen B) Cyclobenzaprine C) Chlorzoxazone D) Carisoprodol
A
Select all that apply: What adverse effects would a nurse most likely assess in a pt who is receiving a centrally acting skeletal muscle relaxant? A) Constipation B) Dry mouth C) Urinary retention D) Drowsiness E) Insomnia
A B D E
Select all that apply: Spasmolytics, or centrally acting muscle relaxants, block the reflexes in the CNS that lead to spasm. While a pt is taking one of these drugs, which of the following interventions should be implemented? A) Rest for the affected muscle B) Heat to the affected area C) Ice packs to the affected area D) Use of anti-inflammatory agents E) Body temp check every 2 hrs to watch for malignant hyperthermia F) Positioning to decrease pain and spasm
A B D F
A pt receives baclofen intrathecally at 0800. The nurse should expect the pt serum levels of the drug to peak at what time? A) 1400 B) 1200 C) 1600 D) 1000
B
Dantrolene is being considered for the treatment to a pt w/ spasticity. Which aspect of the pt current health status is most likely to contraindicate the use of this med? A) The pt takes opioid analgesics regularly B) The pt spasticity is due to rheumatoid arthritis C) The pt adherence to drug therapy has been irregular D) The pt has type 1 diabetes and takes insulin regularly
B
The nurse is preparing to administer a pt scheduled dose of baclofen and notes that the pt most recent oral temp was 100.9. What is the nurse's best action? A) Perform a focused respiratory assessment B) Administer the med as prescribed and monitor the pt C) Hold the baclofen, administer antipyretics as prescribed, and reassess the pt in 1 hr D) Report this assessment finding promptly to the care provider
B
What pt is most likely to benefit from botulinum toxin type A injections? A) A 68 yr old pt who has chronic lumbar and thoracic pain following a workplace accident B) A 54 yr old pt who suffered debilitating migraines 2-3 days per week C) A 16 yr old pt w/ cerebral palsy whose upper body spasticity has worsened in recent months D) A 60 yr old pt who was diagnosed w/ myasthenia gravis 18 months ago
B
A pt has been prescribed baclofen and will be taking the drug on an outpatient basis. The pt asks the nurse if it's still okay to drink wine with meals or end the day with a margarita, the nurse should say what? A) "You're to permitted to drink alcohol while you are taking baclofen." B) "If you combine baclofen and alcohol, you could suffer a severe allergic-type rxn." C) "The combination of baclofen and alcohol could depress your nervous system to a dangerous level." D) "It's best to keep your alcohol intake to a low level when you're taking muscle relaxants."
C
A pt has been prescribed cyclobenzaprine for the treatment of injury-related muscle spasticity. The pt asks if it is safe to take ibuprofen while taking cyclobenzaprine. What should the nurse say? A) "Ask your care provider, but the combo might make you dangerously drowsy." B) "Confirm with your provider, but it would likely be quite hard on your liver." C) "Check w/ your care provider, but it's likely not a problem." D) "It would probably be unsafe because both drugs are from similar families."
C
Dantrolene is associated w/ potentially fatal cellular damage. If your pt condition is being managed w/ dantrolene, the pt should: A) Have repeated complete blood counts during therapy B) Have renal function tests done monthly C) Be monitored for signs of liver damage and have liver function tests done regularly D) Have a thorough eye examination before and periodically during therapy
C
Define extrapyramidal tract
Cells from the cortex and subcortical areas, including the basal ganglia and the cerebellum, which coordinate unconsciously controlled muscle activity; allows the body to make automatic adjustments in posture or position and balance
A pt presents to the clinic seeking info about having botulinum toxin type A injections to reduce eye wrinkles. What should the nurse teach the pt about this treatment? A) "You would need to be sedated so you're able to stay perfectly still during the injections." B) "Some pt have adverse effects of botulinum toxin type A involving muscle spasticity." C) "The effectiveness of botulinum toxin A injections has been greatly overstated in the media." D) "This isn't a permanent solution. It has to be repeated in 3 months."
D
A pt w/ a recent history of muscle spasticity has been prescribed baclofen. What finding on the pt most recent lab report should prompt the nurse to contact the care provider? A) Rise in blood urea nitrogen B) Decline in sodium C) Decline in neutrophils D) Rise in liver enzymes
D
Dantrolene differs from the other skeletal muscle relaxants because: A) It acts in the highest levels of the CNS B) It is used to treat muscle spasms as well as muscle spasticity C) It cannot be used to treat neuromuscular disorders D) It acts directly within the skeletal muscle fiber and not within the CNS
D
Muscle spasticity is the result of: A) Direct damage to a muscle cell B) Over-stretching of a muscle C) Tearing of a ligament D) Damage to neurons within the CNS
D
True or False: The pyramidal tract is located primarily within the basal ganglia.
False; Located in the CNS
True or False: Muscle spasticity is the result of damage to peripheral structures rather than to injured neurons.
False; Muscle spasticity is the result of damage to neurons within the CNS rather than injury to peripheral structures
Define pyramidal tract
Fibers within the CNS that control precise, intentional movement
Define spindle gamma loop system
Simple reflex arcs that involve sensory receptors in the periphery that respond to stretch and spinal motor nerves and cause muscle fiber contraction: Responsible for maintaining muscle tone and keeping an upright position against the pull of gravity
Define hypertonia
State of excessive muscle response and activity
Define spasticity
Sustained muscle contractions
Select all that apply: Muscle relaxants would be used in which of the following circumstances? A) To treat spasticity related to spinal cord injury B) To treat spasticity that contributes to locomotion, upright position, or increase in function C) To treat spasticity that is related to toxins, such as tetanus D) To treat spasticity that is a result of neuromuscular degeneration E) To reduce the severity of head position associated w/ cervical dystonia F) To reduce the appearance of frown lines (glabellar lines)
A C D E F
Select all that apply: The nurse reviews the pt medical record before administering dantrolene. What factors would the nurse identify as placing the pt at risk for hepatocellular injury? A) She is 39 yrs old B) She has been diagnosed w/ rheumatic arthritis C) She is married w/ 3 children under 10 yrs of age D) She visits the gym daily to ride a stationary bicycle E) She takes birth control pills containing estrogen
A E
A pt sustained a musculoskeletal injury to his left leg that resulted in occasional spasticity. What should the nurse expect the health care provider to prescribe? A) Cyclobenzaprine B) Baclofen C) Botulinum toxin type B D) Dantrolene
A; Used to treat discomfort from acute conditions
Select all that apply. The nurse is preparing a teaching plan for a pt who is to receive botulinum toxin type A for frown lines. What adverse effects should the nurse inform the pt that could possibly occur? A) Abnormal hair growth B) Drooping eyelids C) GI upset D) HA E) Respiratory infections
B D E
The nurse administers a pt scheduled dose of dantrolene P.O. at 10:00. The nurse should expect the duration of action to extend until approximately what time? A) 15:00 B) 20:00 C) 17:00 D) 13:00
B; Duration of action is 8-10 hours
What pt is using his or her pyramidal tract to the largest extent? A pt who is: A) Reaching to flush the toilet B) Filling out the dietary preferences card for the next day C) Walking to the dining room D) Rising from a sitting to a standing position
B; pyramidal tract controls precise intentional movement such as writing
The use of neuromuscular junction blockers may sometimes cause a condition known as malignant hyperthermia. The drug of choice for prevention or treatment of this condition is: A) Baclofen B) Diazepam C) Dantrolene D) Methocarbamol
C
When reviewing the med record of a pt who is to receive dantrolene, which condition would alert the nurse for the need of close monitoring? A) Has an infected surgical wound B) Is 67 years old C) Has respiratory depression from opioid analgesia D) Received a blood transfusion less than 24 hrs ago
C; It can increase muscular weakness and make respiratory depression worse
A pt w/ impaired liver function secondary to hepatitis C requires a centrally acting skeletal muscle relaxant for temporary pain relief. What med would put the lest metabolic burden on the pt liver? A) Orphenadrine B) Methocarbamol C) Baclofen D) Diazepam
C; It is not metabolized
The nurse is assessing a pt for possible risk factors for the development of hepatotoxicity with the use of dantrolene. What situations would the nurse identify as requiring cautious use of the drug? A) Cirrhosis B) Spasticity contributing to locomotion or upright position C) Age less than 30 yrs D) Female gender
D
The nurse is caring for a pt w/ an intrathecal catheter in place to treat muscle rigidity. What centrally acting skeletal muscle relaxant could the nurse administer intrathecally? A) Chlorzoxazone B) Cyclobenzaprine C) Carisoprodol D) Baclofen
D
When reviewing the medical record of a pt who is to receive dantrolene, which condition would alert the nurse for the need of close monitoring? The client: A) Has an infected surgical wound B) Received a blood transfusion less than 24 hrs ago C) Is 67 yrs old D) Has respiratory depression from opioid analgesia
D
