Pharmacology Chapter 25
Diazepam 2 mg orally every 8 hours 1s prescribed for muscle spasms. The drug is available as 5 mg/mL. How much should the nurse administer at each dose?
0.4 mL
A patient with multiple sclerosis (MS) is participating in a rehabilitation program. The patient has just been started on baclofen [Lioresal] 5 mg 3 times a day to help manage spasticity. How will the baclofen interfere with rehabilitation activities? A. By producing drowsiness, lethargy, and blurred vision B. By causing gastrointestinal distress C. By reducing sensation in the extremities D. By impairing coordinated movements
A. By producing drowsiness, lethargy, and blurred vision Drowsiness, lethargy, and blurred vision are adverse effects of baclofen that initially make it difficult for the patient to participate actively in rehabilitation activities. These adverse effects are most common during the early phase of therapy but subside with continued use. These effects can be reduced by starting with a small dose and gradually increasing it.
The nurse on an orthopedic unit routinely cares for patients receiving carisoprodol [Soma]. For which adverse effects should the nurse monitor these patients? (Select all that apply.) A. Drowsiness and sedation B. Decreased renal function C. Risk of dependence D. Decreased neutrophil count E. Unusual hair growth
A. Drowsiness and sedation C. Risk of dependence Carisoprodol is a centrally acting skeletal muscle relaxant and as such can produce generalized central nervous system (CNS) depression. These agents may also cause physical dependence when taken long term or in high doses.
The nurse is caring for a patient after total hip replacement on postoperative day 1. The nurse notes that the patient's urine is dark brown. The nurse reviews the medication administration record for which medication? A. Methocarbamol [Robaxin] B. Carisoprodol [Soma] C. Baclofen [Lioresal] D. Cyclobenzaprine [Flexeril]
A. Methocarbamol [Robaxin] Methocarbamol may turn urine brown, black, or dark green; patients should be forewarned of this harmless effect.
A patient with multiple sclerosis is admitted with pneumonia. She is receiving cyclobenzaprine to relieve muscle spasms What are common anticholinergic adverse effects associated with this drug and nursing interventions relating to these effects?
Adverse effects and nursing interventions, respectively, include the following: dry mouth—suck on ice chips or hard candy; blurred vision—advise patient to listen to music instead of watching television for diversion, read written instructions out loud, explain that blurred vision can affect driving; photophobia— avoid turning on bright overhead lights, keep shades (curtains) closed; urinary retention—assess for bladder distention, intake and output (I&O), explain importance of voiding every 2 hours while awake; constipation—provide fluids.
Which statement made by a patient indicates a need for further discharge instruction about baclofen [Lioresal]? A. "If I develop any difficulty urinating, I will call my physician." B. "I'm glad I can still have a glass or two of wine at dinner." C. "I'll contact my healthcare provider when I feel I no longer need the medication." D. "I'll need to check with my healthcare provider before taking my allergy medications."
B. "I'm glad I can still have a glass or two of wine at dinner." Alcohol can intensify the CNS depressant effects of baclofen; therefore, further instruction is needed. The first statement indicates that the patient understands that urinary retention is a potential side effect. Baclofen should not be discontinued abruptly, because this can lead to hallucinations, paranoid ideation, and seizures. Patients should discuss withdrawal of baclofen with their healthcare provider, because it should be done over 1 to 2 weeks. Allergy medications should be evaluated by the healthcare provider to determine whether they contain antihistamines, which intensify the depressant effects.
The healthcare provider orders diazepam [Valium] 5 mg IV every 8 hours. The medication available is diazepam [Valium] 5 mg/mL. How many mL will the nurse administer? A. 0.5 mL B. 1 mL C. 1.5 mL D. 2 mL
B. 1 mL 1 mL is correct. The order is for 5 mg, and there is 5 mg/mL, so the nurse would give 1 mL of medication.
Which skeletal muscle relaxant is also the drug of choice for treating malignant hyperthermia? A. Baclofen [Lioresal] B. Dantrolene [Dantrium] C. Diazepam [Valium] D. Tizanidine [Zanaflex]
B. Dantrolene [Dantrium] Dantrolene, a direct-acting skeletal muscle relaxant, is the preferred treatment for malignant hyperthermia. Malignant hyperthermia is a life-threatening syndrome that usually occurs when a general anesthetic is used with a neuromuscular blocking agent. It presents with muscle rigidity and profound temperature elevation.
Administration of dantrolene [Dantrium] for the treatment of muscle spasticity is contraindicated in which patient? A. A patient with a C6 spinal cord injury B. A patient with cerebral palsy C. A patient with multiple sclerosis and underlying cirrhosis D. A patient experiencing malignant hyperthermia
C. A patient with multiple sclerosis and underlying cirrhosis Although dantrolene is effective for treating spasticity in multiple sclerosis, it is contraindicated in this patient because of the underlying liver disease. Dantrolene is useful for relieving muscle spasticity associated with cerebral palsy and spinal cord injury and, in intravenous form, for managing life-threatening malignant hyperthermia.
The nurse is caring for a patient receiving dantrolene [Dantrium] for spasticity associated with MS. Which laboratory test will be important in monitoring for a potential adverse effect of this drug? A. Blood urea nitrogen (BUN) B. Albumin level C. Gamma-glutamyltransferase (GGTP) D. Complete blood count (CBC)
C. Gamma-glutamyltransferase (GGTP) In large doses dantrolene has been associated with fatal liver failure. Liver function tests, such as gamma-glutamyltransferase (GGTP), should be performed at baseline and periodically thereafter.
A 19-year-old man is admitted to the neurologic intensive care unit after a motorcycle accident. He is paraplegic with severe lower extremity muscle spasms. He is receiving intrathecal baclofen. A pump is being used to infuse the drug because abrupt discontinuation can cause rhabdomyolysis and multiple organ system failure. Developmentally, this patient is at risk for nonadherence to therapy. Why should the patient be discouraged from abrupt discontinuation of baclofen?
Can cause visual hallucinations, paranoid ideation, and seizures.
A 19-year-old man is admitted to the neurologic intensive care unit after a motorcycle accident. He is paraplegic with severe lower extremity muscle spasms. He is receiving intrathecal baclofen. A pump is being used to infuse the drug because abrupt discontinuation can cause rhabdomyolysis and multiple organ system failure. The patient is transferred to a rehabilitation unit. Baclofen 20 mg is prescribed 4 times a day. What assessments should be included in the nurse's plan of care for this patient relating to drug therapy?
Constipation and urinary retention; spasms, rigidity, pain, range of motion (ROM), and dexterity; dizziness, drowsiness, and fatigue; nausea, vomiting, tea- colored urine, clay-colored stool, right upper quadrant tenderness; yellowish discoloration of eyes or skin; LFTs.
Which medication acts as an agonist at the presynaptic alpha-2 receptor site? A. Baclofen [Lioresal] B. Dantrolene [Dantrium] C. Diazepam [Valium] D. Tizanidine [Zanaflex]
D. Tizanidine [Zanaflex] Tizanidine promotes inhibition by acting as an agonist at presynaptic alpha2 receptors. Dantrolene relieves spasm by suppressing release of calcium from the sarcoplasmic reticulum. Baclofen and diazepam promote inhibition by enhancing the effects of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter.
True or False Blocking the neurotransmitter y-aminobutyric acid (GABA) reduces spasticity.
False
True or False Dark brown or black urine should be reported to the prescriber of methocarbamol.
False
True or False Diazepam is the most effective muscle relaxant.
False
True or False It is important for the nurse to review he blood urea nitrogen (BUN) lab results when a patient is prescribed tizanidine, metaxalone, or dantrolene.
False
True or False Muscle relaxant drugs shorten time of rehabilitation from traumatic injuries that cause muscle spasms.
False
True or False The nurse should assess all patients who are prescribed a centrally acting muscle relaxant for feelings associated with depression.
False
Dantrolene 250 mg by rapid intravenous (IV) infusion iS prescribed. The recommended dose to treat malignant hyperthermia is initially 2 mg/kg. The patient weighs 185 lb. Is this a safe dose?
No. The safe dose is 210 mg.
A patient with multiple sclerosis is admitted with pneumonia. She is receiving cyclobenzaprine to relieve muscle spasms What nonpharmacologic interventions and teaching could the nurse provide to help relieve the patient's discomfort and prevent complications?
Nonpharmacologic interventions include ROM exercises, proper body mechanics, turning and repositioning, support of joints in functional position, skin care, and coughing and deep breathing.
A patient returns to the postanesthesia care unit after general anesthesia. The vital signs have increased from normal to a temperature of 103.6°F, pulse 116 beats/min, respirations 22 breaths/min, and BP 145/99 mm Hg. The patient is developing muscular rigidity. Why are antipyretics not appropriate to treat this fever?
This patient is having symptoms of malignant hyperthermia. The fever is caused by excessive muscle contraction, not a change in the set point in the hypothalamus.
A 19-year-old man is admitted to the neurologic intensive care unit after a motorcycle accident. He is paraplegic with severe lower extremity muscle spasms. He is receiving intrathecal baclofen. A pump is being used to infuse the drug because abrupt discontinuation can cause rhabdomyolysis and multiple organ system failure. What is rhabdomyolysis, what organ is particularly sensitive to its effects, and what assessment findings would suggest that this is occurring?
Rhabdomyolysis is the breakdown of skeletal muscle, releasing myoglobin; the kidneys are particularly sensitive to its effects. Findings of dark color of urine from myoglobin, hyperkalemia, metabolic acidosis, and dysrhythmias are suggestive of rhabdomyolysis.
A patient returns to the postanesthesia care unit after general anesthesia. The vital signs have increased from normal to a temperature of 103.6°F, pulse 116 beats/min, respirations 22 breaths/min, and BP 145/99 mm Hg. The patient is developing muscular rigidity. The patient is prescribed dantrolene 150 mg IV push. Why is it important to position the patient on his or her side with the side rails up?
The patient is still recovering from the effects of general anesthesia. Nausea and vomiting are adverse effects of the administration of dantrolene.
A 19-year-old man is admitted to the neurologic intensive care unit after a motorcycle accident. He is paraplegic with severe lower extremity muscle spasms. He is receiving intrathecal baclofen. A pump is being used to infuse the drug because abrupt discontinuation can cause rhabdomyolysis and multiple organ system failure. Dantrolene would be more convenient for this patient because it only needs to be taken once a day. Why is it not a good choice for this patient?
Therapy involves conditioning exercises. Dantrolene therapy is associated with weakness. This would impair therapy and the patient's ability to perform activities of daily living.
True or False Baclofen decreases spasticity.
True
True or False Most centrally acting muscle relaxants are not effective in treating spasticity associated with cerebral palsy.
True
True or False Most drugs used to treat spasticity do not relieve acute muscle spasm.
True
True or False The therapeutic effects of taking muscle relaxants are similar to taking aspirin.
True
The nurse should teach a patient who is prescribed a centrally acting muscle relaxant to avoid which drug? a. diphenhydramine b. ibuprofen c. multiple vitamins with iron d. polyethylene glycol
a. diphenhydramine
A resident is writing orders for hospitalized patients. The nurse would consult the prescriber if baclofen was prescribed to relieve muscle spasms for a patient with which condition? a. cerebral palsy b. cerebrovascular accident c. multiple sclerosis d. spinal cord injury
b. cerebrovascular accident
Which assessment finding does not suggest a possible adverse effect when a patient is prescribed metaxalone? a. nausea and vomiting b. confusion c. sensitivity to light d. rash
c. sensitivity to light
The nurse knows that the priority nursing interventions and teaching for a patient receiving a centrally acting muscle relaxant are related to: a. elimination b. emotional support c. nutrition d. safety
d. safety
