Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PATHO/PHARM II > Conditions Effecting the Musculoskeletal System and PharmacotherapyPart Six: Muscle Spasm and Spasticity > Flashcards

Conditions Effecting the Musculoskeletal System and PharmacotherapyPart Six: Muscle Spasm and Spasticity Flashcards

Exam 4 (Final)

1
Q

Muscle Spasticity: What is it?

A

Group of movement disorders of CNS origin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Muscle Spasticity: Group of movement disorders of CNS origin

What increases?

A

Increased muscle tone

Increased DTRS, clonus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Muscle Spasticity: Group of movement disorders of CNS origin

Why does this occur?

A

Due to hyperexcitability of stretch reflex

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Muscle Spasticity: Group of movement disorders of CNS origin

What does this result in?

A

Results in muscle being continuously contracted

Leads to stiffness/tightness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Muscle Spasticity: Group of movement disorders of CNS origin

What is there a loss in?

A

Loss of dexterity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Muscle Spasticity: Group of movement disorders of CNS origin

What is it dependent on? Also what phenomenon is involved?

A

Velocity-dependent

Clasp-knife phenomenon

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Muscle Spasticity:

What are common causes?

A

Multiple sclerosis

Cerebral palsy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Muscle Spasticity:

Muscle relaxants: What do they do?

A

depress neuronal action in the CNS and may even augment neuronal inhibition in the skeletal muscles

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Muscle Spasticity: What are the two main reasons drugs act?

A

Centrally acting

Direct actions on skeletal muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Muscle Spasticity:

Drug TX: 4 drugs
What are the four drugs?

A

Baclofen,

diazepam,

tizanidine

Dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Muscle Spasticity:

Drug TX: 4 drugs

Which drugs are centrally acting?

A

Baclofen,

diazepam,

tizanidine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Muscle Spasticity:

Centrally acting drugs:
What do they act on?

A

Act in CNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Muscle Spasticity:

Centrally acting drugs:
What are they used for?

A

Used in cases of spasticity to repress hyperactive reflexes.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Muscle Spasticity:

What drugs have Direct actions on skeletal muscle?

A

Dantrolene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Muscle Spasm: What does it cause?

A

Painful & ↓ ability to function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Muscle Spasm: What is it?

A

Involuntary sudden contraction of a muscle or muscle group

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Muscle Spasm: How does it occur?

A

Sudden onset, transient, localized

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Muscle Spasm:

How are muscles? What feeling of muscles?

A

Visible muscle twitching, and a feeling of tightness or hardness in the affected muscle.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Muscle Spasm:

Variety of causes like…

A

Epilepsy

Hypocalcemia (tetany)

Acute and chronic pain syndromes

Trauma (localized muscle injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Muscle Spasm:

Physical measures include

A

PT

Specific exercises

Whirlpool baths

Heat application

⍉ cold ~ for pain & swelling, does not relieve spasm

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Muscle Spasm:

Drug TX is what?

A

Analgesics

Centrally acting muscle relaxants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Muscle Spasm:

Drug TX are Analgesics like?

A

APAP, NSAIDs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Muscle Spasm:

Drug TX- Centrally acting muscle relaxants
like?

A

Cyclobenzaprine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Baclofen [Lioresal]

Mechanism:

Where does it act in?

A

Acts in the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Baclofen [Lioresal]

Mechanism:

What does it do?

A

Suppresses hyperactive reflexes involved in regulation of muscle movement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Baclofen [Lioresal]

Mechanism:

What may it mimic?

A

May mimic the action of GABA on spinal neurons

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Baclofen [Lioresal]

Mechanism:

What does it NOT do?

A

⍉ direct-muscle action so it does not ↓ muscle strength

It will not exacerbate muscle weakness, so it is preferred to direct-acting agent (Dantrolene)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Baclofen [Lioresal]

How can it be taken?

A

+/- food

Can be given intrathecal route via approved implantable pump

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Baclofen [Lioresal]

Therapeutic uses include:

A

Reduce spasticity from Multiple Sclerosis, spinal cord injury

Decreases flexor and extensor spasms

Suppresses resistance to passive movement

These actions reduce the discomfort of spasticity and allow increased performance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Baclofen [Lioresal] (Cont.)

What are adverse effects:

A

CNS and gastrointestinal (GI) tract effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Baclofen [Lioresal] (Cont.)

CNS and gastrointestinal (GI) tract effects
include: (CNS symptoms)

A

Drowsiness, dizziness, weakness, fatigue (diminish over time with cont’d use)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Baclofen [Lioresal] (Cont.)

CNS and gastrointestinal (GI) tract effects
include:

What are the GI symptoms?

A

Gastrointestinal symptoms (eg, nausea, constipation)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Baclofen [Lioresal] (Cont.)

CNS and gastrointestinal (GI) tract effects occur, so how should med be administered?

A

Small dose initially –> gradual increase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Baclofen [Lioresal] (Cont.)

Adverse effects: What can an overdose lead to?

A

Overdose can produce coma and respiratory depression – no antidote

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Baclofen [Lioresal] (Cont.)

Adverse effects:

How should the med be withdrawn?

A

Gradual withdrawal over 1 to 2 weeks

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Baclofen [Lioresal] (Cont.)

Adverse effects: What happens if there is an abrupt withdrawal (PO)?

A

Abrupt W/D PO: Visual hallucinations, paranoid ideation, and seizures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Baclofen [Lioresal] (Cont.)

Adverse effects: What happens if there is an abrupt withdrawal (intrathecal)?

A

Abrupt intrathecal withdrawal more dangerous:

Risk for rhabdomyolysis from muscle rigidity, higher fever, AMS, multiple organ system failure, exaggerated rebound spasticity, death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Baclofen [Lioresal] (Cont.)

Adverse effects: What can it lead to?

A

Urinary retention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Baclofen [Lioresal] (Cont.)

Contraindications/Interactions

A

Alcohol & other CNS depressants

40
Q

Baclofen [Lioresal] (Cont.)

Contraindications/Interactions: What may the drug exacerbate?

A

May exacerbate psychiatric conditions

41
Q

Baclofen [Lioresal] (Cont.)

Contraindications/Interactions: What should you monitor patients for?

A

Monitor pts with which urinary conditions? On which class of meds?

42
Q

Diazepam [Valium]:

What family is it part of?

A

Member of the benzodiazepine family

43
Q

Which drug in the benzodiazepine family can treat muscle spasticity?

A

Diazepam [Valium]

44
Q

Diazepam [Valium]:

What is this drug considered?

A

Controlled substance

45
Q

Diazepam [Valium]:

Mechanism: What does it act on?

A

Acts in the CNS

46
Q

Diazepam [Valium]:

Use:?

A

Spasticity due to SCI or CNS condition

Musculoskeletal pain and muscle spasms

47
Q

Diazepam [Valium]:

Mechanism: What does it mimic?

A

Mimics action of GABA to enhance presynaptic inhibition

48
Q

Diazepam [Valium]:

Musculoskeletal pain and muscle spasms

A

pain, inflammation, trauma

49
Q

Diazepam [Valium]:

What are adverse effects:

A

Sedation, CNS depression, hypotension

50
Q

Diazepam [Valium]:

Adverse effects: What may it cause?

A

May cause paradoxical CNS stimulation or antegrade amnesia

51
Q

Diazepam [Valium]:

Administration considerations:
How can tabs be given? How about oral solutions? IV?

A

Admin tabs with food or liquid.

Oral solution may be mixed with juice or soft foods

IV administration must be slow (maximum rate 5mg/min)

52
Q

Dantrolene

MOA: What does it act directly on?

A

Acts directly on skeletal muscle

53
Q

Dantrolene

MOA: When it acts directly on skeletal muscle what does it do?

A

Suppress release of Ca –> muscle less able to contract

54
Q

Dantrolene

MOA: What does giving it in therapeutic doses do?

A

Therapeutic doses – minimal effect on smooth muscle & cardiac muscle ctx

55
Q

Dantrolene

Uses?

A

Spasticity - MS, CP, SCI

56
Q

Dantrolene

ADRs: What are the two main ones?

A

Significant reduction in strength (benefits must > risks)

Hepatic toxicity

57
Q

Dantrolene

ADRs: Other ones? (7)

A

Muscle weakness

Drowsiness (systemic effects due to bloodstream distribution)

Diarrhea

Dysphagia

Hoarseness

N/V

Erectile dysfunction

58
Q

Dantrolene (Adm how)

A

+/- food

Capsule maybe sprinkled on soft food

59
Q

What is the most used centrally acting skeletal muscle relaxant

A

Cyclobenzaprine (Flexeril)

60
Q

Cyclobenzaprine (Flexeril): Why is it given?

A

Rx’d to reduce spasms & pain caused by musculoskeletal injuries

61
Q

Cyclobenzaprine (Flexeril):

MOA: Where does it work and what role does it play?

A

Works in brainstem - plays a crucial role in regulating muscle tone and reflexes.

62
Q

Cyclobenzaprine (Flexeril):

MOA: What does it decrease? How? What does it not interfere with?

A

Decreases muscle activity by acting upon motor nerves but doesn’t interfere with muscle function

Reduction of tonic motor activity (stiffness)

63
Q

Cyclobenzaprine (Flexeril):

Kinetics
Absorbed? How is it metabolized? How is it administered?

A

Absorption: PO, cyclobenzaprine is rapidly absorbed in GIT

Metabolism: In liver, CYP-450 pathway

Adm with/without food

64
Q

Cyclobenzaprine (Flexeril):

Kinetics:

How much of the drug reached circulation? Why?

A

only 40%-50% of the drug reaches circulation due to first-pass metabolism

65
Q

Cyclobenzaprine (Flexeril):

Kinetics: When does it peak?

A

Peaks in 4 hours, comes in ER – peak 7-8 hours

66
Q

ADRs cyclobenzaprine

A

CNS depressant effects

Anticholinergic ADEs

Cardiac rhythm disturbances

67
Q

ADRs cyclobenzaprine:

Anticholinergic ADEs: What does this drug do?

A

Antagonizes muscarinic receptors

68
Q

ADRs cyclobenzaprine:

Anticholinergic ADEs:

Antagonizes muscarinic receptors-What does this mean?

A

~ ↑ fiber & fluid, stool softeners, photophobia, urinary retention, constipation, dry mouth

69
Q

ADRs cyclobenzaprine:

What does this drug have structural similarities to?

A

Has structural similarities to tricyclic antidepressants (TCAs) and can influence serotonergic pathways.

70
Q

ADRs cyclobenzaprine:

What is a major issue of this drug?

A

Serotonin Syndrome

71
Q

ADRs cyclobenzaprine:

Serotonin syndrome: What does this mean you should be cautious with?

A

Caution w/ SSRIs, SNRIs, TCAs ~ serotonin syndrome

72
Q

ADRs cyclobenzaprine:

Serotonin syndrome:

How does it effect the CNS?

A

CNS: agitation, restlessness, hallucinations, h/a, unconsciousness

73
Q

ADRs cyclobenzaprine:

Serotonin syndrome:

What are autonomic symptoms of this?

A

Autonomic sx: diaphoresis, hyperthermia, htn, tachycardia, pupil dilation

74
Q

ADRs cyclobenzaprine:

Serotonin syndrome:

What are Neuromuscular symptoms of this?

A

Neuromuscular: muscle twitch, tremors, ataxia –> seizures

75
Q

ADRs cyclobenzaprine:

Serotonin syndrome:

What are GI symptoms of this?

A

n/v/d

76
Q

ADRs cyclobenzaprine:

Nursing considerations: What should you inform patients about?

A

Inform pts about CNS depression & possible interactions with other drugs (etoh, benzos, opioids, antihistamines)

77
Q

ADRs cyclobenzaprine:

Nursing considerations: What should you tell patients to report?

A

Report urinary retention

78
Q

ADRs cyclobenzaprine:

Nursing considerations: What should you tell patients to do for dry mouth?

A

Chew sugar-free gum for dry mouth

79
Q

ADRs cyclobenzaprine:

Nursing considerations: What should you tell patients to do for photophobia?

A

Wear sunglasses to manage photophobia r/t dilated pupils

80
Q

Pt education for CNS muscle relaxants for spasms:

Why should you avoid abrupt DC of drugs?

A

Avoid abrupt d/c to prevent abstinence syndrome/withdrawal

81
Q

Pt education for CNS muscle relaxants for spasms:

Avoid abrupt DC of drugs: Avoid abrupt d/c to prevent abstinence syndrome/withdrawal

A

Chronic high-dose tx can cause physical dependence if drugs abruptly withdrawn

82
Q

Pt education for CNS muscle relaxants for spasms

How long are drugs for spasms taken?

A

Drugs for spasm are usually taken for no longer than a few wks

83
Q

Pt education for CNS muscle relaxants for spasms

What should you avoid doing with drugs? Why?

A

Avoid combining muscle relaxants with alcohol and CNS depressants

CNS effects may be intensified.

84
Q

Pt education for CNS muscle relaxants for spasms:

What kind of side effects should you report?

A

Report side effects of the muscle relaxant, including nausea, vomiting, dizziness, fainting, headache, and diplopia.

85
Q

Pt education for CNS muscle relaxants for spasms:

How should you take muscle relaxants to avoid GI upset?

A

Take muscle relaxants with food to avoid GI upset.

86
Q

Pt education for CNS muscle relaxants for spasms:

When should you use OTC meds with muscle relaxants?

A

Advise to avoid use of OTC meds (e.g., cough preparations, antihistamines) unless directed by the health care provider.

87
Q

Pt education for CNS muscle relaxants for spasms

Why would they cause drowsiness initially?

A

CNS depressant effect of all central muscle relaxants may cause severe drowsiness initially

88
Q

Pt education for CNS muscle relaxants for spasms

What shouldn’t you do while taking this drug (activity wise)?

A

Do not to drive, operate heavy machinery, or make important legally-binding decisions when taking muscle relaxants (sedative effects and may cause drowsiness).

89
Q

Lifespan concerns:

What is diazepam associated with?

A

Diazepam is associated with low birth weights, prematurity, hypoglycemia, and respiratory depression.

90
Q

Lifespan concerns:

What has been seen in neonates taking diazapam?

A

Neonatal withdrawal syndrome has been observed with benzodiazepines.

91
Q

Lifespan concerns:

What effect does baclofen, tizanidine, and dantrolene have in pregnancy?

A

Animal studies have yielded adverse events for baclofen, tizanidine, and dantrolene in pregnancy.

These drugs can cause adverse effects in infants.

92
Q

Lifespan concerns:

What is not recommended for newborns while taking drugs?

A

Breast-feeding is not recommended.

93
Q

Lifespan concerns:

At the dosage required to have adequate effect, these drugs may cause what?

A

At the dosage required to have adequate effect, these drugs may cause sedation and cognitive impairment, thus creating a fall risk in older adults.

94
Q

Long-acting benzodiazepines (e.g. diazepam is an issue for older adult patients) what are the issues?

A

slower metabolism, elimination may be delayed, and active drug may accumulate.

95
Q

Cyclobenzaprine: some criteria?

A

Cyclobenzaprine – Beer’s criteria
potentially inappropriate for older adults.

96
Q

LOOK AT SLIDE 13 VERY IMPORTANT!!

A

PATHO/PHARM II (27 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions