Muscle Relaxants

Question 1

Use of Muscle Relaxants Across the Lifespan: Children

Answer 1

○Safety and effectiveness of some drugs have not been established
○Dosage based on weight
○Monitor for CNS and hepatic toxicity

Question 2

Use of Muscle Relaxants Across the Lifespan: Adults

Answer 2

○Safety precautions
○Use non-drug measures for muscle injury or pain
○Contraindicated in pregnancy and lactation
○Females >35 years have increased risk of hepatoxicity with dantrolene

Question 3

Use of Muscle Relaxants Across the Lifespan: Older adults

Answer 3

○More likely to experience adverse effects
○Lower doses may be needed
○Monitor closely for toxicity
○Older women using hormone replacement at same increased risk for hepatoxicity as premenopausal women
*carisoprodol is a good choice for older adults with renal and hepatic impairment

Question 4

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the drug names in this class?

Answer 4

●Baclofen
●Carisoprodol
●Cyclobenzaprine
●Metaxalone
●Methocarbamol
●Tizanidine

Question 5

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the actions?

Answer 5

○Work in upper levels of CNS to interfere with reflexes causing muscle spasm
○Lyse or destroy spasm (spasmolytics)
○Exact mechanism unknown, thought to involve action in upper or spinal

Question 6

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the indications?

Answer 6

○Relief of discomfort associated with acute, painful musculoskeletal conditions
○Adjunct to rest, physical and occupational therapy, and other measures

Question 7

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the contraindications?

Answer 7

○Known allergy
○Rheumatic disorders (these drugs don’t work on muscle spasms associated with rheumatic disorders)

Question 8

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the cautions?

Answer 8

○Epilepsy (drugs may lower the seizure threshold)
○Cardiac dysfunction (centrally acting muscle relaxants can cause hypotension or arrhythmias potentially worsening cardiac problems)
○Conditions marked by muscle weakness (these drugs can exacerbate weakness in conditions like myasthenia gravis or other neuromuscular disorders)
○Hepatic or renal impairment
○Pregnancy or lactation

Question 9

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the adverse effects?

Answer 9

○Drowsiness, fatigue, weakness, confusion, headache, insomnia
○Nausea, dry mouth
○Hypotension
○Urinary frequency

Question 10

Drug class: Centrally Acting Skeletal Muscle Relaxants
What are the drug-drug interactions?

Answer 10

○CNS depressants
○Alcohol

Question 11

Nursing Considerations for Centrally- Acting Skeletal Muscle Relaxants
Assessments:

Answer 11

○Assess for contraindications or cautions
○Perform a physical assessment
-Assess temperature; skin color and lesions
-Assess orientation, affect, reflexes, bilateral grip strength, and spasticity evaluation
-Monitor bowel sounds and reported output
○Monitor liver and renal function tests

Question 12

Nursing Considerations for Centrally- Acting Skeletal Muscle Relaxants
Nursing diagnoses:

Answer 12

○Impaired comfort related to GI and CNS effects
○Altered thought processes related to CNS effects
○Injury risk related to CNS effects
○Knowledge deficit regarding drug therapy

Question 13

Nursing Considerations for Centrally- Acting Skeletal Muscle Relaxants
Implementations:

Answer 13

○Provide additional non pharmacological measures to relieve discomfort
○Discontinue drug at any sign of hypersensitivity reaction or liver dysfunction
○If using baclofen, taper the drug slowly over 1 to 2 weeks
○If patient is receiving baclofen through a delivery pump, the patient should understand the pump, the reason for frequent monitoring, and how to adjust the dose and program the unit
○Monitor respiratory status
○Provide thorough patient teaching

Question 14

Nursing Considerations for Centrally- Acting Skeletal Muscle Relaxants
Evaluation:

Answer 14

○Monitor patient response to the drug (improvement in muscle spasm and relief of pain; improvement in muscle spasticity).
○Monitor for adverse effects (CNS changes, GI depression, urinary frequency).
○Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage, name possible adverse effects to watch for and specific measures to prevent them, and describe, if necessary, proper intrathecal administration).
○Monitor the effectiveness of comfort measures and compliance with the regimen.

Question 15

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the drug names?

Answer 15

(-botulinumtoxin)

●Dantrolene
●IncobotulinumtoxinA
●OnabotulinumtoxinA
●RimabotulinumtoxinB

Question 16

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the actions?

Answer 16

○Enter the muscle to prevent muscle contraction directly

Question 17

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the indications?

Answer 17

○Treatment of spasticity directly affecting peripheral muscle contraction
○Management of spasticity associated with neuromuscular diseases
■Dantrolene - muscle spasticity in patients with multiple sclerosis or cerebral palsy, malignant hyperthermia
■IncobotulinumtoxinA - cervical dystonia, blepharospasm, and chronic sialorrhea (excessive drooling).
■OnabotulinumtoxinA - chronic migraines, muscle spasms, excessive sweating, overactive bladder, and is the botox used for wrinkles.
■RimabotulinumtoxinB - treat pain associated with cervical dystonia, treat chronic sialorrhea

Question 18

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the contraindications?

Answer 18

○Known allergy
○Pregnancy and Lactation
○Spasticity- that contributes to locomotion, upright position, or increased function
○Hepatic disease

Question 19

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the cautions?

Answer 19

○Women
○All patients older than 35 years
○Liver disease
○Cardiac disease, respiratory depression

Question 20

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the adverse effects?

Answer 20

○Fatigue
○Weakness
○Confusion
○GI irritation
○Enuresis

Question 21

Drug class: Direct-acting Skeletal Muscle Relaxants
What are the drug-drug interactions?

Answer 21

○Estrogen (increased risk for hepatotoxicity)
○Neuromuscular junction blockers and others that interfere with neuromuscular transmission

Question 22

Nursing Considerations for Direct- Acting Skeletal Muscle Relaxants
Assessments:

Answer 22

○Assess for contraindications or cautions
○Perform a physical assessment
-Assess temperature; skin color and lesions
-Assess orientation, affect, reflexes, bilateral grip strength, and spasticity
-Assess respiration and adventitious sounds; pulse, electrocardiogram, and cardiac output
-Monitor bowel sounds and reported output
○Monitor liver and renal function tests

Question 23

Nursing Considerations for Direct- Acting Skeletal Muscle Relaxants
Nursing Diagnoses:

Answer 23

○Impaired comfort related to GI and CNS effects
○Altered thought processes related to CNS effects
○Injury risk related to CNS effects
○Knowledge deficit regarding drug therapy

Question 24

Nursing Considerations for Direct- Acting Skeletal Muscle Relaxants
Implementations:

Answer 24

○Discontinue the drug at any sign of liver dysfunction
○Do not administer botulinum toxins into any area with an active infection
○Monitor intravenous access sites of dantrolene for potential extravasation
○Institute other supportive measures (e.g., ventilation, anticonvulsants as needed, cooling blankets) for the treatment of malignant hyperthermia
○Periodically discontinue dantrolene for 2 to 4 days to monitor therapeutic effectiveness
○Establish a therapeutic goal before beginning oral therapy with dantrolene
○Discontinue dantrolene if diarrhea becomes severe
○Provide thorough patient teaching

Question 25

Nursing Considerations for Direct- Acting Skeletal Muscle Relaxants
Evaluation:

Answer 25

○Monitor patient response to the drug (improvement in spasticity, improvement in movement and activities, improvement in continence, migraines, dystonia, facial lines, sweating with botulinum toxins).
○Monitor for adverse effects (CNS changes, diarrhea, liver toxicity, urinary urgency).
○Evaluate the effectiveness of the teaching plan (patient can give the drug name and dosage, possible adverse effects to watch for and specific measures to prevent adverse effects, and therapeutic goals).
○Monitor the effectiveness of comfort measures and compliance with the regimen.