Treatment of Muscle Spasms - Chapter 14 Flashcards
Central Vs. Peripheral acting Muscle Relaxants
- Central Acting: Those used to produce muscle paralysis during surgical procedures and in the ICU
- Peripheral Acting: Those used to reduce muscle spasticity in a variety of painful conditions
Symptoms of Spasticity
Positive:
- Increased muscle tone
- Exaggerated tendon jerks
- Hyperexcitable stretch reflex
Negative:
- Muscle weakness
- Decreased endurance
- Reduction in the capacity to make voluntary muscle movements
Conditions That Produce Spasticity
- Spinal chord injury
- Stroke
- Cerebral palsy
- Amyotrophic lateral sclerosis
- Multiple sclerosis
- Muscle strain
Neurotransmitters Involved in Spasticity
- Acetylcholine
- Y-Aminobutyric Acid
- Glycine
- Glutamate
-Spasticity is a symptom of upper motor neuron syndrome. The cause may be excess activity of neurotransmitters (glutamate or ACh), or decreased activity of inhibitory transmitters (Y-aminobutyric acid, glycine)
Drugs Used to Treat Spasticity
- Peripheral acting drugs
- Central acting drugs
Peripheral Acting Drugs Examples
- botulinum toxins
- dantrolene
Brand: Botox
Generic: onabotulinum toxin A
-Inhibits presynaptic release of ACh to cause paralysis in muscles that received injections
Brand: Dantrium
Generic: dantrolene
-Used to treat spasticity associated with spinal chord injury, stroke, cerebral palsy, MS, and malignant hyperthermia
Central Acting Drugs
- Bind to receptor sites that control motor movement in brain and spinal chord
- Categorized according to the mechanism of action
Categories of Central Acting Drugs
- GABAergic
- a2 adrenergic drugs
GABAergic Drugs MOA
-Bind directly to GABA receptors or enhance GABA binding
GABAergic Drugs Examples
- baclofen
- diazepam
Brand: Lioresal
Generic: baclofen
Brand: Valium
Generic: diazepam
A2-Adrenergic Drugs MOA
-Prevent release of excitatory neurotransmitters in spinal cord and increases actions of inhibitory neurotransmitter glycine
A2-Adrenergic Drugs Examples
-tinazidine
Brand: tinazidine, Zanaflex
Generic: tinazidine
baclofen ADR’s
- Sedation or dizziness
- Hypotension
- Headache
- Nausea
- Confusion
- Weakness or fatigue
Tinazidine ADR’s
- Sedation or dizziness
- Hypotension
dantrolene ADR’s
- Sedation or dizziness
- Weakness or fatigue
- Diarrhea
- Hepatotoxicity
Treatment of Muscle Strain
-Central acting skeletal muscle relaxants
Central Acting Skeletal Muscle Relaxants
-Used to treat stiffness, pain, spasms associated with muscle tension, strain, sprains, or injury
Central Acting Skeletal Muscle Relaxants (For Muscle Strain) Examples
- cyclobenzaprine
- orphenadrine
- methocarbamol
- methocarbamol/ASA
- methocarbamol/ASA/codeine
- methocarbamol/acetaminophen
- methocarbamol/acetaminophen/codeine
- methocarbamol/ibuprofen
- acetaminophen/chlorzoxazone
- acetaminophen/chlorzoxazone/codeine
Brand: cyclobenzaprine, Flexeril
Generic: cyclobenzaprine
Brand: Norflex
Generic: orphenadrine
Brand: Robaxin, Robaxin 750
Generic: methocarbamol
Brand: Methoxisal, Robaxisal
Generic: methocarbamol/ASA
Brand: Methoxisal (1/8) (1/4) (1/2), Robaxisal-C 1/8, C 1/4, C 1/2
Generic: methocarbamol/ASA/codeine
Brand: Methoxacet, Robaxacet
Generic: methocarbamol/acetaminophen
Brand: Methoxacet C1/8.
Robaxacet-8
Generic: methocarbamol/acetaminophen/codeine
Brand: Robax Platinum
Generic: methocarbamol/ibuprofen
Brand: Acetazone Forte
Generic: acetaminophen/chlorzoxazone
Brand: Acetazone Forte C8
Generic: acetaminophen/chlorzoxazone/codeine
Skeletal Muscle Relaxants Tech Note
- Should not be combined with alcohol
- Alcohol increases the central nervous system depression which is exhibited as excessive drowsiness and decreased alertness
Skeletal Muscle Relaxants ADR’s
- Dizziness or drowsiness
- Blurred vision
- Discoloration of urine
Skeletal Muscle Relaxants Warning Labels
- MAY CAUSE DIZZINESS OR DROWSINESS
- MAY IMPAIR ABILITY TO DRIVE
- AVOID ALCOHOL
- TAKE WITH FOOD (baclofen)
- MAY DISCOLOUR URINE (chlorzoxazone, methocarbamol)
- MAY BE HABIT FORMING (diazepam)
- SWALLOW WHOLE; DONT CRUSH OR CHEW
