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Physical Therapy > Pharmacology Muscle Relaxants > Flashcards

Pharmacology Muscle Relaxants Flashcards

1
Q

What is the primary goal of muscle relaxers

A

Selectively decrease muscle excitability

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2
Q

What is meant by selectively decreasing excitability

A

Only decrease excitability of the muscles with too much excitability

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3
Q

Muscle spasm

A

Result of an injury to a muscle or a peripheral nerve, causes a tonic contraction.

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4
Q

What is a tonic contraction

A

A sustained Strong solid contraction over time

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5
Q

Muscle spasticity

A

Damage to the CNS resulting in exaggerated Stretch reflexes

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6
Q

What agents are used to treat muscle spasms

A

Polysynaptic inhibitors

Diazepam (Valium)

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7
Q

What are Polysynaptic inhibitors

A

They act on the Polysynaptic reflex arc to decrease excitability of alpha motor neuron

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8
Q

Common Polysynaptic inhibitor names

A 
Carisoprodol 
Chlorophenesin 
Chlorzoxazone 
Cyclobenzaprine 
Metaxalone 
Methocarbamol 
Orphenadrine citrate
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9
Q

How do anti-spasm drugs work

A

Work through sedative effect

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10
Q

What shoulder be coupled with anti-spasm drugs during rehab

A

Aggressive PT

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11
Q

When and how should anti-spasm drugs be taken away

A

ASAP (3-4 days), and then use PT to continue anti-spasm effects

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12
Q

What type of agent is diazepam and what was it originally made for

A

Benzodiazepine, made as an anti-anxiey first

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13
Q

How does Diazepam(valium) work

A

Increases the inhibitory effects of GABA.

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14
Q

How does Valium increase the effects of GABA

A

GABA binds to the BDR protein allowing Cl- to enter the muscle making the muscle more negative and harder to excite. The Valium increases the binding of GABA so it can stay on the BDR protein longer and allow more Cl- to enter.

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15
Q

What is a draw back of Valium

A

Excess amounts will cause sedation

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16
Q

What agents are used to treat spasticity

A 
Diazepam (Valium) 
Baclofen
Alpha-2-agonists 
Gabapentin 
Dantrolene 
Botulinum toxin
17
Q

How does diazepam treat spasticity

A

Acts on the CNS to increase GABA mediated inhibition, also causes sedation

18
Q

What is the best patient to treat with diazepam

A

Pt who has spasticity and anxiety issues

19
Q

How does Baclofen work

A

Is a synthetic form of GABA which activates the receptors (GABAb) to open channels for Cl-

20
Q

How is Baclofen administered

A

Orally or Intrathecally (spinal injection)

21
Q

Why use intrathecal over oral

A

Takes less dosage to get same results
Better effect
Injected locally

22
Q

What is a intrathecal Baclofen pump

A

Catheter placed in the abdomen that pumps the baclophen into the subarachnoid space at the level of the cauda equina

23
Q

Drawbacks of the intrathecal Baclofen pump

A

Repitory problems
Stupor
Coma
Withdrawal if the pump malfunctions and does not pump anymore

24
Q

What are alpha-2 agonists

A

Stimulate a receptor on interneurons in the spinal arc. These alpha-2 receptors inhibit the excitability of the interneurons

25
Q

What is the primary agent that is a alpha-2 receptor

A

Tizanidine

26
Q

How does Gabapentin work

A

Enhances GABA by blocking Calcium from entering and decreasing glutamate. More effective GABA means decreased excitability

27
Q

How does dantrolene sodium (dantrium) work

A

Blocks the entry of Ca into skeletal muscle, so there is less actin/myosin interactions causing weaker or less muscle contractions

28
Q

What makes dantrolene sodium different from other muscle relaxants

A

Is the only one that acts directly on the skeletal muscle where as the others act on the CNS

29
Q

What is botulinum toxin

A

Local injections used for severe spasms such as torticollis and laryngospasms. Causes paralysis of muslce

30
Q

Botulinum toxin mechanism of action

A

Eats up the connection proteins so the vessicles don’t release AcH. Now when there is an action potential it will have no effect on the muscle.

31
Q

How long does it take for botulinum to take effect and how long does it last

A

3-7 days

Lasts 2 to 3 months

32
Q

What are some of the problems or limitations with botulinum

A

Immune system may create antibodies that destroy the toxin
Can only use on one muscle.
Must pick the muscle that you believe would increase function the most.

33
Q

Signs of OD from Botulinum toxin

A

Drooping of eyes
Difficulty speaking
Muscle weakness
Respiratory problems

34
Q

What are some concerns for muscle relaxants

A

Weakness
Sedation
Drastic change in tone in short time

Physical Therapy (18 decks)

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