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Clin Med II - FINAL > Muscle Relaxants > Flashcards

Muscle Relaxants Flashcards

1
Q

What are skeletal muscle relaxants?

A
  • General classes of drugs based on therapeutic use
  • Those used to reduce muscle excitability
    • Spasticity
    • Muscle spasm
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2
Q

What is the goal of skeletal muscle relaxants?

A

to decrease muscle excitability without limiting muscle function

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3
Q

What is spasticity?

A
  • Occurs after a CNS injury or disease
  • Due to an exaggerated muscle stretch reflex
  • Is velocity dependent
  • Usually in antigravity muscles (biceps)
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4
Q

What are spasms?

A
  • Increased muscle tension following injury and inflammation
  • Due to an orthopedic injury
  • Myogenic, does have a neuro component/time
  • Continuous, tonic
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5
Q

When does hypertone develop?

A

when there is:
* ↓ in inhibition from cortex and inhibitory sp cord interneurons
Following an Upper Motor Neuron lesion
* Spasticity – velocity dep hypertone, on the against gravity mm side of a joint

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6
Q

Why do muscle spasms devleop?

A

due to:
* Electrolyte imbalance
* Dehydration
* Mm overuse
* Mm strain

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7
Q

Muscle spasm has both a ___ and a _____ component when prolonged

A

neurogenic, myogenic

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8
Q

What is baclofen used for?

A

primarily for hypertone

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9
Q

What is tizanidine used for?

A
  • polysynaptic inhibitor (within spinal cord)
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10
Q

What is diazepam used for?

A
  • polysynaptic inhibitor and central acting
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11
Q

What is dintrolene used for?

A

Acts directly on the muscle

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12
Q

What is botox used for?

A

Acts ar the neuromuscular junction

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13
Q

What are the qualities of polysynaptic inhibitors?

A
  • Centrally acting
  • Mechanism of action is poorly understood
  • Can cause a general reduction in CNS activity
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14
Q

What should we know about a reduction in CNS activity with muscle relaxants?

A

This may be the reason why the muscles tend to relax

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15
Q

What are some commonly used polysynaptic inhibitors?

A
  • Diazepam
  • Carisoprodol, chlorphenesin carbamate, chlorzoxazone, cyclobenzaprine, metaxalone,
  • Methocarbamol, orphenadrine citrate
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16
Q

What is baclofen doing physiologically?

A
  • GABA-B agonist
    • hyperpolarization
  • ↓s release of excitatory NT
  • ↑neuronal inhibition
17
Q

What should we know about programming baclofen intrathecally?

A
  • Externally programmed via computer software
  • Instructions transmitted through a “wand” by radio telemetry to the infusion pump
  • Can be programmed for a continuous dose over 24 hours up to 12 specific dosages throughout the day:
    – Simple continuous
    – Periodic Bolus
    – Complex-Continuous
18
Q

What is the average dose of baclofen?

A

300-1000 mcg

19
Q

how often do you have to refill a programmed baclofen inthrathecal pump?

A

every 4-12 weeks

20
Q

What should we know abotu a pump for administering baclofen intrathecally?

A
  • Surgically implanted SC in abdomen
  • Stores & releases prescribed amounts of drug
  • Holds 18 ml (3.5 teaspoons)
  • Refilled q 1-5 months depending on pump size, concentration, and dose
21
Q

What should we know about a catheter for baclofen?

A
  • Small diameter, silicone rubber tube
  • Travels from pump, under skin, to delivery site in spinal cord
  • Catheter introduced below L3, advanced to T8-10
22
Q

What are disadvantages of an intrathecal pump for baclofen?

A
  1. Requires surgery to implant the pump
  2. Expensive
  3. Tubing can become disconnected or kinked
23
Q

What are risks with an intrathecal pump?

A

Infection
Baclofen overdose
Pump dysfunction
Symptoms of withdrawal

24
Q

What are advantages of an intrathecal pump for baclofen?

A
  1. Medicine is sent directly to the nerve cells
  2. Medicine dosage can be adjusted
  3. Less medication is needed, which reduces side effects.
  4. Reservoir can be easily refilled when needed
  5. Surgery is reversible
25
Q

What are S&S of overdose with muscle relaxants?

A

Somnolence
Drowsiness
Seizures
Respiratory Depression
Hypertonia
Loss of consciousness

26
Q

What makes someone a candidate for getting baclofen intrathecally?

A
  • Moderate to severe hypertonicity
  • Potential to be more independent with ADL’s
  • Non-ambulatory with tone interfering with caregiving
  • Pain or at risk for skeletal deformity
  • Committed support system
  • Over 4 y/o
  • Respond to intrathecal test dose < 100 micrograms
  • One year post TBI
27
Q

How does diazepam work physiologically?

A
  • ↑s GABA’s central inhib effect @ Inhibitory interneuron
  • CNS depressant
28
Q

How does dantrolene work physiologically?

A
  • Acts directly on mm
  • An antagonist of the ryanodine receptor (Ca channel receptor in SR of skeletal mm)
29
Q

How does zanaflex (tizanidine) work physiologically?

A
  • Central acting alpha-2 agonist
  • ↑inhib effects of Inhibitory interneuron
30
Q

How does botulinum toxin work physiologically?

A
  • Prevents release of acetylcholine vesicles from presynaptic axon @ NMJ
  • Toxin binds to presynaptic axon terminal
  • Internalization of toxin
  • Inhibition of NT release
  • Administered IM in specific muscles
  • Chemical denervation within days – lasts approx 3 months
31
Q

What is the onset and duration of carisoprodol (soma)?

A

within 30 mins
4-6 hours

32
Q

What is the onset and duration of chlorzoxazone (paraflexx, parafon forte)?

A

within 60 mins
3-4 hours

33
Q

What is the onset and duration of cyclobenzaprine (flexuril)?

A
  • within 60
    12-24 hours
34
Q

What is the onset and duration of diazepam (valium)

A
  • 15-45 mins
    varible duration
35
Q

What is the onset and duration of metaxalone (skelaxin)

A

60 mins
4-6 hrs

36
Q

What is the onset and duration of methocarbamol (carbacot, robaxin)

A

within 30 mins
24 hours

37
Q

What is the onset and duration of orphenadrine citrate (antiflex, norflex)

A

within 60 mins
12 hours

38
Q

What are some adverse reactions to muscle relaxants?

A
  • Generalized muscle weakness
  • Decreased muscle tone
  • Sedation
  • Dizziness
  • Ataxia
39
Q

What are some effects interfering with rehabilitation with muscle relaxants?

A
  • Motor control problems
  • Functional decline
  • Decreased alertness
  • Weakness
  • Tolerance and physical dependence

Clin Med II - FINAL (5 decks)

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