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nursing pharm

Terms in this set (85)

CNS

Centrally acting skeletal muscle relaxants are used to treat acute muscle spasms caused by
anxiety
inflammation
pain
trauma

spasticity caused by MS and cerebral palsy
carisoprodol
Centrally acting
after LT therapy with carisoprodol
don't stop abrupptly d/t W/D symptoms ....
insomnia
headache
nausea
ab pain
obtain an order for ..... with CNS depressants
analgesics for headache
chlorphenesin
Centrally acting
chlorzoxazone
Centrally acting
Nursing process need to closely monitor ___ with LT use of chlorzoxazone
hepatic function
UA results
Nursing process need to closely monitor hepatic function and UA results with long term use of
chlorzoxazone
cyclobenzaprine
Centrally acting
Nursing process need to closely monitor ____ with centrally acting muscle relaxants
CBC
centrally acting muscle relaxants

Nursing process need to closely monitor ___ with
cyclobenzaprine
platelet counts
metaxalone
Centrally acting
methocarbamol
Centrally acting
Nursing process need to closely monitor for orthostatic hypotension with ____
methocarbamol
Nursing process need to closely monitor ___ with methocarbamol
orthostatic hypotension
methocarbamol can cause
decreased cholinergic effect of drugs to Tx
MYASTHENIA GRAVIS
orphenadrine
Centrally acting
tizanidine
Centrally acting
CNS

tizanidine combined with
DIURETICS,
CENTRAL ALPHA-ADRENERGIC AGONISTS
BP LOWERING DRUGS

can cause
INCREASED hypotensive
CNS

concurrent use of tizanidine with other CNS depressants=
increased depressant effects
CNS

Hormonal contraceptive can cause a reduced clearance of tizanidine =
dose reduction required
longest acting CNS
cyclobenzaprine
12-25h
typical duration of action for centrally acting agents
4-6h
centrally acting agents (aka CNS depressants) don't act on muscles directly. muscle relaxation likely from sedative effects
...
drug interactions of centrally acting agents
other CNS depressants:
alcohol
opioids
antianxiety drugs
anticonvulsant drugs
tricyclic antidepressants
barbiturates
drug interactions of centrally acting agents
other CNS depressants:
(alcohol
opioids
antianxiety drugs
anticonvulsant drugs
tricyclic antidepressants
barbiturates)

Causing...
increased sedation
impaired motor function
resp depression
drug interactions of centrally acting agent CYCLOBENZAPRINE
MAOI (causes high temp, excitation, seizures)

depress antiHTN effects of BP lowering drugs clonopine and guanethidine
drug interactions of centrally acting agent
CYCLOBENZAPRINE and ORPHENADRINE

(centrally acting muscle relaxants )
soemtimes enhance effects of cholinergic blocking drugs
drug interactions of centrally acting agent
ORPHENADRINE

(centrally acting muscle relaxants )
reduce effects of phenothiazines
ORPHENADRINE and PROPOXYPHENE can together cause

(centrally acting muscle relaxants )
additive CNS effects:
mental confusion
anxiety
tremors
Adverse reaction of centrally acting muscle relaxants=
dependence (physical and psychological)
abrupt stop of centrally acting muscle relaxants=
W/D symptoms
W/D symptoms of centrally acting muscle relaxants=
returning spasticity
hypotension
paresthesia
muscle rigidity
common reactions of centrally acting muscle relaxants=
dizziness and drowsiness
severe rxn of centrally acting muscle relaxants=
arrhythmias
bradycardia
less common Rxn of centrally acting muscle relaxants=
abdominal distress
ataxia
constipation/diarrhea
heartburn
n/v/d
heartburn
Give oral forms of centrally acting muscle relaxants with
milk or meals
to
decrease GI upset
PT Ed about centrally acting muscle relaxants
allow rest periods (spread out activity trhroughout day)
drowsiness is transient
avoid other CNS depressants
change positions slowly
take with milk or meals (reduce GI distress)
report urinary hesitancy with which centrally acting muscle relaxants
CYCLOBENZAPRINE

BACLOFEN
PT Ed about centrally acting muscle relaxants
CYCLOBENZAPRINE or BACLOFEN
report
urinary hesitancy
PT Ed about centrally acting muscle relaxants
METHOCARBAMOL or CHLORZOXAZONE
may
change urine color
Which centrally acting muscle relaxants change urine color
METHOCARBAMOL

CHLORZOXAZONE
Only direct acting skeletal muscle relaxants
Dantrolene
Dantrolene, the Only direct acting skeletal muscle relaxants, has effects ___ to centrally acting muscle relaxants
similar to but has different method of action
Dantrolene, the Only direct acting skeletal muscle relaxants, is most effective for Tx of ____ in pt with stroke, MS, cerbral palsy, and spinal cord injury

HOWEVER
spasticity

but it causes muscle weakness which can be questionable use in patients with compromised strength
Dantrolene half life
9 hours
Dantrolene, the Only direct acting skeletal muscle relaxants, is most effective for Tx of spasticity in pt with (4)
stroke
MS
cerbral palsy
spinal cord injury
Dantrolene is used as an antidote for ____ caused by ____
malignant hyperthermia
anesthesia
____ is used as an antidote for malignant hyperthermia
caused by anesthesia
Dantrolene
malignant hyperthermia is
rare but life threatening Rxn to anesthesia
malignant hyperthermia characterized by
muscle rigidity and high fever
Drug interactions of Dantrolene with Estrogen
liver toxicity
Drug interactions of Dantrolene with IV Verapamil
cardiovascular collapse
Do not give ____ with Dantrolene due to cardiovascular collapse
IV verapamil
CNS depressants given with Dantrolene can cause increased CNS depression ____
lack of coordination
resp depression
sedation
Dantrolene has less adverse impact on CNS (b/c works directly on muscles)
but
high therapeutic doses are toxic to liver
...
Common adverse effects of Dantrolene
drowsy
dizzy
malaise
muscle weakness
Serious A-E of Dantrolene
seizures
liver toxicity
hepatitis
bleeding
With Dantrolene therapy monitor
CBC
LFTs
Withhold dose of Dantrolene and notify dr. if
severe diarrhea
severe weakness
hepatitis
pt ed with Dantrolene
take with milk or meals (reduce GI distress)
analgesic for headache
do not stop abruptly
Two additional drugs used as skeletal muscle relaxants
Baclofen
Diazepam (antianxiety drug, Tx seizures and alcohol W/D)
daizepam is valium
...
Baclofen absorbed from
GI tract
long wait with Baclofen
hours to weeks to see effects
drug of choice to Tx spasticity is ____ b/c causes less muscle weakness and sedation
Baclofen
Baclofen is the drug of choice to Tx spasticity b/c it causes less muscle weakness than Dantrolene and less sedation than Diazepam
...
Baclofen used for para/quadrapalegic pt with spinal cord lesions caused by MS or trauma
...
Baclofen relieves muscle spasms
...
pt ed of baclofen
-give with milk or meals (less GI distress)
-avoid abruptly stopping
what happens when intrathecal Baclofen is stopped abruptly?
high fever
altered mental status
exaggerated rebound spasticity
muscle rigidity that may possibly lead to rhabdomyolosis, multiple organ failure and death
Early signs of intrathecal Baclofen W/D
return to baseline spasticity

pruritus

hypotension

paresthesia
If intrathecal administration of Baclofen is delayed ____ can help stave of potentially fatal sequelae
gamma-aminobutyric acid agonist
or
IV benzodiazepines
most common A-E of Baclofen
transient drowsiness
hyperkinesia
(abnormal increase in motor function)
eith Baclofen___ seizure precautions for pt with seizure disorder (increased RF seiazures in this pop)
...
Drug interactions of Baclofen:
with
CNS depressants *** (most significant interaction)***
increased CNS depression

with
fentanyl=
Analgesia prolonged

with
lithium carbonate=
aggravate hyperkinesia

with
Tricyclic antidepressants =
increased muscle relaxation
...
with all the muscle relaxants
obtain Hx of pain and muscle spasms and reassess reg after starting therapy

assess degree of relied to up/lower dose accordingly

Monitor CBC results closely

Assess compliance of pt on LT therapy

Eval pt/fam understanding of drug therapy
Neuromuscular blocking drugs
2 types
depolarizing and nondepolarizing
Neuromuscular blocking drugs
3 uses
1. surgery
(relax skeletal muscle during surgery)

2. seizures
(reduce intensity of muscle spasms in drug-induced or electrically induced seizures)

3. Ventilator
(manage opt fighting use of vent)
Neuromuscular blocking drugs

nondepolarizing blocking drugs aka competative or stabilizing

end in
-curium
-curonium
poorly absorbed from GI tract

IV route more predictable
Neuromuscular blocking drugs compete with ____
Ach at receptors
Neuromuscular blocking drugs can be countered with antiAchase drugs
-neostigmine
or
-pyridostigmine
...
Neuromuscular blocking drugs

paralysis pattern: muscle weakness turns to flaccid (loss of muscle tone)

(recovery from paralysis occurs in opposite order)
face, eyes, neck,

limb, abd, trunk

intercostal muscles and diaphragm
Neuromuscular blocking drugs

pt is conscious and aware (can feel pain) but can't move or talk

= give with antianxiety or analgesic
...
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