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Terms in this set (11)
Skeletal muscle relaxants
used to treat conditions associated with hyper-excitable skeletal muscle- specifically, muscle spasms with the ultimate goal a decrease in muscle hyper-excitability without a profound decrease in muscle function. Patients with various pathologies may present with muscle spasms including whiplash, sciatica, HNP, as well as other conditions presenting with muscle spasms.
Non-steroidal anti-inflammatory drugs
-relieve mild-moderate pain (analgesia)
-decrease the elevated body temperature associated with fever (antipyresis)
- decrease blood clotting by inhibiting platelet aggregation (anticoagulation)
Steroidal anti-inflammatories (corticosteroids)
extremely effective anti-inflammatory agents, but are associated with a number of serious side effects. Systemic administration may be indicated for management of rheumatoid arthritis and osteoarthritis. Corticosteroids are often utilized to manage chronic inflammation within joints through a steroid injection in conditions such as trochanteric bursitis, bicipital tendonitis.
medications target the inflammation and pain to attempt to manage the condition allowing the patient continued mobility of the joint. NSAID's are often utilized in addition to pain medications.
Note: Tylenol/Acetaminophen is NOT a NSAID. Though it does provide pain relief, it does not manage inflammation. For this reason it is the drug of choice for the pain associated with OA as it has fewer side effects.
not an inflammatory condition but rather results in a weakening of the bone secondary to demineralization. Though typical management involves calcium supplements and exercise to stimulate bone growth, medications are often utilized to facilitate this process.
are used to decrease muscle excitability and contraction through an effect at the spinal cord level (centrally/CNS acting relaxants) or on the muscle cell itself (direct-acting relaxants). Produce muscle relaxation by inducing a sense of calm or tranquilizing effect on the patient. Examples: Diazepam (Valium) or Flexeril.
Considered to be prostaglandin (found in inflammatory exudates) inhibitors. Prevent synthesis of prostaglandins at the site of inflammation. Common examples: aspirin, naproxen, Aleve, ibuprogen, Motrin, Advil and Celebrex.
Steroidal anti-inflammatories (corticosteroids))
can be administered systemically (orally), epidurally or injected directly into the facets/discs/joints (intraarticular injection) as well as soft tissues such as bursae and tendons. Local injections minimize adverse effects. Examples: Prednisone, Dexamethasone and Hydrocortisone
inhibit bone resorption to retain the integrity of the bone. Vitamin D and Calcium may also be utilized. Example: Fosamax
The most common side effect seen with NSAIDs is gastrointestinal irritation i.e., heartburn, indigestion, nausea, vomiting, diarrhea and constipation.
Long term use of corticosteroids have a general catabolic (breakdown) effect on muscle, tendon and bone resulting in side effects of osteoporosis, muscle wasting/weakness, aggravation of diabetes mellitus. Additionally, the immune system may become depressed. These side effects emphasize the need to limit coricosteroid therapy as much as possible.
Elevation in blood pressure may indicate fluid retention which is often a side effect of prostaglandin inhibitors (NSAIDs)
Aspirin and other prostaglandin agents (NSAIDS) have as their main side effect, gastric irritation. Never take aspirin on an empty stomach. Enteric coated aspirin have less gastric irritation associated with them.
Routine use of aspirin prior to surgery is discontinued as excessive bleeding may occur.
Certain antacids (TUMS) alter the pH of the stomach limiting the absorption of Calcium. This is a particular concern for patients taking Calcium for osteoporosis.
Tylenol/Acetaminophen is often preferred for children (under age of 18) over aspirin due to the connection of aspirin and the development of Reyes Syndrome.
Considerations for the PT Assistant
Muscle Relaxants often enhance the results that can be obtained by the use of therapeutic modalities and other interventions.
Since sedation/drowsiness is often a side effect of agents used to treat muscle spasms, pain and inflammation, it may be necessary to consider scheduling patients at times when the agent is less active. Additionally, patients with already compromised balance/mobility due to their pathology may be at an increased risk of falls if this drowsiness is experiences.
Be aware that a reduction in spasm, pain, and/or inflammation will often result in an increase in movement as motion will no longer produce discomfort which would typically be protective inhibiting movement. If movement should be discouraged, due to a medical condition or surgical procedure, it is important to discuss this with the patient.
Because of the inhibition of platelet activity by the NSAID user, people taking these drugs on a chronic basis have the potential for easy bruisability. Avoid soft tissue trauma.
Patient's with osteoporosis are at an increased risk for fractures. Fall Precautions as well as Fall Education should be incorporated into Physical Therapy.
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