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TL Muscle Relaxants

Centrally Acting Muscle Relaxants

What are skeletal muscle relaxants used for? relief of musculoskeletal pain, spasm, and severe spasticity such as in multiple sclerosis, cerebral palsy, stroke, and spinal cord injuries
Define multiple sclerosis. progressive demyelization of the white matter of the brain and spinal cord resulting in widespread neurologic dysfunction
Define cerebral palsy motor function disorder caused by neurologic damage usually incurred during the peri-natal period or the first two years of life often associated with hypoxia
What are the two main classes of skeletal muscle relaxants? centrally acting and direct acting
Describe “cycling” as it relates to muscle spasms. an impulse such as severe cold, lack of blood flow, or overexertion causes a muscle to send messages to the CNSsetting a reflexive muscle contraction. The muscle contraction further stimulates sensory receptors resulting a more intense contraction.
How do centrally acting muscle relaxants work to treat muscle spasms? the act as sedatives in the CNS
Which centrally acting muscle relaxant is prescribed for chronic and intermittent spasms? tizanidine
Name 7 centrally acting muscle relaxants that might be used to treat acute muscle spasms. (CCCMMOT) Carisoprodol, Chlorzoxazone, Cyclobenzaprine, Metaxalone, Methocarbamol, Orphenadrine, Tizanidine
Say Carisoprodol. Care s soap pro dull
Say chlorzoxazone. Chlor ZOX uh zone
Say Tizanidine. Tie Zan uh deen
How long do centrally acting muscle relaxants take to work? 30 minutes to 1 hour
How long do centrally acting muscle relaxants last? 4-6 hours except cyclobenzaprine
Which centrally acting muscle relaxant can last from 12 – 25 hours? cyclobenzaprine
What are the big interactions, adversities to be aware of with centrally acting muscle relaxants? they are CNS depressants so would have cumulative effects with other CNS depressants – Watch for respiratory depression, sedation, impaired motor function
What are some other CNS depressants our patients on centrally acting muscle relaxants should avoid? alcohol, narcotics, barbiturates, anticonvulsants, tricyclic antidepressants, kava kava, antianxiety drugs
What could result if centrally acting muscle relaxants are taken with MAOIs? high body temperature, excitation, seizures
What’s the problem with combining cyclobenzaprine and blood pressure lowering drugs guanethidine or clonidine? cyclobenzaprine can cause them not to work effectively
What can happen as a result of the combination of cyclobenzaprine or orphenadrine and cholinergic blocking drugs? enhanced effect of the cholinergic blocking drug
What can happen as a result of the combination of methocarbamol and anticholinesterase drugs used to treat myasthenia gravis? methocarbamol can block the effects of the anticholinesterase drug
What can happen if orphenadrine and propoxyphene are combined? additive CNS effects such as confusion, anxiety, and tremors
Discuss the interactions we should watch for if our patient is taking tizanidine. with diuretics, central alpha agonist or antihypertensive possible hypotension; with CNS depressants increased CNS depression; with hormonal contraceptives reduced clearance of tizandine = decreased dosage required
What do we need to know about long term use of centrally acting muscle relaxants? They can cause physical psychological dependence – abrupt cessation will produce severe withdrawal symptoms.
Name two common adverse reactions associated with centrally acting muscle relaxants. Dizziness, drowsiness
Name 6 occassional adverse reaction to centrally acting muscle relaxants. abdominal distress, constipation, diarrhea, heartburn, nausea, vomiting, ataxia
Define ataxia. loss of ability to control muscular movement
Name 3 severe reactions to centrally acting muscle relaxants. allergic, arrhythmias, bradycardia