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Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.

Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Upper Saddle River, NewJ ersey07458
All rights reserved.
Chapter 21
Drugs for
Neuromuscular
Disorders
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Media Directory
Slide 17 Cyclobenzine Animation
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Muscle Movement Dependent
on Body Systems
Nervous
Muscular
Endocrine
Skeletal
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Functioning of Neural Pathways
and Muscles, Bones, J oints
Determined by blood levels of
Sodium
Potassium
Calcium
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Muscle Spasms
Involuntary contractions of muscles
Diminished level of functioning
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Muscle Spasticity
Results from damage to CNS
Muscles in continuous state of contraction
Muscles become stiff
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Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Nonpharmacologic Treatment
of Muscle Spasms
Combined with medication
History and physical to determine etiology
Immobilization, heat or cold, hydrotherapy
Ultrasound, exercise, massage,
manipulation
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Nonpharmacologic Treatment
of Muscle Spasticity
Physical therapy
Muscle stretching, strengthening
Repetitive motion
Surgery in extreme cases
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Goals of Muscle Relaxants
Minimize discomfort
Increase range of motion
Improve ability to function independently
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Muscle Spasm
Pharmacotherapy
Analgesics
Anti-inflammatory agents
Centrally acting muscle relaxants
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Role of Nurse
Do complete health history, including
allergies, drug history, drug interactions
Establish baseline level of consciousness
and vital signs
Assess for drowsiness and dizziness
Monitor pain: location, duration,
precipitating factors
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Role of Nurse (continued)
Monitor for withdrawal reactions
Monitor muscle tone, range of motion,
degree of muscle spasm
Provide additional pain-relief measures
Monitor for side effects
3
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Education of Client
Those with liver disease,
pulmonary/cardiac dysfunction should not
take these drugs
Warn against alcohol and drugs that
depress CNS
Abruptly stopping these drugs can result in
seizures
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Skeletal Muscle Relaxants
Treat local spasms from muscular injury
Decrease pain and tenderness
Result in increased range of motion
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Direct-Acting Antispasmodics
Act at neuromuscular junction and skeletal
muscle
Suppress hyperactive reflexes
Are used for spasms associated with CNS
disorders
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Centrally Acting
Muscle Relaxants
Prototype drug: cyclobenzaprine (Flexeril)
Mechanism of action: inhibits upper-motor-
neuron activity
Causes CNS depression, alters simple spinal reflexes
Primary use: to treat localized spasms
Adverse effects: CNS depression, hepatic
toxicity, physical dependence, anticholinergic
effects
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Cyclobenzine Animation
Click here to viewan animation on the topic of cyclobenzine.
Back to Directory
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Direct-Acting Antispasmodics
Prototype drug: dantrolene (Dantrium)
Mechanism of action: interferes with
release of calcium ions in skeletal muscle
Primary use: to relieve dystonias and leg
cramps
Adverse effects: hepatic toxicity, muscle
weakness, drowsiness, diarrhea
4
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs for
Neuromuscular Disorders
Assessment
Complete health history
Physical exam
Baseline vitals and labs
Baseline level of consciousness (LOC)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Nursing Diagnoses
Pain
Impaired physical mobility
Risk for injury
Deficient knowledge
Drugs for Neuromuscular
Disorders (continued)
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs for Neuromuscular
Disorders (continued)
Planning
Goals
Decrease in pain
Increased range of motion
Reduced muscle spasms
No adverse effects
Understanding of drug regimen
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Drugs for Neuromuscular
Disorders (continued)
Implementation
Monitor LOC and vital signs
Monitor pain
Monitor muscle tone, range of motion, degree
of spasm
Provide adjunct therapy
Evaluation of effectiveness of drug therapy
Goals met
Expected outcomes met
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Centrally Acting Skeletal
Muscle Relaxants
Table 21.1 Centrally Acting Skeletal
Muscle Relaxants
Pharmacology for Nurses: A Pathophysiologic Approach 2nd Ed.
Michael Patrick Adams, Leland Norman Holland, J r., and Paula Manuel Bostwick
Copyright 2008 by Pearson Education, Inc.
Direct-acting
Antispasmodic Drugs
Table 21.2 Direct-acting
Antispasmodic Drugs