Muscle

Relaxan
ts
Credo, Mary Cleir
Cose, Mhendylean
A.
Generic and Brand
Names
Centrally Acting
Muscle
Relaxants
 Centrally acting muscle
relaxants work in the CNS
to interfere with reflexes
that cause muscle spasms.
They essentially destroy or
lyse spasms and are often
referred to as spasmolytics.
 Centrally Acting Muscle
Relaxants
Therapeutic Action Indications
• Up per motor ne uron (UMN ) is
acti vated i n th e cereb ral cortex
Primary indication is relief of
an d Acti on Potential Travel Down discomfort associated with
the s pin al cord or the s yna ps e acute, painful
with the Lower m otor neuron
(LMN ) a t the level of exit. musculoskeletal conditions
Inhib itory Inter N eurons regulate as adjunct to rest, physical
the excitation of the element an
acti on potenti al tra veling d own therapy, and other measures.
the upp er motor neuron that will Alleviation of signs and
caus e the relea se of excitory
symptoms of spasticity, may
N eurotra nsm itters lik e
N orepinep hr ine Glutam ate on to the be of use in spinal cord
(LMN ), which will a ctivate th e m us cle injuries or spinal cord
. Inhib itory neurotra ns mitter GAB A is
r eleas ed from the inhi bitory neuron diseases.
an d acts to decrea s e the excita tion
of elem ent.
Pharmacokinetic
s
Centrally Acting Muscle
Relaxants
Contraindications Adverse Effects
and Cautions
-CNS: depression, drowsiness, fatigue,
weakness, confusion, headache, insomnia.
Allergy to centrally acting
-CV: hypotension, arrhythmias
skeletal muscle relaxants.
-GI: nausea, dry mouth,
Skeletal muscle spasms caused
anorexia, constipation.
by rheumatic disorders.
-GU: urinary frequency, enuresis,
History of epilepsy.
urinary urgency
Cardiac dysfunction.
-Chlorzoxazone may turn urine into
Condition marked by muscle
purple- red color.
weakness. Hepatic, renal dysfunction.
-Tizanidine has been associated with liver
Baclofen.
toxicity and hypotension in some
patients.
-Baclofen is tapered over 1-2 weeks to
prevent development of psychoses
and hallucinations.
 Interaction
s
THE FOLLOWING ARE DRUG-DRUG INTERACTIONS INVOLVED
I N THE U S E OF CENTRALLY ACTING MUSCLE RELAXANTS:

1.Other CN S depressants
2.alcohol
 Nursing
Considerations
Nursing
A ssessm en
t Provide additional spasm and
Assess for mentioned
contraindications and cautions
(drug allergy, cardiac
depression, rheumatic disorder,
pregnancy and lactation, etc.)
to prevent untoward
complications.
Conduct thorough physical
assessment (temperature, skin
color and lesion, C NS
orientation, affect, reflexes,
bilateral grip strength,
spasticity evaluation; bowel
sounds and urine output) to
obtain baseline data.
Monitor liver and renal
function tests to detect
potential adverse effects.
Im plem en tation
Evaluation
with Rationale
• Monitor patient response
to therapy (improvement
pain relief like rest periods,
in muscle spasm and
heat application, (Non-
relief of pain;
steroidal anti-inflammatory
improvement in muscle
drugs) N S A I D s as ordered, and
positioning to augment the spasticity).
• Monitor for adverse
effects of the drug at relieving
effects (CNS changes, GI
the musculoskeletal discomfort.
depression, urinary
Discontinue drug at any sign
urgency, etc.).
of liver and renal dysfunction
to prevent severe toxicity.
Provide comfort measures
to help patient tolerate
drug effects.
Provide safety measures
(adequate lighting, raised
side rails, etc.) to prevent
injuries.
Direct-Acting
Skeletal Muscle
Relaxants
Generic and Brand
Names
 Direct-acting skeletal
muscle relaxants enter the
muscle to prevent muscle
contraction directly.
 Direct-Acting Skeletal
Muscle Relaxant
s
Therapeutic Action Indications

Dantrolene acts within skeletal May be used for treatment of

muscle fibers and interfere with malignant hyperthermia:
calcium ion release from the the very rare but life-
muscle tubules. Therefore, the threatening disorder
fibers are prevented from triggered by general
contracting. It does not anesthesia.
interfere with neuromuscular Dantrolene is used to treat
transmission and does not upper motor neuron spasticity
affect skeletal muscle surface in children.
membrane.
Pharmacokinetic
s
 Direct-Acting Skeletal
Muscle Relaxant
s
Contraindications Adverse Effects
and Cautions
CNS: drowsiness, fatigue, weakness,
confusion, headache, insomnia,
Allergy to direct-acting skeletal
visual disturbances.
muscle relaxants.
GI: GI irritation, diarrhea,
Spasticity contributes to
constipation, abdominal cramps.
locomotion, upright position,
GU: urinary frequency, enuresis,
increased function. Active hepatic
urinary urgency, crystalline urine with
disease.
pain or burning on urination.
Pregnant and lactating woman.
Others: acne, abnormal hair growth,
History of liver disease or
rashes, photosensitivity, abnormal
previous dysfunction.
sweating, chills, nyalgia.
Respiratory depression.
Dantrolene can cause direct
Cardiac disease.
hepatocellular damage and potentially
fatal hepatitis
 Interaction
s
1.Estrogens: increased incidence of
hepatocellular toxicity if used with dantrolene
2.Neuromuscular junction blockers, lincosamides,
quinidine, magnesium sulphate,
anticholinesterase, succinylcholine, polymyxin,
aminoglycosides: increased risk of additive
effects
 Nursing
Considerations
Nursing Im plem en tation
Evaluation
A ssessm en with Rationale
t Monitor intravenous access
Monitor patient response
to therapy (improvement
sites of dantrolene for in spasticity, movement
Assess for mentioned potential extravasation and activities).
contraindications and cautions because drug is alkaline and Monitor for adverse effects
(drug allergy, cardiac very irritating to tissues. (CNS changes, diarrhea,
depression, rheumatic disorder, Periodically discontinue liver toxicity, etc).
pregnancy and lactation, etc.) dantrolene for 2-4 days as Monitor patient
to prevent untoward ordered to monitor compliance to drug
complications. therapeutic effectiveness. therapy.
Conduct thorough physical Provide comfort measures
assessment (temperature, skin to help patient tolerate
color and lesion, C NS drug effects.
orientation, affect, reflexes,
bilateral grip strength,
spasticity evaluation; bowel
sounds and urine output) to
obtain baseline data.
Monitor liver and renal
function tests to detect
potential adverse effects
 Pharmacology is
benefited by the
prepared mind.
You need to know
what you are
looking for.
S ID D H A RTH A
MUKHERJEE
 Questions:
1. All of the following are direct-acting skeletal muscle relaxants, except:

A.botulinum toxin type A

B. Myobloc
C. Dantrium
D. None of the above

Answer: D. None of the above.

Botulinum toxin type A (Botox Cosmetic), botulinum toxin type B (Myobloc),
and dantrolene (Dantrium) are all direct-acting skeletal muscle relaxants.
2. What is the centrally acting muscle relaxant of choice for children with
tetanus?

A. botulinum toxin type B

B. Dantrium
C. Baclofen
D. Methocarbamol

Answer: D. Methocarbamol.
Both botulinum toxin type B and Dantrium are direct-acting skeletal muscle relaxants.
Baclofen is indicated for relief of spasticity in children with cerebral palsy.
 Thank
you!

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