ATI The Neurological System Part 1
What two types of drugs treat muscle spasms?
Centrally acting muscle relaxants and peripherally acting muscle relaxants.
Baclofen
Lioresal
What is the expected pharmacologic action of centrally acting muscle relaxants?
Enhance the inhibitory effects of GABA on receptors in the spinal cord, resulting in
suppression of hyperactive reflexes.
Adverse drug reactions of centrally acting muscle relaxants.
Drowsiness, dizziness, weakness, fatigue, nausea, vomiting, constipation and urinary
retention.
Do centrally acting muscle relaxants cause physical dependence?
NO. However, abruptly stopping the drug after long-term therapy can result in the
symptoms of withdrawal which include; anxiety, restlessness, visual hallucinations and
seizures.
Interventions for centrally acting muscle relaxants.
Give the lowest effective dose and gradually increase to minimize adverse effects.
Ensure clients take oral doses with food to decrease gastric irritation.
Teach PTs to drink LOTS of water.
How long should centrally acting muscle relaxants be tapered off after long-term
use?
1 to 2 weeks.
Client instructions for centrally acting muscle relaxants.
Change positions slowly if they feel dizzy.
Do not drive or perform activities that require mental alertness if they feel drowsy.
Take PO doses with food or milk.
Increase fiber and fluid intake.
Taper the dosage off over a period of 1 to 2 weeks, no stopping the drug immediately.
Contraindications and precautions for centrally acting muscle relaxants.
Clients with a known hypersensitivity.
No concurrent usage with MAOIs (monoamine oxidase inhibitors) -could result in
hypotension or increased CNS depression.
Use with caution in older adults, children and clients with a severe mental illness,
seizure disorder or CVA (cerebrovascular accident).
Can you drink alcohol with centrally acting muscle relaxants?
NO.
How do peripherally acting muscle relaxants/direct acting skeletal muscle
relaxers work?
Relax skeletal muscle spasms that occur as a result of CVA or stroke, spinal cord injury,
MS and cerebral palsy.
dantrolene
Dantrium
expected pharmacologic action of peripherally acting muscle relaxants
Act directly on skeletal muscle tissue by inhibiting the release of calcium, which is
normal for muscle contraction.
Adverse effects of dantrolene (peripherally acting muscle relaxant)
, Muscle weakness, drowsiness, dizziness, diarrhea. Watch for liver toxicity in long term
therapy.
Peripherally acting muscle relaxants safety alerts
Monitor client muscle strength, falls could possibly happen.
Peripherally acting muscle relaxants administration.
PO or IV.
If to treat malignant hyperthermia, how long should a client preoperatively taken
dantrolene (a peripherally acting muscle relaxant)?
1-2 days prior to the surgery.
During surgery, give it via an IV bolus.
Client instructions for peripherally acting muscle relaxants.
Warn PTs this could interfere with their ADLs.
Report prolonged diarrhea.
Avoid driving or performing or activities that require mental alertness.
NO alcohol.
Report symptoms such as; abdominal pain, sclera of the eye and jaundice ASAP.
Contraindications or peripherally acting muscle relaxants.
PTs with liver disease.
Use with caution in clients who have cardiac or pulmonary disease or a neuromuscular
disorder.
People over the age of 35 are at an increased risk of liver damage.
What heart condition may develop after taking Dantrolene (peripherally acting
muscle relaxant?)
dysrhythmias, especially in clients who take calcium channel blockers.
AEDs
Anti-epileptic drugs
What main categories of AEDs are there?
Traditional AEDs and newer AEDs.
Which of the two main categories of AEDs are used to treat tonic-clonic seizures
(AKA grand mal seizures).
Traditional AEDs.
Hydantoins: Phenytoin
Phenytoin (Dilantin)
Expected Pharmacologic Action
Hydantoins decrease the neuronal activity of seizure generating cells in the brain by
inhibiting the influx of sodium through sodium channels.
Adverse drug effects of hydantoin (a traditional AED)
Mild drowsiness and other CNS depressant effects.
Gingival hyperplasia, an abnormal growth of tissue around the gums.
Skin rash.
Our jobs as nurses for hydantoin (a traditional AED)
Is to monitor for excessive drowsiness and other CNS effects. Excessive drowsiness is
a sign of toxicity.
Observe the gums for hyperplasia.
Monitor for rashes.
What two types of drugs treat muscle spasms?
Centrally acting muscle relaxants and peripherally acting muscle relaxants.
Baclofen
Lioresal
What is the expected pharmacologic action of centrally acting muscle relaxants?
Enhance the inhibitory effects of GABA on receptors in the spinal cord, resulting in
suppression of hyperactive reflexes.
Adverse drug reactions of centrally acting muscle relaxants.
Drowsiness, dizziness, weakness, fatigue, nausea, vomiting, constipation and urinary
retention.
Do centrally acting muscle relaxants cause physical dependence?
NO. However, abruptly stopping the drug after long-term therapy can result in the
symptoms of withdrawal which include; anxiety, restlessness, visual hallucinations and
seizures.
Interventions for centrally acting muscle relaxants.
Give the lowest effective dose and gradually increase to minimize adverse effects.
Ensure clients take oral doses with food to decrease gastric irritation.
Teach PTs to drink LOTS of water.
How long should centrally acting muscle relaxants be tapered off after long-term
use?
1 to 2 weeks.
Client instructions for centrally acting muscle relaxants.
Change positions slowly if they feel dizzy.
Do not drive or perform activities that require mental alertness if they feel drowsy.
Take PO doses with food or milk.
Increase fiber and fluid intake.
Taper the dosage off over a period of 1 to 2 weeks, no stopping the drug immediately.
Contraindications and precautions for centrally acting muscle relaxants.
Clients with a known hypersensitivity.
No concurrent usage with MAOIs (monoamine oxidase inhibitors) -could result in
hypotension or increased CNS depression.
Use with caution in older adults, children and clients with a severe mental illness,
seizure disorder or CVA (cerebrovascular accident).
Can you drink alcohol with centrally acting muscle relaxants?
NO.
How do peripherally acting muscle relaxants/direct acting skeletal muscle
relaxers work?
Relax skeletal muscle spasms that occur as a result of CVA or stroke, spinal cord injury,
MS and cerebral palsy.
dantrolene
Dantrium
expected pharmacologic action of peripherally acting muscle relaxants
Act directly on skeletal muscle tissue by inhibiting the release of calcium, which is
normal for muscle contraction.
Adverse effects of dantrolene (peripherally acting muscle relaxant)
, Muscle weakness, drowsiness, dizziness, diarrhea. Watch for liver toxicity in long term
therapy.
Peripherally acting muscle relaxants safety alerts
Monitor client muscle strength, falls could possibly happen.
Peripherally acting muscle relaxants administration.
PO or IV.
If to treat malignant hyperthermia, how long should a client preoperatively taken
dantrolene (a peripherally acting muscle relaxant)?
1-2 days prior to the surgery.
During surgery, give it via an IV bolus.
Client instructions for peripherally acting muscle relaxants.
Warn PTs this could interfere with their ADLs.
Report prolonged diarrhea.
Avoid driving or performing or activities that require mental alertness.
NO alcohol.
Report symptoms such as; abdominal pain, sclera of the eye and jaundice ASAP.
Contraindications or peripherally acting muscle relaxants.
PTs with liver disease.
Use with caution in clients who have cardiac or pulmonary disease or a neuromuscular
disorder.
People over the age of 35 are at an increased risk of liver damage.
What heart condition may develop after taking Dantrolene (peripherally acting
muscle relaxant?)
dysrhythmias, especially in clients who take calcium channel blockers.
AEDs
Anti-epileptic drugs
What main categories of AEDs are there?
Traditional AEDs and newer AEDs.
Which of the two main categories of AEDs are used to treat tonic-clonic seizures
(AKA grand mal seizures).
Traditional AEDs.
Hydantoins: Phenytoin
Phenytoin (Dilantin)
Expected Pharmacologic Action
Hydantoins decrease the neuronal activity of seizure generating cells in the brain by
inhibiting the influx of sodium through sodium channels.
Adverse drug effects of hydantoin (a traditional AED)
Mild drowsiness and other CNS depressant effects.
Gingival hyperplasia, an abnormal growth of tissue around the gums.
Skin rash.
Our jobs as nurses for hydantoin (a traditional AED)
Is to monitor for excessive drowsiness and other CNS effects. Excessive drowsiness is
a sign of toxicity.
Observe the gums for hyperplasia.
Monitor for rashes.
